Is Simulation the Future Is Simulation the Future of Nursing Education?of Nursing Education?

Nigel WynneNational Teaching Fellow

Senior Academic Learning & TeachingSenior Academic Learning & TeachingBirmingham City University

DisclosureProject Lead for the Virtual Case Creator O li Si l ti k t d Online Simulation workstream – made available to HEI and Health Care Organisations Under LicenseOrganisations Under License

No Personal Financial GainNo Personal Financial Gain

Birmingham Cityg y

• Acquired University status in 1992 status in 1992

• Approx. 25000 stds• 8 Faculties8 Faculties• New £150m City

Centre Campus

F lt f H lthFaculty of Health• Approx 7000 students• Approx. 7000 students• Nursing (4 branches),

SLT, Radiography, Social Work, ODP’s, Midwifery

• Centre for Defence • Centre for Defence Medicine

• 3000 pre-registration nursing stds

• 300 staff

BCU Simulation

• 2004 Online simulation

BCU Simulation Milestones

platform (VCC)• January 2005 CETL Status• May 2005 International ay 005 e a o a

Council of Nurses conf. Taiwan

• March 2006 Pitt visit• Sept 2006 NMC Pilot• June 2006 QAA rating• April 2007 Installation of • April 2007 Installation of

VERT

BCU Simulation BCU Simulation Milestones

• January 2007 Laerdel HQ• Nov 2007 Laerdel Int.

ConferenceConference• Jan 08 2nd Pitt Visit• March 08 Scoping Exercise

• BU and WU Med • BU and WU Med Schools

• July 08 3rd Pitt Visit: formalise collaborative formalise collaborative projects

The Pendulum That Swung Too Far?Too Far?

• 20th century -Practice Based LearningE l 1990’ P2K • Early 1990’s – P2K and HE

• Peach Report 1999 –Peach Report 1999 Damming Critique

P ti M k P f tPractice Makes Perfect

Practice Makes PermanentPractice Makes Permanent

Only well supervised practice with constructive feedback that makesconstructive feedback that makes good practice permanent (Nichol, 2006)

Project 2000 and Higher Education IntegrationIntegration

• The development of the “knowledgeable h h d h l f

The development of the knowledgeable doer”

• Focus upon academic disciplines

Research showed that upon qualification nurses had less developed clinical skills

setsocus upo acade c d sc p es• Development of critical thinking skills• Heavily criticised

sets.

Heavily criticised

“I must be the only knowledgeable doer

Phillips et al (1994), While et al (1995), Luker et al (1996), Macleod Clarke et al (1996), Runciman et al (1998), Carlisle

et al (1999).I must be the only knowledgeable doer who doesn’t know what they are doing”

et al (1999).

Defining SimulationgSimulation is a technique - not a technology – to amplify experiences that evoke or replicate amplify experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.

Gabba (2004)

C ll d d i k f h li Controlled and risk free encounters that replicate real life scenarios allowing students to learn rehearse and apply skills before transferring these pp y gto clinical practice.

Morgan(2006)

Nurse/Simulation PublicationsNursing&Simulation Publications

140CINAHL Plus Literature Search

99

132126

100

120

Literature Search

49

7080

73

60

80Frequ

46

3327

4939

20

40Over 4 fold increase in Simulation/Nursing P bli ti f 2000 0

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Year Nov

Publication cf 2000

The Power of High Fidelity Simulation

NMC PilotBackground • Nursing and Midwifery Council

• regulator for 682,000 nurses and midwives in UK

• Commissioned Simulation and Practice • Commissioned Simulation and Practice Based Learning Project in 2006

• 13 pilot sites selected to capture a wide ange of app oaches to sim lation range of approaches to simulation

focussed learning within pre-reg. nursing only

NMC Pilot

• Aimed to identify what is required to ensure that simulation can develop skills as safely as practice experience

• Potential Outcome: Changes in the proportion of time learners need to p pspend in practice during their course

NMC Pilot

• Study population approx. 1000 learners Sept – Dec 06

• On average 6 days of clinical practice g y preplaced by simulation based learning.g

• Most learners participated in 6 simulation scenarios.simulation scenarios.

