Theories Informing Simulation-Based Education #Simtheory

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 January 14-16, 2016 IMSH 2016 - DISCOVER|SHARE|LEAD Source: Michelle Kelly 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 do people do, Why what they do? Person(ality) Situation Person(ality) Situation Person(ality) Situation Person(ality) Situation Jung Lave & Wenger Adler Goffman Kelly Lewin Kurt Lewin DIMS Dieckmann, P.

(1890 – 1947)

The whole as starting point Dynamic of situations

Psychological aspects http://www.tavinstitute.org/ B=f(P,E) Person Habits Wishes

Perception Knowledge

Memories Anticipation Life Space

P+ Life Space

Affordances describe the value of elementsDIMS Dieckmann, P. for a person in the life space - - + + + + P + Life Space

Not all is achieveable (easily) DIMS Dieckmann, P. Borders have different strengths - - + + + P ++

Material Aspects

Social and Organisational Aspects

Installation P. Dieckmann, CAMES Dieckmann, P. Material Layer

Embodied Competence

Societal and organisational control

Saadi Lahlou

Installation P. Dieckmann, CAMES Dieckmann, P. Material Layer E Embodied Competence P Societal and organisational control E

Saadi Lahlou

Installation Compensations P. Dieckmann, CAMES Dieckmann, P. ML

Saadi Lahlou

Installation Compensations P. Dieckmann, CAMES Dieckmann, P. ML

Declining EC Eyesight

Saadi Lahlou Installation Compensations

Increase CAMES Dieckmann, P. ML Light

Declining Extend EC Eyesight Arm

SC Reluctance to buy glases

Saadi Lahlou Installation Compensations

Restart Computer CAMES Dieckmann, P. Software ML Bugs

Ask your colleague EC Find workaround

SC Inform programmer

Saadi Lahlou Installation Compensations

Hide Folders CAMES Dieckmann, P. ML

“Violations“ EC Block implementation

SC „Unworkable“ Feedback to designers Guidelines Complain to colleagues

Saadi Lahlou Clinical Practice Simulation / Educational

Practice P. Dieckmann, CAMES Dieckmann, P.

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

Medical Educational Local Safety Science Efficiency Organization Quality of care

Human Factors Ergonomics Process sceience … Standardized Teaching Learning Variable “Standardized” Learning Teaching Variable

P. Dieckmann, CAMES

Thank you P. Dieckmann, CAMES Dieckmann, P.

Peter Dieckmann [email protected] @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

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