Transcript Slides
Retooling Health
Assessment: It
Takes More Than a
Hammer
Cheryl Wilson
MSN, ARNP, ANP-BC
Objectives
Understand the gap between knowledge and skill
Identify strategies to bridge knowledge and skill
from Advance Health Assessment across to
clinical courses
Understand the continuum of simulated learning
and how to apply in blended courses
Who Am I?
Advanced Registered
Nurse PractitionerAdult Health Board
Certified
Instructor Graduate
and Undergraduate
programs
Disclosure-provide noncompensated consultation as a
SME to Shadow Health
What were the challenges?
Hybrid course only met 3
times a semester
No simulation integrated
into Health Assessment
course
Identified a gap between
knowledge and skills
Application of skills in the
clinical setting
Faculty challenges
Use of simulation
Faculty background and
training
Preparation for lab
Ratio of faculty to
students
Consistency of lab
experiences
Modalities of Learning
Task Trainers
Digital Clinical Experience
(DCE)
Problem Based Learning (PBL)
Clinical Reasoning exercises
Case Studies
Electronic Health Records
(EHR)
Observed Structured Clinical
Exam (OSCE)
Standardized Patients (SP’s)
Digital Clinical Experiences
Students interview the
patient for a full health
history
Go through full
physical exam of each
system
Documentation of
findings
Digital Clinical Experience
Standardized
experience
Communication
skills
Physical exam
skills
Clinical judgment
Problem Based Learning
Case presentation in
small groups
Provide partial information
in history
– Students ask additional
History questions
– Discuss physical exam they
would perform
– 4-5 differential diagnosis
– Match up signs and
symptoms from case
Observed Structured Clinical Exam
Utilization of
standardized patients
Full health history
Focused physical
exam
Differential diagnosis
Final course
competency-putting all
the pieces together
Continuum of Simulated Learning
Why Simulation?
– Provide opportunities to enhance critical
thinking and clinical judgment
– Ability to evaluate students effectively
– Provide scenarios to enhance learning
• Clinical situations possibly encountered in practice
and how to work through clinical problems.
Continuum
OSCE
Standardized
Patients
DCE
High Fidelity
Low Fidelity
Task
Trainers
Faculty involvement
Role of course coordinator
Integration of simulation
Digital clinical examination
Facilitation of clinical reasoning
Consistency of skills taught across all
sections
Pedagogical Background
Development of
expertise
Clinical
competence
Benner (1984)
From Novice to
Expert
Expert
Proficient
Competent
Advanced Beginner
Novice
Benner, P. (1984)
Training
Provide faculty training in integration of the
digital clinical experience
– How to review results
– Synthesize results
– Troubleshoot student problems with software
application
Weekly schedule of all lab activities
– Assigned to each faculty
– Resource to prepare for upcoming lab sessions
Documentation
Integrated documentation
of patient findings within
the DCE
– Model notes provided
in grading rubric
Documentation in EHR of
Problem Based Learning
group work
Strategies
Provide consistent
training of all faculty in
lab
Integration of
simulation throughout
the course
Inter-rater reliability of
grading and
evaluation
Conclusion
Re-tooling of the course to integrate
simulation and strengthen diagnostic
reasoning/clinical judgment skills.
Utilization of multiple modalities of learning
Training of faculty for reliability in
evaluation and consistency of delivery
Continuous evaluation of course to improve
student learning outcomes
References
Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing
Practice. Menlo Park: Addison Wesley.
Fitzgerald, C., Kantrowitz-Gordon, I., Katz, J., & Hirsch, A. (2012). Advanced practice
nursing education: Challenges and strategies. Nursing Research and Practice.
doi:10.1155/2012/854918
Jerlock, M., Falk, K., & Severinsson, E. (2003). Academic nursing education
guidelines: Tools for bridging the gap between theory, research and practice.
Nursing and Health Sciences, 5, 219-228.