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2. 2 Shock Skills Critical Care Simulations Scenarios A software development project Ian Cole Lecturer in ICT Department of Health Sciences University of York

3. 3 Background TIDC funded project (£2500). Project Team Content provider (Alison Foster - nursing expert). Content developer (myself – software designer). Researcher (Carl Thompson – Clinical Judgement Analyst). Alison Ian Carl

4. 4 Project Outline The Proposal Combine a piece of networked e-learning software. With web based simulation scenarios. To teach nursing students the principals of dealing with clinical shock. Research Aims To develop an effective means of capturing the judgment policies of (student) nurses. To determine what changes are made by a educational intervention (lecture / software)

5. 5 Phase 1 = Research study using web based simulation scenarios. Phase 2 = Creation of the piece of learning technology (Shock Skills) Phase 3 = Replacement of a Lecture with Shock Skills. Analyse results. Project Plan

6. 6 Phase 1 - Research Study The social judgement approach Attach varying weights to associated ‘cues’. Examine these weights to see how people make a judgement. Research Method Judgment of diagnosing someone in hypovolaemic shock. Judgment based on 6 clinical cues. These cues presented as 20 online scenarios. 3 levels – abnormal, normal & equivocal Carl

7. 7 Web based scenarios method Web pages created and linked to Macromedia Coldfusion platform. Created a database of results. Exported as a text file into SPSS. Carl

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9. 9 Research Study – Phase 1 A group of 2 nd year nursing students (23). Asked to judge if a fictitious patient was in shock (pre-test). Students then given a lecture. (this would be replaced in phase 3 by a piece of learning technology – Shock Skills) After lecture, students come back and retake the test (post-test). Carl Alison

10. 10 We Wanted: To know if the lecture make a difference? Compare results with a future student group when the lecture is replaced with Shock Skills. We Found: A greater variability in the use of some cues than others. A wide variety of judgements. Pre test = similar importance to all cues except GCS. Post test = respiratory rate was the most important factor. Research Study – Initial Results

11. 11 Phase 2 – Shock Skills Involved the content expert & developer. Used Parson’s & Oja System Development Life Cycle. Network Software /CD-Rom. Internet limited for video use. Limited by 650Mb CD-Rom. Alison Ian

12. 12 Phase 2 – Shock Skills SDLC Analysis - Lots of interactivity Mini Quizzes & Click ’n’ Drag exercises. Video of clinical procedures. Animations. Lots of images. Planning. Project Plan. Macromedia Director / Flash. Spent the money (Software / video camera). Usability Evaluation Team (12) Ian

13. 13 Phase 2 – Shock Skills SDLC Design. Storyboarded the lecture in PowerPoint. Navigation model designed. Design metaphor. Ian

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15. 15 Phase 2 – Shock Skills SDLC Implementation. Prototype Implementation Aug 2003 Planned for April 2004 – SLIPPED!!!! Planned for September 2004 Ian

16. 16 Phase 2 – Shock Skills SDLC Testing. Usability Evaluation Dec 2003 to Jan 2004. Team of 12 evaluators (Staff & Students). 58 Question Questionnaire. Based on Shneiderman’s usability scale & criteria. 1 member performing a Cognitive Walkthrough Experiment. Ian

17. 17 Shock Skills Usability Results Criteria: Images Readability Colour Navigation Interactivity Reactions No: Questions Descriptors (0 to 9)Mean Q8Navigating from this screen is? Hard to Easy8.4 Q55Overall ReactionsTerrible to Wonderful7.5 Q55Overall ReactionsDull to Stimulating 7.7 Q55Overall ReactionsDifficult to Easy7.2 Q55Overall ReactionsFrustrating to Satisfying7.2 Q55Overall ReactionsRigid to Flexible6.5 Q56Learning to use the software is? Difficult to Easy7.7 Q57The ‘TC’ character image is? Pointless to Excellent6.0 Q58Educational content is?Poor to Excellent7.5 Q59Software usability is?Poor to Excellent7.6

18. 18 System Design Life Cycle Norman’s Seven principles of User-Centered Design 1: Use both knowledge in the world and knowledge in the head. 2: Simplify the structure of tasks. 3: Make things visible: bridge the gulfs of Execution & Evaluation. 4: Get the mappings right. 5: Exploit the power of constrains, both natural and artificial 6: Design for error. 7: When all else fails, standardize. Shock Skills Methodologies

19. 19 Phase 3 – The end is in sight! Project started in Summer 2002. Phase 3 should have started April 2004 Project should be finished now. Underestimated the time needed. Underestimated the funding. No protected time. For content expert. Should have held back some money to buy in a proof reader. 80 screens to proof read.

20. 20 August 04: Finish the software proof reading. September 04: Install on network October 04: Another group of nursing students. Undertake the pre-test /Shock Skills /post test Analyse and compare differences. Publish end of the year (we hope!!!). Regardless the project will be completed. What's Next?

21. 21 Conclusions: We have an effective method of analysing judgement policies. But more research is needed. We used a clearly defined development path. BUT!!!! Don’t underestimate the amount of time & money software development takes. Don’t only have one content expert. Everybody needs protected time to work on e- learning projects.

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