Developing a Web-Based Patient-Centered Care Simulation: Lessons Learned McKeon, Cardell, & Norris University of Tennessee Health Science Center

QSEN Proposal Original Plan –Expose students to different “doses” of PBLI in a pediatric course and measure learning using a pretest/posttest web-based simulation design. Good News/Bad News –After QI workshop, all pediatric faculty wanted to incorporate PBLI in clinical experience

QSEN Revised Plan Is web-based simulation as effective as traditional manikin-based simulation to teach quality and safety skills? –Students (N=60) completed a 10-minute pediatric patient-centered care web-based simulated test created in Simwriter (pre-test) –Students participated in a pediatric patient-centered care simulation Group 1 (n = 30) web-based Group 2 (n = 30) traditional manikin based –Students (N=60) will complete a 10-minute acute care patient-centered care web-based simulated test created in Simwriter (post-test)

Pre-test Simulation Attributes (Gaba, 2007) Aim: Performance Assessment (and Training*) Participant: Individual Experience Level: Pre-licensure, Term 2 of 3 Healthcare Domain: In-hospital Health Care Discipline: Nursing KSAs: Patient-centered Decision-making Patient Age: Adolescent Technology: Web-based case scenario Site: Learners home* Extent of participation: Remote viewing with debriefing Feedback: Automatic critique

SimWriter Software to develop customized simulation without the expertise of –an instructional designer, –a graphic artist, and –a sophisticated programmer. Includes all components necessary to develop a simulation program –Mapping –Writing –Designing –Building –Testing Interface is everything –Training the next generation of workers requires interactivity –Complexity of care requires branching scenarios

Karrer, A. & Martin, L. S. (2001). Simulation Levels in Software

Social Simulations Also known as decision-based simulations, branching stories, non-technical skills simulations Interaction with a character, multiple characters, images, etc. to make decisions that determine what you see next Training occurs through decisions, feedback, coaching, and performance reporting

Social Simulation Outcomes Allows users to perform the process or work though a situation Dynamic, media-rich, and engaging learning Real-world “learn-by-doing” experiences Allows people with different learning styles to interact with their training content at their own pace Improves knowledge retention and critical- thinking skills Allows learning from failure in risk-free environment Tailored to generation of workers raised as gamers

Process for Creating Simulation Pre-planning Thinking through situation and set up Planning characters Creating the outline Mapping Building the storyboard of the actual simulation Linking the components together to the sim’s flowchart Writing Character dialog Decision points Feedback Assigning scoring value to the choices within decision points Attaching learning outcomes to the decisions

Process for Creating Simulation (cont) Designing Screen by screen visual layout of design components Functionality and features of the sim Editing and Reviewing Editorial review (spelling and grammar) Content review (training the right material, realistic scenarios, etc) Recording and Editing Media Recording sound/video for high-or low-bandwidth sims Editing media and linking it into the simulation Building and Testing Compiling all the simulation data into a playback engine Testing the product for errors Making fixes and updates

Tips and Guidelines for Writing Social Sims Keep it conversational Keep it simple and straight forward Use character dialog as transition material Use character dialog to naturally create opportunities to succeed or fail Keep choices close to equal length Use feedback to provide extra information Play characters off one another

Writing the Case Study Selecting patient-centered care competencies Elicit patient values, preferences to assess, plan, and evaluate care Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs Assess level of patient's decisional conflict and provide access to resources Recognize the boundaries of therapeutic relationships Facilitate informed patient consent for care Participate in resolving conflict and building consensus Creating a montage of actual scenarios Establishing content validity Obtaining expert test construction review

Pediatric Patient-Centered Care Case Study