To further expand and make my thinking visible (Eisner, 1998) through academic reflection on the learning technology our team (Team 5) took part in was more challenging than expected. I felt as though we had assessed every angle of the virtual healthcare simulation provided by Centennial College, Ryerson University, and George Brown College and there was nothing left to review. By stepping away from the project and revisiting the team feedback with a more objective lens, allowed me to drop my bias and emotions attached to the simulation.
When our team made the decision to trial a health simulator, I was genuinely excited as my background is in nursing and I have been part of some simulations at the hospital. I expected the simulation to be immersive and interactive, guiding me to new approaches and scenarios. The impact of simulations can help develop confidence and understanding of the specific topic. “Simulations allow healthcare providers to hone their skills without endangering the patient or hurting their self confidence” (Riley, 2008, Ch 33). Simulation can facilitate multiple users at once, which can reduce the physical man power of the organization and “teachers” utilized for training. Because we used a free healthcare simulator which is available for public access, anyone who could be going to a hospital, or experiencing this type of procedure/diagnosis can log in and learn more about the expectations.
Would this help alleviate training costs? Are there other simulations that are more immersive? Are they available to all learners? The public? It would be nice to see statistics on the educational impact that healthcare simulations have on staff, the public and management. Unfortunately “the current system of education, training, and maintenance of proficiency has itself never been tested rigorously to determine whether it achieves its stated goals; the high level reviews of the performance of the healthcare industry” (Gaba, 2004). Offering more scenarios and exploring more critical thinking situations would be beneficial. “Simulation techniques can be applied across nearly all health care domains” (Gaba, 2004), so it would be great to explore all angles of the simulation, not just those designed for healthcare professionals. My biggest concern was the lack of stimulation. There was so much reading, which is understandable given the topic, but more interaction could keep learners engaged and eager to keep going. The lack of options in regards to being steered towards a favorable outcome was concerning. Real life isn’t as black and white as the simulation outlined and although none of us like conflict, it is a necessary evil when it comes to learning and responding. Pushing towards a cognitive simulation where the application is designed with artificial intelligence, in order to think and feel, could help enhance the learning experience and give accurate reactions. “Cognitive simulations provide a realistic replication of a healthcare professionals workday that involves several complex demands that have to be processed simultaneously” (Riley, 2008).
Using the simulation we participated in allowed learners to view different modalities within the healthcare world and see baseline values, assessments, therapeutic approaches, techniques and use of machinery. This is a great introduction to showcase different options to a new nurse or someone who would be interested in switching units. It is very basic and easy to navigate, so for those who are new to the world of simulations, confidence and understanding of new technology can be gained. There are a plethora of simulations available for free through the internet with a google search, but compared to my time with Alberta Health Services, they are not as advanced or as structured as the simulations used in the hospital. The strengths for these platforms are providing an easy to use platform where a wealth of knowledge can be learned, as well as additional links for further research if needed. I do believe that there are superior simulations out there and the world of healthcare simulation will continue to change and advance. “The fate of simulation as a means to a revolutionary change in health care is approaching a tipping point that will resolve itself strongly in the direction of one of these alternate histories over the next 10 years, although it will then take another decade to evolve fully” (Gaba, 2004).
References
May 15, 2020 at 8:21 am
Hi Kerry,
Working in a healthcare setting myself, I am also exposed to the many advantages of simulation for clinicians and its capability to produce high-quality, real-life scenarios that immerse the participants in both acquiring new knowledge and practicing collaborative problem finding and solutioning. As you alluded in your reflection, simulation can be effective if designed well. Clark (1994), in response to Robert Kozma’s criticism of his earlier article on media as a learning tool, emphasized that media are “mere vehicles that deliver instruction but do not influence student achievement any more than the truck that delivers our groceries causes changes in our nutrition” (p.22). And just like the virtual healthcare simulation that your team explored, if the design is not anchored in good pedagogy, the outcome is ineffective learning and disappointed students. Hence, it is crucial that equal importance is given to both the technology and learning design when implementing virtual training.
Reference
Clark, R. (1994). Media will never influence learning. Educational Technology Research and Development 42(2), 21-29. DOI: 10.1007/BF02299088
May 21, 2020 at 8:56 pm
Hi Sharon,
Thank you for your reply, I appreciate it. I really enjoyed the quotes you used, I may have to “borrow” those for my final paper ☺
Because you are in a similar industry, you have seen first hand the impact a well rounded educational tool has. I really like your choice of words, so eloquent “if the design is not anchored in good pedagogy, the outcome is ineffective learning and disappointed students”. Not all of our team members were disappointed, which is fantastic as it brings about a different conversation, but I was left wanting more.
I also agree with what you said regarding equal importance being given to both the technology and learning design – I wonder if this lagged because it was a free simulation. I have researched a few other healthcare simulations and the more interactive, immersive scenarios ask for a sign up fee or a monthly fee. This saddens me as I would want everyone to be able to experience this type of educational tool for their own knowledge/health/understanding.
May 24, 2020 at 8:25 pm
Hi Kerry – thanks for your insightful blog post. When I listened to your group presentation, one of my thoughts as I previewed the video simulation was that it was not very interactive and I expected that educational learning in a hospital setting would include interactive presentations. I echo your comments about lack of stimulation, a tremendous amount of reading on each slide, lack of engagement by learners and lack of options for the participant to be steered toward a favourable outcome (Sharples, 2020). The learning event you shared with us was very much centered around the participant reading, understanding and then making a decision as to how to move forward.
