Making the implicit explicit: Theories informing simulation-based education
#simtheory October 18 Introduction: Debra Nestel Theory #1: Gabriel Reedy Theory #2: Peter Dieckmann November 10 Theory #3: Nancy McNaughton Theory #4: Walter Eppich Theory #5: Ryan Brydges
Simulation education and… Cognitive Load Theory Installation Theory November 10 Critical Theory Cultural-Historical Activity Theory Normative Theory
World views
World views Positivism & post-positivism
World views Positivism & post-positivism Interpretivism
World views Positivism & post-positivism Interpretivism Critical theory
Social Behavioural constructivist Constructivist
Theories can be seen as frameworks of ideas… are complex and contestable Nestel D, Bearman M. Theory and simulation-based education: definitions, worldviews and applications. Clinical Simulation in Nursing . 2015;11:349-54.
Theories are nets cast to catch what we call ‘the world’; to rationalize, to explain and to master it. We endeavor to make the mesh ever finer and finer. Popper K. 1959, The Logic of Scientific Discovery , New York
Theories to illuminate Bordage G. Conceptual frameworks to illuminate and magnify. Medical Education . 2009;43:312-9 .
Theories to magnify Bordage G. Conceptual frameworks to illuminate and magnify. Medical Education . 2009;43:312-9.
Theories as lenses Bordage G. Conceptual frameworks to illuminate and magnify. Medical Education . 2009;43:312-9.
Theories as liquids Not fixed in time, constantly changing, not fixed in space …
• Skills-based
Source: www.hellenic.simulations.com
Source: Michelle Kelly January 14-16, 2016 IMSH 2016 - DISCOVER|SHARE|LEAD
Source: Debra Nestel
#simtheory October 18 Introduction: Debra Nestel Theory #1: Gabriel Reedy Theory #2: Peter Dieckmann November 10 Theory #3: Nancy McNaughton Theory #4: Walter Eppich Theory #5: Ryan Brydges
Cognitive Load Theory and Simulation Education Gabriel Reedy PhD King’s College London Simulation and Interactive Learning Centre at Guy’s and St Thomas’ NHS Foundation Trust
Information Processing Model • How many items are you faced with? • How are the items related to each other and to what you already know? • What rules (schemata) in your long-term memory can help you process them?
Intrinsic Load • How difficult is the task for the learner? – Contextual to task, situation, learner – What is the learner’s previous experience with this or similar tasks – Cannot be lowered, as such – but it can be mitigated and must be considered
Extraneous Load • Not inherent or necessary to complete a task • Based on the design of the task or experience • Adds to intrinsic load • Can potentially overload working memory
Germane Load • Sometimes the task is richly difficult, but working through it can help the learner progress – it is germane to the learning. • Part of intrinsic load • Helps to create schemata in working memory to help learner be successful in the long term with other tasks • Be judicious and thoughtful
Using Cognitive Load in Simulation • Goal-free learning allows for more specific and appropriate learning opportunities – Learner-defined goals – Safe to make mistakes • Setting up the simulation tasks appropriately can make for a more effective learning environment – Set learners up for success – lower the extraneous cognitive load by reminding participants of protocols and previous knowledge – Use confederates judiciously to lower the extraneous cognitive load • Start with simple tasks and move towards more complex ones – Develop learners over time, lower intrinsic load by preparing learners • Develop higher fidelity as learners progress – Too much detail can overwhelm novice learners and is unnecessary
Installation Theory by Saadi Lahlou, LSE Peter Dieckmann PhD, Dipl-Psych
Why do people do, what they do?
