Performance Feedback and Simulation in the Medical Education Curriculum
ADLT 674, Section 901
Spring 2014
Course Director
Ellen Brock, MD., M. P. H.
Medical Director, Center for Human Simulation and Patient Safety
McGlothlin Medical Education Center, 9th floor
Telephone: 628-4519
Email:
Dr. Brock will be assisted by faculty and staff in the Center for Patient Safety
and Human Simulation, including Mr. Ted Carter and Mr. David Walton as well as:
Dr. Moshe Feldman, Assistant Director of Research & Evaluation
Telephone: 828-6878
Email:
Dr. Cheryl Bodamer, Simulation Educator
Telephone: 628-4511
Email:
Dr. Catherine Grossman, Internal Medicine, Pulmonary
Telephone: 828-9071
Email:
Dr. Terry Carter, Associate Dean for Professional Instruction and Faculty Development
Telephone: 828-3134
Email:
Dr. Ken Warren, Instructional Technology for Medical Education
Telephone: 828-3848
Email:
Course Meetings
Tuesdays, 5:15 -7:45 pm
From February 4 through April 29, 2014
McGlothlin Medical Education Center, 9th floor classroom in the Center for Patient Safety and Human Simulation
Course Description
This course introduces medical educators to the use of simulated learning experiences in preparing healthcare professionals for patient care. The emphasis is on acquiring skills to develop and lead a simulation or standardized patient experience within the medical education curriculum. A major focus will be on facilitation skills needed to provide effective feedback to debrief the learning experience with trainees. The course involves participation in simulation experiences in the VCU Center for Human Simulation and Patient Safety as well as preparation of an individual project in the specialty area of the course participant under the guidance of the course director and educational staff.
Textbook (Required):
- Riley, R. H. (Ed). (2008). Manual of simulation in healthcare. New York, NY: Oxford University Press.
Reference Texts
Note: We will photocopy selected chapters from these and post them on the Weekly readings page of the blog, but if you prefer to add to your library on Simulation, there are the texts we recommend: 3848
- Levine, A. I., DeMaria, Jr., S., Schwartz, A. D., &Sim, A. J. (Eds). (2013). The comprehensive textbook of healthcare simulation. New York, NY: Springer.
- Salas, E., & Frush, K. (2012). Improving patient safety through teamwork and team training. New York, NY: Oxford University Press. Note: this is an online accessible book through VCU libraries.
Course Objectives
By the end of this course, learners will have:
- Identified the major components involved in creating authentic simulation experiences for trainees, including: (a) design of the learning experience; (b) use of simulation technology; (c) methods for delivering feedback, including debriefing exercises and small group discussions; and (d) evidence based assessment strategies.
- Participated in at least one simulation experience, including debriefing.
- Reviewed the literature on best practices in simulation-based medical education.
- Designed a simulation scenario applicable to his or her area of medical specialty and submitted it for peer and instructor feedback.
- Determined an appropriate assessment strategy and submitted it for instructor review and feedback.
- Prepared a reflective assessment of the learning experience according to a rubric and participated in a reflective group learning discussion during the final class session.
Description of Course Assignments, with Due Dates
- Engagement, Participation, and Preparation for Weekly Sessions (20% of course grade)
You are expected to attend all class sessions and come to class each week prepared to engage in discussion and dialogue with the instructors and your classmates, having completed the reading assignments for each week. Early in the semester, you will be expected to have identified a course project that consists of a simulation scenario design. Ideally, this should be a skill session that is intended to be embedded within a larger learning experience for your students or trainees. This scenario should follow the event-based learning life cycle that will be discussed in class. Since a considerable part of the class is conducted experientially, absences should be avoided, if at all possible.
- Simulation Project – 60% of course grade
The project consists of several graded elements with due dates as shown below. A good scenario for simulation training addresses a learning task that is difficult to accomplish by other means. What’s the most difficult “thing” for you to teach in your content area, and how can simulation be used to teach it? The goal is for a well-crafted plan that consists of a 15 to 20-minute simulation exercise for a specific group of learners.
Identification of need and establishment of topic(5% of grade) Due Feb 18
Post on the blog page assigned to you a one to two- paragraph written summary of your idea for a simulation scenario. You should describe the intended learners, the instructional aim or goal for the scenario, and why you believe that this instructional goal is best accomplished through simulation. If your simulation is successful in accomplishing your goal, what will your learners be able to do that they have difficulty learning to do with your present method of instruction? This is the question you should address.