OutcomeOutcome

Th i ifi h i UK • The most significant change in UK nurse education in the past 15 years

• Up to 300 hours of the 2300 hours • Up to 300 hours of the 2300 hours practice component to provide clinical training within a simulated practice learning environment in support of providing direct care in the practice setting (NMC Circular 36/2007)setting. (NMC Circular 36/2007)

What is the key challenge facing the field of simulation in health the field of simulation in health

care? 50%

1 Promoting patient safety

24% 22%

1. Promoting patient safety2. Improving the fidelity of

simulation scenarios3 Maximising the

y

5%3. Maximising the

educational value of simulation

4 Obtaining further

romotin

g pati

ent s

afety

mprovin

g the f

idelity

..

Maxim

ising t

he educa

...

Obtaining fu

rther

inv...4. Obtaining further

investment in simulation learning

Pro Im Ma Ob

Effective Education Design and Curriculum Integration: Priceless?Curriculum Integration:

Si E i t £40 000

Sim Staff: £1000

Priceless?

Sim Equipment £40,000

Sim Facilities £500,000

Where do we go from here?g

One SolutionOne Solution

By Applying and Aligning Different Simulation Modalities within a Curriculum

F d F kFocussed Framework

Maximising Learning by Constructive Alignment of Biggs (1999) Co st uct e g e t o

Multiple-Modality Simulation

(CAMMS)

ASSESSMENT INTERVENTION AND EVALUATION FOR ACUTE ADULT NURSING

Virtual Case Creator

LTIPART TASK TRAINING / SKILLS/LO’s Slide 65 PLENARY TRADITIONAL

TEACHING

SIMULATIONS & VIDEO

MOODLE

CLINICAL PRACTICE

SUMMATIVE ASSESSMENT

Full Context Simulation S iScenario

F ilit t t i th l f th•Facilitators act in the role of the students’ ‘mentor’ in practice.E t d t t k•Encourages students to seek

help and ask questions when unsureunsure.•Develops students confidence to question and challengeto question and challenge practice

Streaming Live Videog

•Peer observation•Facilitated plenary and debrief

Modes of debriefModes of debrief

• Private debrief by facilitator immediately post scenario post scenario

• Debrief by peers outside of simulation suite

• Self-guided reflection of video performanceof video performance

This This or This

Scoping Skills and Simulation: MethodsMethods

• Desktop survey of • Desktop survey of over 50 organisations

• National Online Survey

• Curriculum mapping exercise exercise

• Expert Panel • Vision Statements

and Recommendations

Scoping Skills and Simulation: RecommendationsRecommendations

L d hi• Leadership• Multi and Inter professional

learning opportunities• Educational Framework• Regional Staff Dev.

Academy• Regional Advisory Board• Focus on Evaluation• Hub and Spoke Approach Hub and Spoke Approach

to Centre Organisation

So Is Simulation the Future of Nurse Education?of Nurse Education?

• For us, rarely has emphasis on one field of , y peducational innovation, led to such a transformative effect.

• More situated learning on campus• More effective module design• Increased student progression• Increased external fundingg• Increased R&D opportunities

We’re still unsure about We’re still unsure about the impact that simulation

will have on the wider sector but whatever sector but whatever

happens in the future we k h ld know that we would

never go back to the past.e e go bac to t e past

References• Gabba, D.M. (2004) Journal of Quality and Safety in Health Care, 13

(suppl), i2-i10• Lave, J & Wenger, E (1991) Situated Learning. Legitimate peripheral

participation. Cambridge University Press, Cambridge• McCallum, J. (2006) The debate in favour of using simulation education in

pre-registration adult nursing, Nurse Education Today, 27, 825-831p e eg st at o adu t u s g, u se ducat o oday, , 8 5 83• Morgan, R. (2006) Using clinical skills laboratories to promote theory

practice integration during first practice placement – An Irish perspective. Journal of Clinical Nursing, 15, 2, 155 – 165

