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Dubrowski draft
- 1. The different uses of simulation: From education to product testing Adam Dubrowski, PhD Learning and Research Institutes Wilson Centre Department of Paediatrics, UofT
- 3. Chaos in the Brickyard Forscher, BK. Chaos in the Brickyard. Science. 1963 Oct 18; 142(3590): 339.
- 4. Applying the Scientific Method and underpinning research methodology to generate evidence that will be used to build simulation based education programs. General Aim
- 5. • Models of Medical Education • Introduction to Simulation • Working Model • Components of Simulation – Simulators – Educators – Organization • Future Directions Outline
- 6. Apprenticeship Model Trainer Trainee PatientCare Shift in responsibility Ashley, 2000
- 8. Apprenticeship Model Trainer Trainee PatientCare More people die in a given year as a result of medical errors ( 44,000) than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516). "To Err is Human, Building a Safety Health System" (2000).
- 10. Simulation Based Education Learn faster Remember longer Be safer
- 11. The replication of a task or an event for the purpose of education and/or assessment. Simulation Based Education
- 13. Dubrowski, A., Brydges, R., Satterthwaite, L., Xeroulis, G., Classe, R. American Journal of Surgery. in press. Busy Environment: Multitasking Simulation Based Education
- 15. Simulation Based Education Technical Performance Communication Environment Clinical Knowledge Additional Learning Attentional capacity threshold
- 16. Simulation Based Education Technical Performance Communication Environment Clinical Knowledge Additional Learning Attentional capacity threshold
- 17. Simulation Based Education Technical Performance Communication Environment Clinical Knowledge Additional Learning Attentional capacity threshold
- 18. Simulation Based Education Technical Performance Communication Environment Clinical Knowledge Additional Learning Attentional capacity threshold
- 20. Kurahashi et al. Surgery. 2010 Study 1: Does it work? Can simulation based training help in pre-training?
- 21. Practice: Trained Skills Test Written Test 1 week rest Study 1: Does it work? No practice: Novice
- 22. Skills Test: Expert Opinion 0 5 10 15 20 25 Written Test: Score 0 5 10 15 20 25 Trained Novice Novice Trained Novice Novice Study 1: Does it work?
- 23. simulation performanceimproves Study 1: Does it work?
- 24. learningenables Study 1: Does it work? simulation
- 25. Simulation Based Education How to use it?
- 26. Simulation Based Education Components Simulators Educators Organization
- 27. Simulators Information Flow Framework Brydges et al., Am J Surg. 2007, Sidhu et al., J Vasc Surg. 2007
- 28. Study 2: Realism Brydges et al., Am J Surg. 2007, Sidhu et al., J Vasc Surg. 2007 High fidelity Animal model Low fidelity
- 29. Study 2: Realism Brydges et al., Am J Surg. 2007, Sidhu et al., J Vasc Surg. 2007 ExpertOpinion 0 5 10 15 20 25 Senior 0 5 10 15 20 25 Novice Synthetic Cadaver ExpertOpinion Pre-training baseline Synthetic Cadaver
- 30. Study 2: Realism simulation appropriate modelsrequires
- 31. Study 3: Educators Errors in learning Xeroulis et al., Surgery. 2007
- 32. Study 3: Educators Xeroulis et al., Surgery. 2007 ExpertOpinion 0 5 10 15 20 25 Post-training Retention 1 month Pre-training baseline Errors allowed Errors not allowed Independent learning
- 33. Study 3: Educators simulation educated educatorsrequires
- 34. Organization Moulton et al., Ann Surg. 2007 Optimal schedules
- 35. Study 4: Organization Moulton et al., Ann Surg. 2007 1 2 3 4 1 hour block 1 month 1 2 3 4 1 hour block 1 week rest 1 month distributed practice massed practice 1 2 3 41 2 3 41 2 3 41 2 3 41 2 3 4 T T Transfer
- 36. Study 4: Organization Moulton et al., Ann Surg. 2007 distributed massed ExpertOpinion 30 20 10 0 Pre-test Microsurgical drill Post-test Rat Transfer
- 37. Study 4: Organization simulation effective curricularequires
- 38. Summary of Results simulation appropriate modelsrequires simulation educated educatorsrequires simulation effective curricularequires
- 39. Implications Trainer Trainee PatientCare Medical Education = Evidence Based Education
- 40. Simulation for Assessment Framework Preference For learning Of learning Testing
- 43. Simulation for Assessment Results Behavior Learning Reaction Kirkpatrick Does Shows How Knows How Knows Miller
- 44. Simulation for Assessment Results Behavior Learning Reaction Kirkpatrick Does Shows How Knows How Knows Miller Moore
- 45. Simulation for Assessment Assessment of what?
