1. Utilizing Blended Learning to Improve Efficiencies Debra A. Allan Danforth, MS, ARNP, FAANP Director of the Charlotte E. Maguire, M.D. and Tallahassee Memorial HealthCare Clinical Skills and Simulation Center Associate Professor Florida State University, College of Medicine Virginia Henderson and Billye Brown Fellow Debra A. Allan Danforth, MS, ARNP, FAANP Director of the Charlotte E. Maguire, M.D. and Tallahassee Memorial HealthCare Clinical Skills and Simulation Center Associate Professor Florida State University, College of Medicine Virginia Henderson and Billye Brown Fellow

2. FSU C OLLEGE OF M EDICINE Description:  Implementing blended learning can reduce costs, enable training of more people in less time and contribute to standardizing the education delivered across teams and departments. By utilizing combinations of various education methods such as self directed cognitive learning with psychomotor hands on simulation, blended learning can work together to create high level efficiencies in education delivery.

3. FSU C OLLEGE OF M EDICINE Learning Objectives: 1. Determine the goals of continuing education in health care 2. Identify different learning styles and how different forms of e-learning and simulation can address each. 3. Discuss simulation design based on some best practices in simulation education. 4. Discuss how blending eLearning and simulation can improve efficiency and effectiveness resuscitation training programs.

4. FSU C OLLEGE OF M EDICINE Nursing Objectives:  1. Describe different learning styles and how different forms of e- learning and simulation can accommodate each of them  2. Discuss simulation design based on some best practices in simulation education.

5. FSU C OLLEGE OF M EDICINE Faculty Disclosure  I have a partial faculty conflict – Laerdal paid for travel to conference

6. FSU C OLLEGE OF M EDICINE What is Blended Learning?  There no consensus on a single agreed-upon definition for blended learning. The terms “blended” “hybrid” and “mixed–mode” are used interchangeably in current research literature  A blended learning approach combines the best of face to face classroom methods with computer-mediated activities or simulations to form an integrated instructional approach leading to flexibility  By the year 2013, 7 in 10 school will have 40% of their courses with blended learning

7. FSU C OLLEGE OF M EDICINE What is Blended Learning?  According to research shared at the ALN Conference Workshop on Blending Learning & Higher Education November 17, 2005, there is evidence that a blended instructional approach can result in learning outcome gains and increased enrollment retention (http://www.uic.edu/depts/oee/blended/workshop/bibliography.pdf ) – Cameron, B. (2003). The effectiveness of simulation in a hybrid and online networking course. TechTrends, 47(5), 18-21.  This research compared students’ performance on simulation-based courses and static graphic representational teaching of the same courses content in an online learning environment. Results indicate that interactive learning tools, such as simulation, have the potential to increase student motivation and learning in an online environment.

8. FSU C OLLEGE OF M EDICINE Standardized Patient   According to the Association of Standardized Patient Educators (ASPE) a standardized patient is a person trained to portray a patient scenario, or an actual patient using their own history and physical exam findings, for the instruction, assessment, or practice of communication and/or examination skills of a health care provider.

9. FSU C OLLEGE OF M EDICINE Review of Literature: Standardized Patients (SPs)  Nursing education has historically been challenged with the problem of how to objectively evaluate clinical performance. – The National Organization of Nurse Practitioner Faculties (NONPF) has developed guidelines for evaluation of nurse practitioner’s in interpersonal, communication, history-taking, physical examination and clinical decision making skills.  Utilizing standardized patients (SPs) in education has been shown to be a powerful teaching and evaluation tool in medical education and is currently being adopted by undergraduate and graduate nursing programs.

10. FSU C OLLEGE OF M EDICINE Review of Literature: Standardized Patients (SPs)  Utilizing SPs in education allows faculty to develop patient- centered scenarios designed to meet specific curricular objectives.  SP interactions require students to apply classroom knowledge and clinical skills to real life situations. SPs in education allow control of the complexity of the clinical problem while providing students with patient experience in the health and medical sciences in a safe and supportive environment  Literature reports that faculty and nursing students find SP encounters to be realistic, challenging, and a worthwhile experience.

11. FSU C OLLEGE OF M EDICINE Simulators vs. Standardized Patients SimulatorsStandardized Patients CommunicationConversing is difficult Conversing is easy PathologyProgrammedMay be difficult to portray (murmurs) Consistency of findings StandardizedVariable Procedures“Unlimited”Limited Availability“Unlimited”Scheduled

12. FSU C OLLEGE OF M EDICINE e-Learning

13. FSU C OLLEGE OF M EDICINE How to use Products  Laerdal provides eLearning courses for such products as: – VitalSim – SimMan 3G – SimNewB