Development of learning objectives (5% of grade)Due Feb 25
Write three to five learning objectives in either the cognitive, psychomotor, or affective domain for your simulation scenario. Remember that learning objectives are always written with the stem, “By the end of this simulation training, learners will be able to ….” Use strong, active verbs to describe what you intend your learners to accomplish. If you have questions about whether or not your objectives are properly written, see the reference handout posted on our Blackboard site for writing objectives.
Scenario design (40% of grade)Due April 1
The scenario design is comprised of multiple elements, described and graded as follows:
(a)Tools – what are the tools needed for your scenario? – 5 %
(b)Environment – how must the environment be arranged?What drugs, or devices will be used, and for how long?– 5%
(c)Script – Who says what, and when? – 10%
(d)Trigger Events – What events will trigger certain crucial actions in the scenario?What triggers will signal ending of an event?– 5%
(e)Confederate roles and instructions – Who are your confederates, and what do they say and when? All roles must be fully fleshed out and scripted for use by standardized patients and other confederates in the scenario. – 5%
(f)Facilitator instructions – You may not be the only facilitator for your scenario when it is used in the future. What do other instructors need to know to do? What should they expect? What guidelines can you provide them about setting up and carrying out the scenario? These should be instructions for replication– 10%
Assessment Plan (10% of grade)Due April 15
Using guidelines presented for this assignment on Blackboard, prepare a complete assessment plan for your scenario. Be sure that there is alignment between your goals and objectives and the assessment plan, and that the simulation scenario, as the instructional strategy, is designed to allow your learners to achieve the objectives which are measured by the assessment. In a well-designed scenario, there should be complete congruence between the scenario design, the intended objectives, and the assessment of its effectiveness.
- Final Reflection Activity – 10% of course grade
Prior to the final class session, you should use the reflective questions posted on the blog for this assignment to construct a two to three-page reflective essay about what you have learned during the course. Bring a hard copy to the last class and come prepared to discuss your “lessons learned” in designing a simulation scenario.
- Peer Evaluation – 10% of course grade
Using the peer assessment tool provided in class (and on the blog), you should provide written peer feedback in the form of constructive comments as well as scores for each of your peers, as assigned. Bring this written feedback with you to the final class, with one copy to submit for to the instructor(s) and another copy to share with each peer for whom you are providing feedback.
Summary of Graded Assignments
Engagement, participation, and preparation for weekly sessions20 points
Simulation Project60 points
Final reflection activity10 points
Peer evaluation10 points
Total100 points
Grading Rubric
A93-100 / Performed at graduate level of excellence throughout the course. Participated actively in online as well as class discussions and activities, appropriately referencing credible resources from class/external readings and introducing personal/anecdotal/experiential comments that contributed to a broadened awareness of the topic under discussion for all participants.Engaged in scholarly debate with others.Submitted timely, impeccable and well-written documents/papers related to assignments.
B
85-92 / Performed at graduate level on most fronts, did not rise to the level of excellence in all areas.
Participated actively in online discussions and activities (including blog writing) as well as in class dialogue, but with less displayed familiarity with the literature from text and outside readings.
Submitted well-written documents/papers related to assignments that contained only minor errors/problems.
C
77-84 / Participated in online and in-class discussions and activities on a limited basis or did so from an uninformed/personal perspective only.Submitted written documents/papers related to assignments that were less than comprehensive, inadequately researched, or inclusive of important grammatical errors.
D
69-76 / Performed in a substandard manner on several assignments.Failed to demonstrate a basic understanding of concepts and/or failed to adequately contribute to the class through class participation, contribution to blogs, the class wiki, or in other online activities.
F
Below 69 / Engaged in academic dishonesty, stopped participating altogether, or failed to meet the requirements of the class.
Week-by-Week Schedule(revised as of Feb 14, 2014. All handouts posted on the blog.
