5/10/2018 6:22 AM Integrating Instructional Strategies with Thick Narrative Branching Simulations Kira King, PhD Decision Simulation Rosalyn P. Scott, MD, MSHA Dayton Veterans Affairs Medical Center Wright State University Mary Davidson, MSN APRN CHPN Veterans Affairs Healthcare System of Ohio Edward Bope, MD Chief of Primary Care/Palliative Care Physician Columbus Veterans Affairs Ambulatory Care Center © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

Palliative Care VP Simulations Type: thick narrative situational VP Learners: primary care providers Content: communication strategies Access: scheduled as a patient Strategy: video-based choose your own adventure format Reflection: mentor simulates apprenticeship (Baile et al., 2001; Bizzocchi & Schell, 2009) 2

Creating Effective On-Line Learning U.S. Department of Education reviewed 176 experimental research studies between 1996 – 2008. Learners: Most common learner: undergraduate and graduate (90%+) Most common content: healthcare or medical education (20 – 30%) Effective Strategies Ineffective Strategies Adaptive content Media without learner control Self reflection Multiple choice questions “Real change happens when people see things they have not seen before.” (David Rock, 2009, p. 218) http://www2.ed.gov/rschstat/eval/tech/evidence-based-practices/finalreport.pdf

Facilitating Insight Context Decisions Consequences Insights Engagement Reflection (Allen & Sites, 2012; Means,Toyama, Murphy, Badia & Jones, 2010; Rock, 2009)

Matched Examples and Non-Examples Description: Best used to teach a concept or “kinds of” Define concept and show example Highlight the discriminating properties of the concept Provide a pair of similar examples Provide a pair with an example and a non-example Begin with easy to identify contrasts Progress to more similar pairs Matched Pairs for the Concept: Triangle Example Similar Example Example Non-Example (David Merrill, 2009)

Matched Example and Non-Example What will you say next? Dr. Parker: During our last conversation, we went over your test results and how more chemotherapy or radiation would not help…Given these circumstances, I want to focus on what’s most important for you as we move forward. Reflection Reflection Open-Ended Closed-Ended What challenges Are you able to take are you facing? care of yourself?

Matched Example and Non-Example Open-Ended What challenges are you facing? Marcus: Eating is tough. It’s hard to swallow. I’ve been taking little bits of juice and soft stuff like chicken soup. Closed-Ended Are you able to take care of yourself? Marcus: Yes, I’m fine. Dr. Parker: Are you eating well? Marcus: Yeah, I guess…

Discussing Goals of Care Discussion Nursing Home No Goals of Care Cardiac Arrest Reflection Reflection Reflection Non-Example Patient Centered Non-Example

How will you Discuss Goals of Care? Non-Example Let’s talk with the social worker about nursing homes… Marcus: I want to live at home! I don’t want someone telling me what to do! Patient Centered Can you share with me what’s on your mind? Marcus: I want to live at home with my dog, Buddy. And my friend Roger is just upstairs. You’re tired. Let’s discuss this on your next appointment. One month later.. Social Worker: Marcus had a cardiac arrest and is in a nursing home. I don’t think he’ll be able to return home.

Branching: Delayed Consequences I wanted to give you an update on Marcus. Hospice is helping him live as comfortably at home. He’s asked us to help with an Advance Directive. Marcus is in the hospital with all of these tubes. This sure isn’t what he wanted. I was hoping he could have stayed at home, but it was tough without help. Resources New Goals Intubation Home Resources Hospice Not Utilized

Examples & Non-Examples Branching Techniques Examples & Non-Examples Delayed Consequences Decision Promotes insightful learning by demonstrating consequences of decisions as the simulation progresses. Decision Reflection Reflection Consequences Consequences Learners explore examples of what is and what is not the concept. Reflection Reflection

Questions?