Person(ality) Situation
Person(ality) Situation
Person(ality) Situation
Person(ality) Situation Jung Lave & Wenger Adler Goffman Kelly Lewin
P. Dieckmann, DIMS Kurt Lewin (1890 – 1947) The whole as starting point http://www.tavinstitute.org/ Dynamic of situations Psychological aspects
B=f(P,E)
P erson Habits Wishes Perception Knowledge Memories Anticipation
Life Space P +
P. Dieckmann, DIMS Life Space Affordances describe the value of elements for a person in the life space - - + + + + P +
P. Dieckmann, DIMS Life Space Not all is achieveable (easily) Borders have different strengths - - + + + + + P
Material Aspects Social and Organisational Aspects
P. Dieckmann, CAMES Installation Material Layer Embodied Competence Societal and organisational control Saadi Lahlou
P. Dieckmann, CAMES Installation E Material Layer P Embodied Competence Societal and E organisational control Saadi Lahlou
P. Dieckmann, CAMES Installation Compensations ML EC SC Saadi Lahlou
P. Dieckmann, CAMES Installation Compensations ML Declining EC Eyesight SC Saadi Lahlou
P. Dieckmann, CAMES Installation Compensations Increase ML Light Declining Extend EC Eyesight Arm SC Reluctance to buy glases Saadi Lahlou
P. Dieckmann, CAMES Installation Compensations Restart Computer Software ML Bugs Ask your colleague EC Find workaround SC Inform programmer Saadi Lahlou
P. Dieckmann, CAMES Installation Compensations Hide Folders ML “Violations“ EC Block implementation „Unworkable“ SC Feedback to designers Guidelines Complain to colleagues Saadi Lahlou
P. Dieckmann, CAMES Clinical Practice Simulation / Educational Practice ML ML EC EC Connection SC SC Work as imagined / Work as done. (Erik Hollnagel)
Formula for Impact Adapted from Resuscitation 59 (2003) 11-43 Educational Medical Local Safety Efficiency Organization Science Quality of care Human Factors Ergonomics Process sceience …
P. Dieckmann, CAMES P. Dieckmann, CAMES Standardized Variable Teaching Teaching “Standardized” Variable Learning Learning
P. Dieckmann, CAMES Thank you Peter Dieckmann Peter.dieckmann@regionh.dk @pdieckmann
Making the implicit explicit: Theories informing simulation-based education
#simtheory October 18 Introduction: Debra Nestel Theory #1: Gabriel Reedy Theory #2: Peter Dieckmann November 10 Theory #3: Nancy McNaughton Theory #4: Walter Eppich Theory #5: Ryan Brydges
Simulation education and… Cognitive Load Theory Installation Theory November 10 Critical Theory Cultural-Historical Activity Theory Normative Theory
Thank you Debra Nestel AMEE Simulation Committee
Further reading (DN) • Battista, A., Activity theory and analyzing learning in simulations. Simulation and Gaming, 2015. 46 (2): p. 187-196. • Battista, A., & Nestel, D. (In press). Simulation in medical education. In T. Swanwick (Ed.), Understanding Medical Education : Wiley. • Bearman, M., N. McNaughton, and D. Nestel, Theories informing healthcare simulation practice , in Healthcare Simulation Education: Evidence, Theory & Practice , D. Nestel, et al., Editors. 2018, John Wiley & Sons Ltd.: Chichester. p. 9-15. • Eppich, W. and A. Cheng, Cultural historical activity theory (CHAT) - informed debriefing for interprofessional teams. Clinical Simulation in Nursing, 2015. 11 : p. 383-389. • Fenwick, T. and M.A. Dahlgren, Towards socio-material approaches in simulation-based education: lessons from complexity theory. Med Educ, 2015. 49 (4): p. 359-67. • Husebo, S., S. O'Regan, and D. Nestel, Reflective practice and its role in simulation. Clinical Simulation in Nursing, 2015: p. 368-375. • Kneebone, R., Simulation in surgical training: educational issues and practical implications. Medical Education, 2003. 37 (3): p. 267-77. • Nestel, D. and M. Bearman, Theory and simulation-based education: definitions, worldviews and applications. Clinical Simulation in Nursing, 2015. 11 : p. 349-354. • Reedy, G., Using cognitive load theory to inform simulation design and practice. Clinical Simulation in Nursing, 2015. 11: p. 350-360.
#simtheory gabriel.reedy@kcl.ac.uk weppich@gmail.com ryan.brydges@utoronto.ca nmcnaughton@michener.ca mail@peter-dieckmann.de debra.nestel@monash.edu dnestel@unimelb.edu.au
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