1. 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
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2. 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

3. 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)

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

5. 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)

6. 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?

7. 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…

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

9. 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.

10. 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

11. 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

12. Questions?