Retooling Health Assessment: It Takes More Than a Hammer Cheryl
Wilson MSN, ARNP, ANP-BC
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Objectives Understand the gap between knowledge and skill
Identify strategies to bridge knowledge and skill from Advance
Health Assessment across to clinical courses Understand the
continuum of simulated learning and how to apply in blended
courses
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Who Am I? Advanced Registered Nurse Practitioner- Adult Health
Board Certified Instructor Graduate and Undergraduate programs
Disclosure-provide non- compensated consultation as a SME to Shadow
Health
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What were the challenges? Hybrid course only met 3 times a
semester No simulation integrated into Health Assessment course
Identified a gap between knowledge and skills Application of skills
in the clinical setting
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Faculty challenges Use of simulation Faculty background and
training Preparation for lab Ratio of faculty to students
Consistency of lab experiences
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Modalities of Learning Task Trainers Digital Clinical
Experience (DCE) Problem Based Learning (PBL) Clinical Reasoning
exercises Case Studies Electronic Health Records (EHR) Observed
Structured Clinical Exam (OSCE) Standardized Patients (SPs)
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Digital Clinical Experiences Students interview the patient for
a full health history Go through full physical exam of each system
Documentation of findings
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Digital Clinical Experience Standardized experience
Communication skills Physical exam skills Clinical judgment
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Problem Based Learning Case presentation in small groups
Provide partial information in history Students ask additional
History questions Discuss physical exam they would perform 4-5
differential diagnosis Match up signs and symptoms from case
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Observed Structured Clinical Exam Utilization of standardized
patients Full health history Focused physical exam Differential
diagnosis Final course competency-putting all the pieces
together
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Continuum of Simulated Learning Why Simulation? Provide
opportunities to enhance critical thinking and clinical judgment
Ability to evaluate students effectively Provide scenarios to
enhance learning Clinical situations possibly encountered in
practice and how to work through clinical problems.
Faculty involvement Role of course coordinator Integration of
simulation Digital clinical examination Facilitation of clinical
reasoning Consistency of skills taught across all sections
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Pedagogical Background Development of expertise Clinical
competence Benner (1984) From Novice to Expert
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Benner, P. (1984) Expert Proficient Competent Advanced Beginner
Novice
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Training Provide faculty training in integration of the digital
clinical experience How to review results Synthesize results
Troubleshoot student problems with software application Weekly
schedule of all lab activities Assigned to each faculty Resource to
prepare for upcoming lab sessions
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Documentation Integrated documentation of patient findings
within the DCE Model notes provided in grading rubric Documentation
in EHR of Problem Based Learning group work
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Strategies Provide consistent training of all faculty in lab
Integration of simulation throughout the course Inter-rater
reliability of grading and evaluation
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Conclusion Re-tooling of the course to integrate simulation and
strengthen diagnostic reasoning/clinical judgment skills.
Utilization of multiple modalities of learning Training of faculty
for reliability in evaluation and consistency of delivery
Continuous evaluation of course to improve student learning
outcomes