Assessing clinical decision making skills using an interactive online tool. Verina Waights & Ali Wyllie Faculty of Health and Social Care COLMSCT CETL Fellows OU Conference ‘Making Connections’ (30th April 2008) Quality eLearning strand

2 Outline Context of Project Overview principles of quality eLearning experience Outline characteristics of CDM tool Demo CDM Findings to date Looking to the future

3 Background Nurses make clinical decisions in response to changes in each patient's condition, which may occur within very small time-frames The ability to make clinical judgements depends on both a sound theoretical background and good decision-making skills Clinical decisions are strongly influenced by the context in which they are made (Bucknall 2000) As the complexity of decision tasks increases, so context-specific knowledge determines the effectiveness of decision-making (Botti & Reeve 2003)

4 Aims to develop a web-based tool to provide decision-making opportunities, building on Laurillard (2002): who suggests that: ‘Traditional modes of assessment of knowledge are seen as inadequate because they fail to assess students‘ capability in the authentic activities of their discipline’. to assess nursing students’ decision-making skills in a context- driven virtual environment.

5 What makes quality eLearning Boud and Prosser’s (2002) principles for designing a high quality learning environment suggests learning activities should: support learner engagement - build on prior knowledge acknowledge the learning context – integral with study seek to challenge learners – active participation provide practice – through individual and/or group activities

6 Principles of good feedback practice Nicol and Milligan (2007:72) seven principles of good feedback practice. Principle 6: Good feedback practice ‘provides opportunities to close the gap between current and desired performance’. Boud’s (2000:158) arguments about closing the gap can be viewed in 2 ways: It is about supporting students in the act of production of a piece of work It is about providing opportunities to repeat the ‘task – performance – feedback cycle’.

7 Pedagogical approach Based on principles of case-based learning design and experiential learning (Kolb 1984). Students’ options are scaffolded Learning is student - led and asynchronous Feedback is contexual, individualised to student’s learning journey and timely Intention is to assist students to practice in risk-free environment until ready to practice in work setting.

8 Research methods Students’ perceptions of their decision-making skills and efficacy of tool will be evaluated through: Individual completion of an online questionnaire to enable quantitative and qualitative evaluation Qualitative output from video observation and ‘Think aloud’ techniques with students’ interacting in the IET Userlab

9 Case study: patient with a leg ulcer Realistic: case prepared in collaboration with a practice nurse to mimic reality Relevant: Wound healing and clinical decision-making are integral components of Nursing Programme of study Ethical: consent obtained from the patient and anonymity assured Context: Miss Alice Phelps, an independent 80 year old lady with an ulcer on her left lower leg.

10 Case study – patient with leg ulcer

11 Narrative The story evolves over a series of consultations depending on the treatment the patient receives. At each stage students consult resources to find out about their patient’s condition then determine the best treatment from 3 available options. Their decisions result in the patient progressing through successive consultations until an end point is reached. They are encouraged to have a second attempt at the maze if their first attempt is unsuccessful. Images of the consultations and patient’s final outcome create a visual narrative within the maze

12 Practice Resources The students have a range of media resources to consult: l Audios of consultations between the nurse and patient l Photos of leg ulcers l Instruction sheets on possible treatments l Patient charts and records l Patient records l Laboratory reports l Links to the BNF (British National Formulary)

13 Reflective Log The Reflective Log captures each decision point and the student’s reasons for their choice. At the end of each attempt the student can review their pathway and reflect on their decisions and reasoning. The final attempt additionally provides author feedback on decision-making at each stage.

14 Example Reflective log

15 Scoring Scoring at each decision point depends on the type of decision as outlined below and whether it is the first or second attempt: For example: 1st attempt: a 5 b 3 c 0 2nd attempt: a 3 b 2 c 0 The final score is an average of the two attempts at the maze.

16 Findings to date - score 7 students completed tool/8 students partly completed tool

17 Findings to date - questionnaire

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22 Summary to date Students felt using tool:- Increased their confidence in decision-making and caring for leg ulcers – support learner engagement would assist in their practice – acknowledge the learning context Positive, motivating experience – challenge learners Developed their knowledge and skills - provide practice

23 Looking toward the future The approach piloted in this project can be applied in part or whole in other courses, programmes or disciplines. The tool can be combined with other VLE tools, such as online discussion forums and voting tools, to create flexible and collaborative learning and assessment sequences. The Reflective Log can become part of a TMA. Our findings are being used to inform future assessment strategies within HSC. We are particularly interested in: Contextualised CMA questions; Narratives; Embedded multiple media; Case-based CMAs; Decision-Making; Confidence-indicator tool.