Transcript Document

Psychiatric Students’ Evaluation
of Learning in a Simulated
Environment
Siobhán Smyth and Evelyn Byrne
Aim
• To ascertain students’ perspective of a simulated mental
health ward prior to internship using the METI™
Simulation Effectiveness Scale
• To enable students draw on prior knowledge and clinical
experience while caring for patients (actors) under the
supervision of experienced clinicians, lecturers and
service user
Context
• The transition to practice causes great anxiety; the level of
stress newly qualified nurses experience influences their
ability to function effectively in their new role
• The complexity of today’s healthcare system requires
nurses to be
– Critical thinkers
– Provide safe, timely, appropriate & effective care
What is Simulation?
• According to Ker and Bradley (2007)“the narrow, popularist
view of simulation is that of advanced technologies recreating
the clinical experience, such as those found in virtual reality
and advanced computer - controlled human patient
simulators. But simulation does not focus exclusively on
technical or psychomotor performance; it encompasses a
broad perspective, incorporating both cognitive and affective
domains. Simulation may involve a wide range of techniques
and approaches applicable to learners at all levels of seniority,
from novice to expert, one of the major underlying drivers
being to develop safe healthcare practitioners” (p. 164)
Benefits of Simulation
• A valuable approach for engaging students in their learning(Bland et al, 2010)
• Supports teachers --- integrate role play, questioning, reflection, & feedback to
strengthen critical thought & problem solving capabilities, resulting in the
construction of new knowledge
• Environment resembles clinical practice as closely as possible (Rauren, 2004)
• Present students with simple/complex patient scenarios - opportunity to
integrate knowledge, skills, attitude – enhance critical thinking (Guhde, 2011)
• Supports students learning (Baxter et al. 2009), “think on their feet, not in their
seat” (Rauen, 2001), increase students’ confidence (Cant & Cooper , 2010)
Limitations of Simulation
• Does not replace learning in the real work
• Long term benefit of simulation unproven
• Significant costs
– Personnel; low student-teacher ratio
– Equipment, annual maintenance, consumables
– Physical infrastructure
• Time consuming
– Planning and preparation
– Developing case scenarios
Students’ Prior Exposure
• 1st exposure – before 1stclinical placement
– Baseline assessment of patient during OPD review
• 2nd exposure – 3rd year
– Ward simulation
• 3rd exposure – 4th year
– Drug round
– Ward simulation
Simulation in Action!
Quantitative Evaluation
Statement
Strongly
Agree (4)
Agree
(3)
The instructor’s questions helped me to think
critically.
I feel better prepared to care for patients.
I feel like it was OK to make a mistake.
I feel more confident in my decision making skills.
14
2
9
8
9
7
8
7
I feel more confident determining what to tell the
health care provider.
My assessment skills improved.
I feel more confident in my ability to recognize
changes in the patient.
I feel more confident in my ability to predict
changes in a real patient’s condition.
I felt challenged in my critical thinking and
decision-making skills.
6
10
6
7
10
9
6
10
13
3
Disagree
(2)
Strongly
Disagree (1)
Qualitative Evaluation
What one thing did you like or appreciate the MOST from your
simulation experience today?
• Realness of whole situation --“excellent”
• Opportunity to practice in a safe
environment
• Thinking on “my feet”
• Learning about “my deficits”
• Dealing with difficult
situations/aggressive patient
• Encouraged to use “my current
knowledge”
• Cardiac arrest experience --“wonderful”
• Knowing what is expected as
students
• Chance to experience and learn
great skills
• Receiving immediate feedback
from patient and assessor --“excellent”, “very helpful”
Qualitative Evaluation contd..
What one thing did you like or appreciate LEAST from your simulation
experience today?
• Anxiety provoking
• Stressful coping with
“manufactured environment”
“being watched”
“not knowing what to do”
• Pressure
• Threatened with death
• Busyness --- dealing with interruptions
Qualitative Evaluation contd..
What can we do to improve the overall simulation experience?
• Provide regular and frequent simulations
– reduce anxiety
– increase confidence
• Create more clinical space
– avoid busy environment
• Clinical scenarios – dealing with difficult/challenging experiences and
situations
Conclusion
• Critical thinking was identified as a key factor:
– instructor’s questioning technique facilitated students’
critical thinking and enhanced decision-making skills
• Other facets
– students’ feeling better prepared to care for patients
– improvement in their assessment skills
– greater confidence in recognising and predicting
changes in patients’ mental state
Finally
• Suggestions for improvement include integration of
simulation throughout the program despite the stress the
students experienced
• Challenge --- explore ways of increasing frequency of
simulation in an already packed curriculum
Questions
References available from [email protected]