• Nichol M (2006) Simulation in Interprofessional Education Why Bother? • Nichol, M (2006) Simulation in Interprofessional Education. Why Bother? http://www.rgu.ac.uk/nursing/aboutus/page.cfm?pge=38451 accessed 2/11/2008

• Peach Report UKCC Commission for Nursing and Midwifery and education

Fitness for practice. London: UKCC, 1999. SHA (West Mids) (2008) Scoping the Future of Clinical Skills and Simulation. Strategic Health Authority (West Mids) (Not yet published)

Contact Details

Nigel WynneSenior Academic L&T

Birmingham City Universitynigel.wynne@bcu.ac.uk

0121 331 71720797 147 1626

Acknowledgments and ThanksThanks

Professor Stuart Brand – Head of Learning & Teaching Birmingham City University Teaching, Birmingham City University, stuart.brand@bcu.ac.uk

Luke Millard – Learning and Teaching Project g g jManager, Birmingham City University, luke.millard@bcu.ac.uk

Matthew Aldridge Senior Lecturer Birmingham Matthew Aldridge – Senior Lecturer, Birmingham City University, matthew.aldridge@bcu.ac.uk

Lindsay Yardley - Lecturer, Birmingham City y y , g yUniversity, lindsay.yardley@bcu.ac.uk

Part Task Trainers

NG Tube and Tracheostomy Care Airway Management

Wound CareIV Training

PICU Scenario

Learning objects can be linked to support decision making and to scaffold learning

ll i li i l kill t b f h d dallowing clinical skills to be refreshed and further developed.

Online Simulation: Teacher Online Simulation: Teacher and PC Supported Scaffolding

Communication ScenarioCommunication Scenario

Cracks in

Posture perhaps indicating

wall perhaps indicating socio economic

low self esteem, lethargy.

P h

economic status, lack of support, motivation

Withering plant indicating

Perhaps some indication of alcohol dependency/

low motivation

p yfailing to cope

The use of video allows the learner to interview this client and the decision making exercise allows

them to further assess and initiate care.

Advanced Patient SimulatorsAdvanced Patient Simulators

APS Scenarios build upon VCC, Learning Object and Part Task Trainer learningg

Sailing into the Futureg

" The great thing in this world is not so …The great thing in this world is not so much where we stand, as in what direction we are moving…we must sail gsometimes with the wind and sometimes against it, but we must sail, and not drift, nor lie at anchor."

Oliver Wendell Holmes

Who are our students?• http://moodle.bcu.ac.uk/course/view.php?

id 168id=168

Part Task Trainers

NG Tube and Tracheostomy Care Airway Management

Wound CareIV TrainingIV Training

Learning Objects

Urinalysis Oxygen Administrationy yg

Blood Transfusion Early Warning Scoring Systems

Practice Learning Theory

Lave & Wenger Vygotsy Brown et al

Schon

Rejected the dualisticRejected the dualistic construction of knowledge promoted “knowing” as an

Dewey Argyris

promoted knowing as an active and practice immersed process

Practice Learning Theory

VygotsyLave & Wenger Brown et al

Schon

Zone of ProximalZone of Proximal Development

Dewey ArgyrisScaffolding (Bruner)

Practice Learning Theory

Lave & Wenger Vygotsy Brown et al

Schon

Legitimate PeripheralLegitimate Peripheral Participation

Dewey Argyris

Practice Learning Theory

SchonLave & Wenger Vygotsy Brown et al

The swampy lowland of messy practice problems that can’t be

solved by application of facts andsolved by application of facts and formal theories

Dewey Biggs

Practice Learning Theory

Brown et al

SchonLave & Wenger Vygotsy

Situated Cognition

Dewey Biggs

Practice Learning Theory

SchonLave & Wenger Vygotsy Brown et al

Constructive Alignment

Dewey Biggs

Patient Safetyy•To Err Is Human

•An Organisation with a Memory•An Organisation with a Memory

•Astonishing human and economic cost of human error

•Increase in multi site studies that explore in-practice behavioural outcomesbehavioural outcomes

•Potential for Simulation to facilitate these studies