Class Date / Readings & Assignments To PREPARE Before Class / In-Class Learning ActivitiesSession 1
Feb 4, 2014
Note: We meet on the 9th floor of the Center for Human Simulation and Patient Safety, MMEC
*Terry, Ellen, Ted / Readings:
- Riley text, Chapter 9 -Teaching and learning through the simulated environment and
- Chapter 10, Developing your teaching role in a simulation centre
- Orientation to the simulation center
- Teaching and learning in the simulation environment: the components of a simulation
- Participation in a simulation
Session 2
Feb 11, 2014
*Cheryl / Readings:
- Riley text, Chapter 12-Scenario design: theory to delivery, and
- Chapter 17-Problem based learning for simulation in healthcare
- Considerations in choosing a simulation project and developing scenarios
- Building scenarios to optimize learner engagement
- Discussion of simulation projects
- Introduction to use of the blog for projects
Session 3
Feb 18, 2014
*Ellen, Cathy, Cheryl / Readings:
- Rudolph, J.Teaching without harming.
- Cook et al. Comparative effectiveness of instructional design features in simulation-based education
- Work in groups to finish simulation design
- Run and critique simulations
- Project idea identification due – 1-2 paragraphs posted to your individual blog page
Session 4
Feb 25, 2014 / Readings:
Posted On Blog:
- Rudolph, J. Debriefing with Good Judgment.
- Rudolph, J.Debriefing as formative assessment.
- The Harvard DASH debriefing tool.
- Curiosity/Advocacy/Inquiry
- Time for discussion of simulation projects
- Learning Objectives Due – post to your blog page
No Class During the Week of March 3-7, However we will schedule individual sessions to discuss projects as needed
Session 5
March 11, 2014
*Moshe / Readings:
- Levine text, Chapter 14, Computer and Web-based simulators
- Motola et al., Simulation in healthcare education: A best-evidence practical guide, AMEE Guide No. 82 (on blog)
- Choosing and building assessment tools
- Observational performance rating
Session 6
Mar 18, 2014
*Ellen, David
*Ted, Aaron / Readings:
- Cook et al. Comparative Effectiveness of Technology-Enhanced Simulation Versus Other Instructional Methods (article will be posted on the blog)
- Levine text, Chapter 13, Standardized patients
- Orientation to simulator features and software
- Realism vs. relevance in simulation
- Designing SP and hybrid simulations
Session 7
Mar 25, 2014 / No class meeting – Self-directed project work
Individual meeting with simulation staff as needed – please schedule in advance / Work on simulation projects and assessments
Session 8
April 1, 2014
*Moshe, Cathy / Readings:
- Feldman et al., Rater Training to Support High-Stakes Simulation-Based Assessments
- Hamstra,The Focus on Competencies and Individual Learner Assessment as Emerging Themes in Medical Education
- Research(both readings posted on blog)
- Rater training
- Competencies for individual learner assessment
- Debriefing Practice: Viewing of video debriefs / Reframing questions
- Submit simulation scenario designs for instructor feedback – post to your individual blog page
Session 9
April 8, 2014
*Ellen, Cathy, Cheryl / Readings:
- Smith-Jentsch et al. Guided Team Self-Correction: Impacts on Team Mental Models, Processes and Effectiveness.(posted on Bb)
- Salas and Frush, Chapter 1 – The Theoretical Drivers and Models of Team Performance and Effectiveness for Patient Safety and
- Chapter 5 – Educating Healthcare Providers to Promote Teamwork: Issues, Requirements, and Guidelines
- Debriefing practice
- Managing a difficult debriefing
- Guided Team Self Correction for teamwork debriefing
- Group discussion and individual feedback on project designs
Session 10
Apr 15, 2014
Moshe, Ellen / Readings:
- Levine text, Chapter 10, Systems Integration
- Davis et al., Failure modes and effects analysis based on in-situ simulations: A methodology to improve understanding of risks and failures
- Failure mode and effect analysis
- Time for addressing topics of special interest to class
- Final scenario project designs, including an assessment plan: post to your blog page
Session 11
April 22, 2014 / No additional readings
Peer Feedback - bring to class / Run and debrief scenario projects
- Exchange of peer feedback
- Discussion of lessons learned
Session 12
Apr 29, 2014 / Reflective essay due – post this assignment to the subpage on your individual blog page
Peer Feedback – bring to class / Run and debrief scenario projects
- In-class reflection and exchange of peer feedback
- Lessons learned
Supplementary Bibliography
Ferguson, K. J. (2010). Facilitating student learning. In W. B Jeffries & K. N. Huggett (Eds.), An introduction to medical teaching (pp. 1-10). New York, NY: Springer Publishing.
