1. Publishing the Best Practices for QSEN Marilyn H. Oermann, PhD, RN, ANEF, FAAN Thelma M. Ingles Professor of Nursing Director of Evaluation and Educational Research Duke University School of Nursing marilyn.oermann@duke.edu

2. Adopting an Evidence-based Approach to Teaching 1. Question own teaching practices 2. Search for evidence to answer questions 3. Decide if findings are applicable to situation 4. Use evidence to guide teaching

3. Qualities of Effective Teacher  Well studied  Good teaching  Interactional process  Prompt, instructional feedback  Deliberate practice

4. Lecture  What does evidence tell us?  Many studies have been done comparing lecture to other methods  No significant differences in cognitive outcomes (short term)  Lack benefits of active learning

5. Lecture cont  Synthesize information from varied sources  Select most important content to learn  Up-to-date  Integrate research findings about quality and safety  Explain difficult concepts

6. Online Course Design  Meta-analysis of evidence on online courses  High interactivity  Practice exercises  Repetition  Feedback Cook DA, et al. Instructional design variations in internet-based learning for health professions education: a systematic review and meta-analysis. Acad Med. 2010;85(5):909-922.

7. Online Course Design cont  Feedback, more interactivity, and audio narration, video clips, animations  Increase learning time but facilitate higher knowledge and satisfaction  Across all studies, time correlated positively with knowledge outcomes (r = 0.53, p =.021) Cook DA, Levinson AJ, Garside S. Time and learning efficiency in Internet-based learning: a systematic review and meta-analysis. Adv Health Sci Educ Theory Pract. 2010;15(5):755-770.

8. Massive Open Online Course (MOOC)  Information to large numbers of students  Few complete MOOCs (<15%) 1  What are implications for nursing education? 1 Massive study on MOOCs. Harvard Gazette. 2015, April 1. http://news.harvard.edu/gazette/story/2015/04/massive-study-on-moocs/

10. Student-centered Methods  Engaged in learning process  Think about content  Depth of learning  Collaborative learning  Retention 15 mins

11. Student-centered Methods cont  Technology tools  Group activities  Models such as  Team-based learning  Flipped classes  Higher level questions  Integrative cases  Clinical scenarios for analysis  Muddiest point  Think-Pair-Share

12. Short Integrative Cases & Unfolding Cases  Extensive literature  Examples of cases that integrate QSEN knowledge, skills, attitudes  Link to practice  Think about clinical situations not encountered in prior practice but need to know  Promote higher level thinking

13. Sample Unfolding Case Learning ActivityLearning ObjectiveQSEN Safety (KSAs) Photograph with hot spots Classify common types and causes of medication errors Knowledge: describe categories of errors Trigger film: case with medication error Explain context within which medication errors occur Skills: participate in analyzing errors Journal reflection: personal reaction to trigger film Analyze the impact of medication errors Attitudes: value vigilance and accountability Bush et al. Cultivating a culture of medication safety in prelicensure nursing students. Nurse Educ.2015;40(4):169-171.

15. Cases: What Outcomes?  BEME review of case-based learning  104 studies  Majority (61%) with single cohorts  Outcomes Students and teachers enjoy, think enhances learning Evidence unclear as to effects on learning Thistlethwaite JE, et al. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Med Teacher.2012;34:e421-e444.

16. Team-based Learning  Systematic review (14 studies, health professions) 1  Significant increase in knowledge for TBL group compared to non TBL  Negative learner reactions  Initial student perception of TBL may be negative; need time to adjust 1 Fatmi M et al. The effectiveness of team-based learning on learning outcomes in health professions education. Med Teacher.2013; 35:e1608-24. 2 Mennenga et al. Time to adjust: Team-based learning 2 years later. Nurse Educ.2015;40:75-78.

17. Interprofessional Education  Experiences tend to be limited  Focus on learner perceptions, knowledge of roles of other professions  Generalizations across research are difficult because:  IPE initiatives are diverse  Poor evaluation methodology  Impact on practice?

18. Simulation  Meta-analysis of simulation design features 1  289 eligible studies with 18,971 trainees  Increasing focus of evidence reviews on simulation for specific areas of practice 2  Reviews on simulation for IPE 3 1 Cook DA, et al. Comparative effectiveness of instructional design features in simulation- based education: systematic review and meta-analysis. Med Teach.2013; 35(1):e867-898. 2 Fisher D, King L. An integrative literature review on preparing nursing students through simulation to recognize and respond to the deteriorating patient. J Adv Nurs.2013; 69(11): 2375-2388. 3 Murdoch NL, et al. Simulation education approaches to enhance collaborative healthcare: a best practices review. Int J Nurs Educ Scholarsh. 2014 Jan 8;10.

19. Simulation cont  Use of TeamSTEPPS (R) and measurement tools  Nursing and medical schools integrated IPE into curricula so every graduate had TeamSTEPPS education and standardized IPE simulation  Future systematic reviews Horsley TL, et al. Developing a foundation for interprofessional education within nursing and medical curricula. Nurse Educ.2016; doi: 10.1097/NNE.0000000000000255

20. Rethink Clinical Education  Traditional model  New models of clinical education  Dedicated education units  Clinical immersion experiences  Good way of integrating QSEN Studies on outcomes

21. Written Assignments in Clinical Courses  No evidence to guide decisions  Ask yourself:  Goals for each assignment? QSEN competencies to be met?  How much repetition?  Keep assignments short, focused on outcomes  Do some in clinical conferences

22. Examples  Select an actual medical error and as a clinical group do a root cause analysis. Interview experts, review literature on case, develop risk reduction plan with recommendations for system and QI. (2 pp)  Select a new intervention for your patient and summarize evidence for its use. (1 p) Hand MW et al. Linking root cause analysis to practice using problem based learning. Nurse Educ.2016. doi: 10.1097/NNE.0000000000000256

23. Student Evaluations of Teaching  ERIC database: student evaluations of teacher performance - >3000 papers  Evidence shows student ratings of teacher are reliable, valid  Variables not related to student ratings  Instructor age, gender, race, personality, research productivity  Student age, gender, level, GPA  Course time of day

24. Student Evaluations of Teaching cont  Variables related to student ratings  Instructor enthusiasm  Course Elective vs required Level (higher level and graduate courses rated higher) Class size (higher ratings with smaller classes) Work and difficulty

25. Student Evaluations of Teaching cont

26. What Next?  Evaluate your teaching strategies and innovations, tools, assessment methods…  Only way to build evidence Evaluations + dissemination = scholarship

27. Scholarship of Teaching in Nursing 1. Original research that uncovers how students learn and how to produce long lasting learning 2. Evaluation studies of educational practices, methods 3. Reviews that integrate knowledge and provide evidence for teaching

28. Scholarship of Teaching in Nursing cont 4. Application of theory and research to guide teaching 5. Development of innovations and program initiatives  Systematically evaluated, outcomes disseminated Oermann MH. Defining and assessing the scholarship of teaching in nursing. J Prof Nurs.2014;30:370-375.

29. Nursing Education Studies  Studies lack rigor  Small samples, 1 setting  Few replications  Few use valid and reliable tools Build a network at this conference

30. Dissemination is Critical  Write about your teaching methods, projects integrating QSEN in courses, tools you developed…  Share findings of studies, evaluations, other forms of scholarship of teaching  Various dissemination methods  Articles in peer-reviewed journals  Presentations at conference  Book chapters

31. Think Broadly about Journals

32. Think Broadly about Journals cont

33. The Time is Now