Practical Updates in Anesthesiology

Dr. Mark Wigginton MB,BS FRCA

How to Teach A Brainiac:Educational theories in medical

simulation

Content

• Why is simulation not straight forward

• Theories of learning• Types of simulation• How educational theory is relevant to

medical simulation• Fidelity• Effective debrief

Adult Learners

• Highly motivated• Attend courses because they want to

learn• Self directed educational objectives• Teaching adult learners can be

difficult• Defensive reasoning

Dangers of simulation

• Stress inducing• Under performance in company of

peers• Long term self esteem and emotional

issues

Theories of learning

• Behaviourism– Conditioning

• Cognitivism• Humanism– Transformative learning

• Constructivism• Taxonomies of intelligence– Howard Gardner 1983 Frames of Mind

Taxonomies of intelligence

• Linguistic intelligence• Logical-mathematical intelligence • Musical intelligence • Bodily-kinesthetic intelligence • Spatial intelligence • Interpersonal intelligence • Intrapersonal intelligence • Moral / Naturalist /Spiritual / Existential

Types of Simulation

• Simulation for assessment• Simulation for research• Simulation for systems appraisal

• Task training• Application of knowledge scenarios (High

signal)• Human factors – CRM scenario (High noise)

Types of simulation vs educational objectives

• Task training

• Application of knowledge scenarios (High signal)

• Human factors – CRM scenario (High noise)

Example

• Educational objectives:– Increased knowledge of anaphylaxis

algorithm– Increased awareness of how to facilitate

effective teamwork– Increased ability to perform emergency

cricothyroidotomy

• Freidman et al. Clinical Impact of Epidural Anesthesia Simulation on Short- and Long-term Learning Curve. Reg Anesth Pain Med 2009;34: 229-232

Integration of learning theory

Kolb’s learning cycle related to a

simulation scenario

CONCRETE EXPERIENCE: Once the simulation has run the decisions made and the effects they had can be viewed in entirety. They become concrete experience.

REFLECTIVE OBSERVATION: This part of the learning cycle relates to the debrief phase of simulation. If candidates are not able to critically evaluate the results of their actions they will not learn from them.

ABSTRACT CONCEPTUALIZATION: Thinking about the task and using conceptual knowledge in planning strategy. In simulation this may relate to pre-course material or pre-scenario briefing.

ACTIVE EXPERIMENTATION: The process of doing the simulation during which the candidate will make decisions and potentially need to alter these decisions depending on response.

Suspension of disbelief

Techniques for improving fidelity

• High fidelity mannequin• Well programmed scenario• Experienced controller• Reduced scenario leader input• Candidates adopt their normal role• Faculty adopt their normal role• Ambient sound• Realistic setting• Point-of-care simulation

Considerations for point-of-care simulation

• Safety• Interruption of normal activity• Mixing of simulation equipment with

real equipment

Kolb’s learning cycle related to a

simulation scenario

CONCRETE EXPERIENCE: Once the simulation has run the decisions made and the effects they had can be viewed in entirety. They become concrete experience.

REFLECTIVE OBSERVATION: This part of the learning cycle relates to the debrief phase of simulation. If candidates are not able to critically evaluate the results of their actions they will not learn from them.

ABSTRACT CONCEPTUALIZATION: Thinking about the task and using conceptual knowledge in planning strategy. In simulation this may relate to pre-course material or pre-scenario briefing.

ACTIVE EXPERIMENTATION: The process of doing the simulation during which the candidate will make decisions and potentially need to alter these decisions depending on response.

Debrief

• Duration at least as long as the simulation• In a different area• Video debrief• There’s no such thing as non-judgmental

debrief– Espoused theory– Theory-in-use

Summary

• Why is simulation not straight forward

• Theories of learning• Types of simulation• How educational theory is relevant to

medical simulation• Fidelity• Effective debrief

References

• Argyris C. Teaching Smart People How to Learn. Harvard Business Review 1991; 4(2)• Pavlov I. P., (1927). Conditioned reflexes. London: Routledge and Kegan Paul.• Kang SG, Yang KS, Ko YH, Kang SH, Park HS, Lee JG, Kim JJ, Cheon J. A study on the

learning curve of the robotic virtual reality simulator. J Laparoendosc Adv Surg Tech A. 2012 Jun;22(5):438-42.

• Friedman Z., Siddiqui N., Katznelson R., Devito I., Bould M.D., Naik V. Clinical Impact of Epidural Anesthesia Simulation on Short- and Long-term Learning Curve High- Versus Low-fidelity Model Training. Reg Anesth Pain Med 2009; 34(3):229-232

• Gaba D.M., Crisis resource management and teamwork training in anaesthesia. British Journal of Anaesthesia 105 (1): 3–6 (2010)

• Kolb D., (1984) Experiential Learning: Experience as the Source of Learning and Development. Prentice-Hall, Inc., Englewood Cliffs, N.J.

• Coffield F., Moseley D., Hall E., Ecclestone K. (2004) Learning styles and pedagogy in post-16 learning. A systematic and critical review. London: Learning and Skills Research Centre.

• Maslow A. A theory of human motivation. Psychological Review 1943; 50(4): 370-96• Hamann S. Cognitive and neural mechanisms of emotional memory. Trends in

Cognitive Sciences 2001; 5(9): 394-400• Russell J. A Circumplex Model of Affect. Journal of Personality and Social Psychology

1980; 39(6): 1161-1178• Argyris C., Schön D. Theory in practice: increasing professional effectiveness (1974)

Jossey-Bass San Francisco• Rudolph J., Simon R., Dufresne R., Raemer D. There’s No Such Thing as

“Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment. Simulation in Healthcare 2006; 1(1): 49-55