14. FSU C OLLEGE OF M EDICINE Healthcare Providers Course (BLS)  eLearning courses are delivered in one, two or three parts. HeartCode BLS – Part 1. Upon successful completion of the online portion, including the written exam, students receive a Part 1 certificate of completion, which must be presented for parts 2 and 3. – Part 2*, a hands-on skills practice session with an AHA BLS Instructor or using a voice- assisted manikin (VAM) system – Part 3*, a skills test with an AHA BLS Instructor or using a VAM system – *Parts 2 and 3 should be completed in one “skills practice and testing” session.   http://www.youtu be.com/watch?v= SYc8NKVlKn8&feat ure=player_embed ded http://www.youtu be.com/watch?v= SYc8NKVlKn8&feat ure=player_embed ded

15. FSU C OLLEGE OF M EDICINE Hybrid

16. FSU C OLLEGE OF M EDICINE Simulation Case   Interprofessional   SP (voice of simulator or significant other)   SP interviewed and then assess on manikin SP

17. FSU C OLLEGE OF M EDICINE Case Materials TimeMonitor Settings SP or Manikin (Actions) SPM Student Actions First 5 minutes Initial Settings: HR 88BP 132/80SpO 2 94%Temp 99.9  Breath sounds crackles bilaterally  Cough (SP hits button or coughs)  Peripheral pulses strong Wife will ask if student does not introduce XxXx XxXx Should be interviewing simulator and assessing vitals and physical exam

18. FSU C OLLEGE OF M EDICINE Script Elicit functional ability in 3 areas: 1. ADLs (bathing, dressing, grooming, mobility noting any aides, continence, feeding); 2. IADLs (phone use, med use, shopping, cooking, cleaning, finances, transportation); 3AADLs (recreation, church, school, work) Before, how was your ability for personal care, did you have difficulty bathing? Dressing? Grooming? ADL’s (Activities of Daily Living) Everything was fine Before, how was your ability to do things around the house and nearby? Did you have difficulty driving? Cooking? Using your medications? IADL’s (Instrumental Activities of Daily Living) – no problems Before, how were you doing with your work, were you having any problems there? Any problems with your recreation? AADL’s (Advanced Activities of Daily Living) – Recreation- I can tell I’m not a teenager anymore. I have to stretch and warm up

19. FSU C OLLEGE OF M EDICINE Harvey Utilization  Undergraduate – Vital signs – Location of heart sounds  Nurse Practitioner or Medical programs – UMedic Program – Student instructions with case presented then listen to heart sounds – Scenario with standardized patient and then listen to heart sounds for diagnosis

20. FSU C OLLEGE OF M EDICINE Harvey Utilization  Hybrid Harvey_Sam Jones Video Clip.wmv Hybrid Harvey_Sam Jones Video Clip.wmv

21. FSU C OLLEGE OF M EDICINE Infant Simulation

22. FSU C OLLEGE OF M EDICINE Utilizing Blended Learning With The Female Exam

23. FSU C OLLEGE OF M EDICINE Material online   Students observe – Camatasia or Elluminate – Observe a video on clinical breast exam  Palpation  Pressure  Pattern  Perimeter  Position

24. FSU C OLLEGE OF M EDICINE Self Practice in Center   Come to center to practice – On simulated breast (superficial, medium and deep) – On breast pad (simulating breast exam and receiving instant feedback) – On pelvic (inserting speculum)

25. FSU C OLLEGE OF M EDICINE Meeting the Patient for Interview  Students go to the center and start with a focused history with their patients.  Patients are dressed in street clothes.

26. FSU C OLLEGE OF M EDICINE Practicing Breast Exam on Simulated Breast   Go to the next room and practice the techniques on simulated breast with lumps

27. FSU C OLLEGE OF M EDICINE 5 Ps of CBE or SBE  Practice the 5 Ps – Palpation – Pressure – Pattern – Perimeter – Position

28. FSU C OLLEGE OF M EDICINE Annie practice with positioning   Practicing placing Annie in the different positions and walking thru teaching.

29. FSU C OLLEGE OF M EDICINE The exam  When go back in room women are already in gowns and ready for breast and pelvic exam

30. FSU C OLLEGE OF M EDICINE Results to interpret   Students will receive a picture of what they observed   If available will also give a picture of a slide to interpret

31. FSU C OLLEGE OF M EDICINE Patient Teaching and Closure   Students will write script for patient   Students will find a patient teaching either from the internet or their PDA’s   Closure with patient.

32. FSU C OLLEGE OF M EDICINE SP Feedback  Students go back in and SP gives feedback on procedure, technique and demeanor.

33. FSU C OLLEGE OF M EDICINE Mama Natalie

34. FSU C OLLEGE OF M EDICINE Implications for Healthcare Providers:  Allows students to do on their own time (adult learners)  Allows assessment of clinical competence  Allows assessment of curriculum effectiveness

35. Thank You! Questions???? debra.danforth@med.fsu.edu (850) 645-7123 debra.danforth@med.fsu.edu