From my perspective the simulation followed a cognitive constructivist approach to learning. The participant was expected to review the material, form concepts, acquire knowledge and problem solve on her own (Stapleton & Stefaniak, 2019). The simulation provided me the ability to review, understand and problem solve. I can see the merit in constructing the simulation in this way as the target audience was the public who could be going to a hospital for a procedure/diagnosis or wanting more information about what to expect (Sharples, 2020). As a simulation to answer specific questions, it provided me with a visual representation of the environment and answered my questions.
I believe it is about creating the right simulation for the right audience.
References
Sharples, K, (2020, May 13). Unit 2 – Activity 1: Critical Academic Reflection [Blog Post]. Retrieved from: https://malat-webspace.royalroads.ca/rru0109/unit-2-activity-1-critical-academic-reflection/
Stapleton, L., & Stefaniak, J. (2019). Cognitive Constructivism: Revisiting Jerome Bruner’s Influence on Instructional Design Practices. TechTrends, 63(1), 4–5. https://doi.org/10.1007/s11528-018-0356-8
May 27, 2020 at 7:10 pm
Hi Kerry,
I appreciate the honesty in your post. I too, feel as though I’ve explored all I really care to about my groups’ chosen learning experience, and was also left wondering what else there was to discuss.
If it helps, I’ve elected to only loosly tie our group project to my final project; as a launching point to explore a bigger issue.
In regards to your topic:
In the curriculum development I’m working on right now, I have been exploring simulations that could be used to teach practical skills remotely. What I feel is missing in this market, is easy to customize simulations. No matter how well structured any given simulation is, I feel there’s only value if addresses the specific learning outcomes required. What I’ve been finding, is that simulations tend to tackle softer skills, like communication or empathy. I would love to see an approachable ‘build your own’ simulation that could be eaily adapted to meet curricular needs.
So much to think about!
May 28, 2020 at 10:50 am
Some interesting threads here! First, I’m glad (Kerry) to hear that team feedback is helpful. It’s a tool that all of us could use more, opening up our ideas and work to others with the goal from learning from one another and improving what we do. Learning in community. And also the questions you ask are important ones – the idea is to explore promising technologies from as many angles as possible before making decisions about them. Context is critical too, in that a poor simulation for one setting might be good for an orientation, for instance, or a job fair, or for a new nurse as you say. Sharon’s point about learning design anchored in good pedagogy is critical in all of this; thanks for emphasizing it. And Laren, yes to configurable and/or openly licensed simulations. There are some efforts in this direction; here’s one example: https://libguides.mines.edu/oer/simulationslabs
One final thought: I would encourage some further thinking around Clark’s emphasis that media can be compared with trucks, i.e. that both are vehicles that merely transmit content and don’t alter it in any way. In fact media and content to interact very much. For instance, picture an immersive simulation script delivered by podcast or blog. The “content” would come across as incoherent and would need to be entirely rewritten for the other media, if it would even be possible. Beyond effectiveness of “delivery” Clark’s idea overlooks such challenges as the digital divide which has been heavily (and rightfully) discussed in this course. Trucks can’t go everywhere; sometimes you need a boat or an airplane. The larger social context comes into play as well in critical inquiry. Marshal McLuhan’s famous comment may apply here: The medium is the message. https://individual.utoronto.ca/markfederman/article_mediumisthemessage.htm
Thanks Kerry, Sharon and Laren for this excellent exchange.
May 30, 2020 at 9:35 pm
Hey Kerry,
Thank you for your thoughts on Simulation learning within the healthcare domain. You layout many general facets where healthcare simulations are used; and you further illustrate how much more needs to be done in answering the question: has the use of simulations within healthcare been truly positive? I simplify what Gaba (2004) was eluding too, but the general question posed has merit.
Within my profession of air traffic control, the training environment is dominated with simulation training and technology. This is due to one of the facts you pointed out: it allows students to “hone their skills without endangering” anyone or anything (as cited in Riley, 2008, ch. 33). Many of the questions you pose or can be inferred by your post, are all questions air traffic control training departments are asking routinely. How do we best utilize simulation technology reference what knowledge/experience level the student is at? Or, what type of simulation technology should be emphasized at a specific point within a student’s learning program? The latter question referring to the virtual continuum…virtual versus augmented or a combination (See Huang & Slijepcenc, n.d.; as cited in Milgram, Takemura, Utsumi & Kishino, 1994). In terms of the virtual continuum, certain phases of training within air traffic control need not be as real, or in other words have high fidelity of interaction for the student. Early training involves grasping the more simple concepts and the initial applications of general knowledge requirements of the job. These simulations fall under the simple augmented virtuality domain of the continuum itself. Your groups presentation found the simulation you analyzed to be overly simplistic as an almost negative quality to it. But, what should be answered is, at what point of a nurses training is this simulation presented and for what purpose? Is the nurse assessed a mark that will reflect their final mark? or is the nurse assessed and de-briefed on the material as a learning experience that does not reflect a score that impacts their final grade. Many questions to delve into for sure.
There are so many questions and great ways to look at simulation training…I truly believe it is a great tool to use for high-stakes job tasks (healthcare, emergency responders, air traffic control, military etc…), but organizations that utilize simulation within the learning environment must have a robust training plan onto the how and why they are using the simulation for any learning to be effective. Thanks again for the post, loved it.
May 30, 2020 at 9:38 pm
Sorry, here are my references:
Gaba, D. M. (2004). The future vision of simulation in health care. Retrieved from: https://doi.org/10.1136/qshc.2004.009878
Huang, W., & Slijepcenc, N. (n.d.). Augmented reality in education [blog post]. Retrieved from http://www.arined.org/?page_id=43
Milgram, P., Takemura, H., Utsumi, A., & Kishino, F. (1994). Mixed reality (MR) reality-virtuality (RV) continuum. Systems Research, 2351, 282-292.
Riley, R. (2008). Manual of Simulation in Healthcare. Oxford University Press.