Freeth, D. (2010).Interprofessional education. In T. Swanwick (Ed.), Understanding medical education: Evidence, theory, and practice (pp. 53-68). London, UK: Wiley-Blackwell.
Gordon, J. A., Hayden, E. M., Ahmed, R.A., Pawlowski, J. B., Khoury, K. N., &Oriol, N. E. (2010). Earlybedside care during preclinical medical education: Can technology-enhanced patient simulation advance the Flexnerian ideal? Academic Medicine, 85, 370–377.
Hetzel-Campbell, S., & Daley, K. (2008).Simulation scenarios for nurse educators: Making it real. New York, NY: Springer Publishing Co.
Issenberg, S. B., McGaghie, W. C., Petrusa, E. R., Gordon, D. L., &Scalese, R. J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Medical Teacher, 27(1), 10–28.
Mayer R. E. (2010, June).Applying the science of learning to medical education. Medical Education, 44(6), 543-549.
McGaghie, W. C., Issenberg, S. B., Cohen, E. R., Barsuk, J.H., & Wayne, D. B., (2011, June). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review ofthe evidence.Academic Medicine, 86(6), 706–711.
McGaghie, W. C., Issenberg, S. B., Petrusa, E. R., &Scalese, R.J. (2010). A critical review of simulation-based medical education research: 2003–2009. Medical Education, 44(1), 50–63.
Pasquale, S. J. (2010). Teaching with simulation.In W. B Jeffries & K. N. Huggett (Eds.), An introduction to medical teaching (pp. 79-90). New York, NY: Springer Publishing.
Prideaux D. (2003). ABC of learning and teaching in medicine: Curriculum Design. BMJ, 326 (7303), 268-270.
Riley, R. H. (2008). A manual of simulation in healthcare. New York, NY: Oxford University Press.
Rosen, M. A., Salas, E., Wilson, K. A., King, H. B., Salisbury, M., Augenstein, J. S., et al. (2008, Spring). Measuring team performance in simulation-based Training: Adopting best practices for healthcare. Simulation in Healthcare, 3(1), 33-41.
Rudolph, J. W., Siimon, R., Dufresne, R., &Raemer, D. B., (2006, Spring). There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare, 1(1), 49-55.
Rudolph,J. W., Simon, R., Raemer, D. B., &Eppich, W. J. (2008). Debriefing as formative assessment: Closing performance gaps in medical education. Academic Emergency Medicine, 15(11), 1010–1016.
Salas, E., & Frush, K. (2012 ). Improving patient safety through teamwork and team training. New York NY: Oxford University press.
Salas, E., Klein, C., King, H., Salisbury, M., Augenstein, J. S., Birnbach, D. J. et al. (2008, September), Debriefing medical teams: 12 evidence-based best practices and tips. The Joint Commission Journal on Quality and Patient Safety, 34(9), 518-527.
VanHeukelom, J. N. ,Begaz, T., & Treat, R. (2010, April). Comparison of postsimulation debriefing versus in-simulation debriefing in medical simulation.Simulation in Healthcare, 5(2), 91-97.
Wright, M. E., Phillips-Bute, B. G., Petrusa, E. R., Griffin, K. L., Hobbs, G. W., &Taekman, J. M. (2009). Assessing teamwork in medical education and practice: Relating behavioural teamwork ratings and clinical performance. Medical Teacher, 31, 30-38.
VCU Policies
E-mail Policy
Electronic mail or "e-mail" is considered an official method for communication at VCU because it delivers information in a convenient, timely, cost effective and environmentally aware manner. Students are expected to check their official VCU e-mail on a frequent and consistent basis in order to remain informed of university-related communications. The university recommends checking e-mail daily. Students are responsible for the consequences of not reading, in a timely fashion, university-related communications sent to their official VCU student e-mail account. This policy ensures that all students have access to this important form of communication. It ensures students can be reached through a standardized channel by faculty and other staff of the university as needed. Mail sent to the VCU e-mail address may include notification of university-related actions, including disciplinary action. Please read the policy in its entirety: