Designing and Testing a Pedagogical Model for Simulation-based Learning Environments: Preliminary Findings and Perspectives for Future Research 2008–2010 March 2, 2010 SiME Seminar Series Heli Ruokamo Tuulikki Keskitalo

MediPeda III Project`s background ENVI – Virtual Centre of Wellness Campus Unique environment, which utilizes 3D technology and simulations New possibilities, but also challenges for teachers, learners, designers, and researchers Video 1, Video 2, Video 3 We need more research that possibilities of ENVI and other similar environments could be used in a pedagogically appropriate way Figure 1. ENVI Virtual Centre of Wellness Campus. Rovaniemi University of Applied Sciences©2009.

MediPeda III Multidisciplinary research and development project (2008-2010) Aims: Research and develop pedagogical model, user-centered design methods as well as value creation model for virtual and simulation-based learning environments of healthcare Content: Developing a pedagogical model (Tuulikki Keskitalo & Heli Ruokamo) Long-term research of students` learning experiences in virtual and simulation-based learning environments (Paula Yliniemi) Developing a user-centered design methods (Pia Yliräisänen-Seppänen & Eija Timonen) Developing a value creation model (Jussi Haukkamaa) Comparative research in three different simulation-centers (Tuulikki Keskitalo & Heli Ruokamo)

MediPeda III Research Partners: University of Lapland Faculty of Education, Centre for Media Pedagogy (Coord.) International Research Partners: Stanford University, School of Medicine (Palo Alto, California, USA) Development of Education: Rovaniemi University of Applied Sciences Arcada University of Applied Sciences Stanford University, California Financiers: Rovaniemi University of Applied Sciences City of Rovaniemi Hospital District of Lapland Medieco Corp. Nordic Simulators Corp. Heat-IT Corp. Tekes European Regional Development Fund

Developing a Pedagogical Model (Keskitalo, Ruokamo, & Väisänen, accepted)

Goal and Theoretical Background Aim of this research was to develop a pedagogical model to support facilitating, training and learning processes in VR and simulation-based learning environments A pedagogical model can be used to shape curriculums or long term courses of studies, to design instructional materials, and to guide instruction in the classroom and other settings (Joyce & Weil, 1980, p. 1) Generally, this research builds on the socio-constructivist and socio-cultural perspectives on learning (Lave & Wenger, 1991; Vygotsky, 1978) Learning is related to all actions that take into account a person as a whole (body, mind and spirit) and the role of cultural tools and artefacts (technology and language) Learning is also seen as active, life wide, life long collaborative knowledge co-creation process

Pedagogical Model Pedagogical model is built on the facilitating-training-learning (FTL) -processes (cf. Teaching-, studying- and learning (TSL) -process, Kansanen, Tirri, Meri, Krokfors, Husu & Jyrhämä, 2000; Uljens, 1997) and the characteristics of meaningful learning (Hakkarainen, 2007; Jonassen, 1995; Jonassen et al., 1999; Nevgi & Tirri 2003; Ruokamo & Pohjolainen 1999; Vahtivuori-Hänninen et al., 2004) Facilitating Training Learning

Facilitating describes teacher`s activity Facilitators promote students` meaningful learning (e.g. Jonassen, 1995): choose the resources and scenario based on students’ characteristics, characteristics of meaningful learning and competencies facilitate and guide students` meaningful learning process Facilitating

The Characteristics of Meaningful Learning Training In training, students` meaningful learning should be promoted: Experiential and experimental Students can use their own experiences as a starting point for learning (Kolb, 1984), but they also have an opportunity to gain valuable experiences before entering real healthcare practice (Cleave-Hogg & Morgan, 2002). Emotional Emotions are always intertwined with learning (Engeström, 1982). Emotions affect motivation, but they also affect how we act in the simulation setting and what we remember later on (Damasio, 2001).

…the Characteristics of Meaningful Learning Socio-constructive and collaborative Training collaboratively means that students provide support and modelling as well as construct their own knowledge while solving the healthcare cases together with other students (Jonassen, 1995; Lave & Wenger, 1991). Learning is also seen as being tool-dependent (Vygotsky, 1978). Active and responsible Students should engage in finding, evaluating, and constructing knowledge (Jonassen, 1995), while also being responsible for planning, executing, and evaluating their own learning. Consequently, instruction involves supporting these processes.

…the Characteristics of Meaningful Learning Reflective and critical Reflectivity means that learners articulate what they have learned and reflect on the processes and decisions that were entailed by the process (Jonassen, 1995). In higher education, learners should also critically evaluate the FTL process as well as the acquired information and the learning environment. Competence-based and contextual Facilitators should structure the training with specific learning objectives in mind, based on the competencies students will need to handle real-life situations (Fanning & Gaba, 2007). These competencies are usually embedded into a scenario whose aim is to transfer the learned skills into real-life settings, since learning is typically contextual (Jonassen, 1995).

…The Characteristics of Meaningful Learning Goal-oriented and self-directed Characteristics indicate that students are encouraged to set their own goals for learning, which they try to attain by planning, realizing and evaluating their own learning (Brockett & Hiemstra, 1991). Individual Learning is also individually different (De Corte, 1995); therefore, facilitators should provide time and effort to get to know each student and his or her level of competency properly in order to provide an individual learning experience, guidance and feedback.

At best, training has been meaningful for students. Learning The students have reached the learning goals and the new learning goals have been set. At best, training has been meaningful for students.

Figure 2. The preliminary pedagogical model.

Research Question From facilitators` and students` perspective, what are the most important characteristics of meaningful learning that are realized during the simulation-based learning? www.risteilijat.fi

Methods Designing a pedagogical model is conducted using design-based research method (DBR) (Brown, 1992; Design-based Research Collective, 2003)

Figure 3. Arcada Patient Safety and Learning Centre Figure 3. Arcada Patient Safety and Learning Centre. Arcada University of Applied Sciences©2009.

Data Collection: Data Analysis: Altogether 14 second year paramedic students and four teachers participated in the course titled The Treatment of Critically Ill Patient Students had 11 scenarios (7–26 min) at the Arcada Medical Simulation Centre as well as lectures and self-studying During the training sessions students worked in teams on scenarios related to the topic areas The structure of the course followed the Learning through Simulations model (Introduction, Simulator Briefing, Scenarios, Debriefing) (Joyce et al., 2002; cf. Dieckmann, Gaba & Rall, 2007) Data collected using pre- and post questionnaires, interviews, learning diaries, video-recordings Data Analysis: Qualitative content analysis of facilitators and students` interviews, open questions of the pre- and post questionnaires, learning diaries and video recordings

Results The characteristics that were strongly supported were experiential, experimental, socio-constructive, collaborative, active, responsible, reflective, competence-based, contextual and self-directed. “…we have to be active, that we can have most of it…” (student 13.) Emotional, Critical, goal-oriented and individual characteristics were not fully realized. “…they do not arouse so much emotions…” (student 14.)

Figure 4. Redesigned pedagogical model. 1. INTRODUCTION Presentation of a course topic as well as other important concepts. Explanation of how course is organised (pedagogical models and methods). 2. SIMULATOR BRIEFING Introduction of a scenario, case, problem etc. Introduction of goals, roles, rules, procedures, and decisions. Setting the individual goals. Participants familiarise themselves with the environment, the case and their roles. 4. DEBRIEFING Comprehensive evaluation, reflection and critical analysis of the FTL process, the knowledge and the learning environment. Providing individual guidance and feedback. 3. SCENARIOS Participating in simulations. Practising of skills and knowledge. Training Experiential Experimental EMOTIONAL Socio-constructive Collaborative Active Responsible Reflective CRITICAL Competence-based Contextual GOAL-ORIENTED Self-directed INDIVIDUAL Competencies set for the healthcare personnel Facilitating Choosing the resources and scenario based on students` characteristics, characteristics of meaning learning and competencies. Facilitate and guide students` meaningful learning. Learning VR and simulation-based learning environment (context) Figure 4. Redesigned pedagogical model.

Future Development of Pedagogical Model Testing the pedagogical model is conducted applying design-based research method (DBR) (Brown, 1992; Design-based Research Collective, 2003) 2. Cycle of the pedagogical model design: 1. Designing of the pedagogical model based on theories and results of previous researches. 2. Testing the redesigned pedagogical model and data collection at the Stanford University, School of Medicine 2009–2010. 3. Analysis of Data. 4. Redesigning of the pedagogical model based on data collection and analysis.

Data Collection at Stanford University Started February 18, 2010 and ends March 12, 2010 Pre- and post questionnaires for students dealing with expectations and experiences of meaningful learning Group interviews of students Group interviews of facilitators Video recordings of simulation sessions Participant observations during the session and field notes Participants At the moment 11 students and 4 facilitators Courses ACRM 2 (VA), Surg 313a (GC), IMPES (VA) and Anes 306a

Data Analysis Qualitative content analysis of facilitators and students` group interviews Quantitative analysis of the pre- and post questionnaires Qualitative content analysis of video recordings Analysis is supported by field notes

Future research The redesigned model is developed further on the basis of the results from Stanford University Facilitators will be trained in Finland on the basis of the results New project funding will be applied The 3. cycle of DBR will be carried out at the Rovaniemi University of Applied Sciences 2011 Additional value of VR will be tested The final model will be presented

Conclusion This study provides us with a learning theoretical approach to realize VR and simulation-based learning It develops a new pedagogical model for VR and simulation-based learning environments It gives more information about the use of the pedagogical model and the VR and simulation-based learning environments from facilitators, students and researchers perspectives

Publications Keskitalo, T. (accepted). Teachers` Conceptions and Their Approaches to Teaching in Virtual Reality and Simulation-based Learning Environments. Teachers and Teaching: Theory and Practise. Keskitalo, T., Ruokamo, H., & Väisänen, O. (Accepted). How Does the Facilitating, Training and Learning Support Characteristics of Meaningful Learning in Simulation-based Learning Environment from Facilitators and Students Perspectives? ED-Media (World Conference on Educational Multimedia, Hypermedia and Telecommunications) 2010. Yliräisänen, P., & Timonen, E., (Accepted). Development of an Immersive Learning Environment Based on User Experiences. ED-Media (World Conference on Educational Multimedia, Hypermedia and Telecommunications) 2010. Keskitalo, T., & Ruokamo, H. (2009). Designing a Pedagogical Model for Virtual Reality and Simulation-based Learning Environments of Healthcare. Manuscript submitted for publication. Yliniemi, P. (2009). Nursing and Health Care Students’ Experiences of Training in Simulation-based Learning Environment - “ENVI”. In T. Bastiaens et al. (Eds.), Proceedings of World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education 2009 (pp. 3275-3279). Chesapeake, VA: AACE.

Centre for Media Pedagogy (CMP) Thank you! Centre for Media Pedagogy (CMP) www.ulapland.fi/CMP MediPedaIII www.ulapland.fi/MediPeda P.O.Box 122, FI-96101 Rovaniemi, FINLAND Tel. + 358 16 341 341 Email: Firstname.Lastname@ulapland.fi