- 48. PGY 1-5 Gen Surgery residents Knot tying: surface (easy) and depth (difficult) Assessed with expert-based (GRS) and computer- based (motion analysis device) assessments Brydges et al., J Am Coll Surg. 2008 Assessment of Performance
- 49. T T T T T T T T T T 400 200 100 0 5 4 3 2 1 0 T T T T T T T T TT 1000 800 600 400 200 0 T T T T T Surgical Volume Expert-basedComputer-based 1 2 3 4 5 Depth Surface Brydges et al., J Am Coll Surg. 2008 Assessment of Performance
- 50. simulation valid assessmentsrequires Brydges et al., J Am Coll Surg. 2008 Assessment of Performance
- 51. simulation realistic contextprovides Brydges et al., J Am Coll Surg. 2008 Assessment of Performance
- 52. Porte et al., AJS. 2007 Assessment for Learning
- 53. Computer Practice Pre Test Retention Test 1 week restComputer + Crit Expert Post Test Porte et al., AJS. 2007 Assessment for Learning
- 54. T T T T T T T T T Pre Post Retention ExpertOpinion 20 10 0 Computer Computer + Crit Expert Porte et al., AJS. 2007 Assessment for Learning
- 55. Porte et al., AJS. 2007 assessments for learning: choices Assessment for Learning
- 57. Building Skills, Changing Practice: Simulator Training for Hand Hygiene Protocols Canadian Institutes of Health Research Partnerships for Health System Improvement A. McGeer, MA. Beduz, A. Dubrowski Assessment of Learning
- 58. Purpose • Current models of knowledge delivery about proper hand hygiene rely on didactic session • Transfer to practice is low Assessment of Learning
- 59. PurposeAssessment of Learning Results Behavior Learning Reaction Does Shows How Knows How Knows
- 60. PurposeAssessment of Learning Results Behavior Learning Reaction Does Shows How Knows How Knows
- 61. PurposeAssessment of Learning Results Behavior Learning Reaction Does Shows How Knows How Knows
- 62. Recruitment Clinical monitoring (audits) Clinical monitoring (audits) Δ in Behavior Δ in Performance Reaction Education (Sim/traditional) PurposeAssessment of Learning Sim Sim
- 63. • Simulation Design Scale • Educational Practices Questionnaire PurposeAssessment of Learning Frequency 100 50 0 Disagree Strongly Agree 90 66
- 64. Pre-test Post-test Hand Hygiene Compliance (average of all opportunities; all 4 moments) 62% (n=558 opportunities) 64% (n=550 opportunities) Average Adequacy (Excellent/ Satisfactory/ Unsatisfactory) Satisfactory (n=252 observations) Satisfactory (n=282 observations) Average Duration 13 seconds (n=254 observations) 13 seconds (n=252 observations) # Extra Washes 140 90 PurposeAssessment of Learning
- 65. 98 24 51 9292 44 48 93 0 10 20 30 40 50 60 70 80 90 100 Bef-Pat/Env Bef-Asp Aft-Bfl Aft-Pat/Env PreTest (n=558) Post Test (n=550) Moment 1 Moment 2 Moment 3 Moment 4 PurposeAssessment of Learning *
- 66. • No transfer of knowledge • No changes in performance, no learning • Ineffective education and not transfer to practice PurposeAssessment of Learning
- 67. Assessment for Testing Product and Process testing
- 70. Is it an effective tool? Does it disturb the flow? What is the frequency of use? What is the most optimal format? Assessment for Testing
- 72. Porte et al., AJS. 2007 simulation with process testinghelps Assessment for Testing
- 73. Summary
- 74. Summary Best available evidence Ongoing assessment Educator’s experience • Simulators • Educators • Schedule
- 75. Summary Best available evidence Ongoing assessment Educator’s experience • Simulators • Educators • Schedule • Performance • For learning • Of learning • Other uses
- 76. Summary Best available evidence Ongoing assessment Educator’s experience • Simulators • Educators • Schedule • Performance • For learning • Of learning • Other uses Simulation may not be the answer
- 77. End
Notas do Editor
- Being trained as a kinesiologyst and neuroscientist the general aim of my research is to apply the scientific method and the underpinning research methodology to generate evidence which can then be used to build simulation augmented education programs
- I will do this by first introducing the past med education models that are rooted in the principles of apprenticeshipNext I will introduce SimulationAfter that I will present samples of research that look at the optimization of various components of Simulation. Specifically, I will look at evidence that can help us decide what simulators to use, how we should train the teachers or educators, and how the courses which utilize simulation should be organized.Finally I will talk about a few possible future direction
- For that I will use anon-going study that looked at the use of simulation for the adherence of hand hygiene protocols
- What we normally want to know is wehther our programs impact learning of skills, which then lead to change in behavour, which can be measured in the clinical setting. This is what is known as transfer to practice. However,
- Typically what we assess is whether the learning happened based on what the learners know. When we don’t see transfer to practice, we cannot say whether this failure is due to ineffective education or transfer to practice mechanisms. Using simualtion ….
- … for assessments ofcompetnacy and proficiency at a skill can help us in the understanding of the low transfer to practice phenomenon.
- In this study …..