1. From Learning Objectives to Outcomes Assessment During Simulation Paul E. Phrampus Director Winter Institute for Simulation, Education and Research (WISER) University of Pittsburgh

2. Why What When Where How Assessment

3. The Future of Simulation………

4. What is a simulation for? 1.Education 2.Assessment 3.Fun 4.1 and 2

5. TESTINGTEACHING The Simulation Advantage Psychomotor Skills Decision Making Skills and Decisions Individuals Teams

6. What is Simulation….. Really…..

7. The Job of Healthcare Educators Psychomotor Skills Communications Skills Professionalism Skills Decision Making Base Knowledge Teamwork Skills

8. Why is this so hard?

9. Learning Objective You have to have a clear reason of why you are running any simulation.

10. Lets Watch

11. What is most important aspect to debrief?

12. Where does a simulation fit? It depends on what your doing!

13. EACH Sim is part of a bigger plan!

14. What is this?

15. Does it belong here?

16. Course (Global) objectives v sim objectives

17. Global Objectives Course Objectives – 1. Demonstrate a proper patient assessment – 2. Demonstrate following the emergency protocol – 3. Demonstrate Airway Management Skills

18. Course Schedule / Flow Sim 1 Sim 2 Lecture Skills Lab Sim 3 Sim 4 Course Objectives Course Objectives Session Objective 1.Ventilate w BVM 2.Recognize Narcotic Overdose 3.Activate Protocol Session Objective 1.Ventilate w BVM 2.Recognize Narcotic Overdose 3.Activate Protocol

19. How do you determine success of a simulation? 1.Students liked it 2.Learning objectives achieved 3.Students passed the scenario 4.Not Sure

20. How do you determine success of a simulation? Instructor Number 1 Instructor Number 2 Instructor Number 3

21. How do you determine success of a simulation? Instructor Number 1Instructor Number 2Instructor Number 3 Measure Here

22. You can only keep track of so many things at one time

23. How many of you feel like this ?

24. Tools for Success Make it easy for your faculty to stay on track In my opinion…..

25. Assessment Methodology – Identify methods for measuring core aspects in simulation education / assessment – Discuss development and deployment of measurement tools

26. Student Learning Outcomes Curriculum Teaching & Learning AssessmentEvaluation

27. Assessment and Evaluation Assessment and Evaluation often used interchangeably Assessment – learner outcomes Evaluation – course or program outcomes

28. Performance Assessment

29. Rate the Performance Pass or Fail Score Performance Procedural Check

30. Assessment Why What When Where How Rosen, MA et al. Measuring Team Performance in Simulation-Based Training: Adopting Best Practices for Healthcare. Sim Healthcare 3:2008;33–41.

31. ACTION PERFORMANCE COMPETENCE KNOWLEDGE Miller GE, The assessment of clinical skills/competence/performance. Academic Med. 1990 Sep;65(9):S63-7. Assessment of clinical skills/competence/performance

32. Clinical Competence & Performance To attain competent performance – basic Knowledge, Skills & Attitudes required Competence – is the application of specific KSAs. Performance – is the translation of competence into action

33. Performance Assessment Basic to performance – Do they know it and know how? Competence – Can they do it? Performance – Do they do it?

34. DOES SHOWS HOW KNOWS HOW KNOWS Knows When Miller GE, The assessment of clinical skills/competence/performance. Academic Med. 1990 Sep;65(9):S63-7. Assessment of clinical skills/competence/performance

35. DOES SHOWS HOW KNOWS HOW KNOWS Knows When Miller GE, The assessment of clinical skills/competence/performance. Academic Med. 1990 Sep;65(9):S63-7. Assessment of clinical skills/competence/performance Knowledge Tests MCQs, Essay, Oral exam Clinical Based Tests Pt Mgt Qs, Essay, Oral Performance Tests OSCE, TaskDemo, SIM/SP Practice Review Audits, Video, UC-SP, 360 O

36. Assessment Formative Assessment – Lower stakes assessment – One of several assessments over time of course or program – May be evaluative, diagnostic, or prescriptive – Often results in remediation or progression to next level Summative Assessment – Higher stakes assessment – Generally final course or program assessment – Primary purpose is performance evaluation – Often results in a Go-No Go outcome

37. Assessment Assessors – Instructors – Observers – SIM/Patients – Peers – Participants Instruments –AV annotation –Pencil/Paper –Scantron form –TabletPC or PDA Assessment data sources –Live observation –Video recording –SIM device logs

38. STUDENT EVALUATOR ASSESSMENTPATIENT Variables in Assessment

39. Assessment Validity Validity – – Degree to which an assessment tool measures what it is intended to measure – Construct validity – Accuracy of tool to measure intended construct Concurrent validity Content validity Predicative validity

40. Assessment Reliability Test Reliability – – consistency of a test to yield the same measure over time (does not assure validity) – Test-Retest Reliability consistency among different administrations – Parallel Forms Reliability to assure that memory effects do not occur use a different pre- and posttest – Inter-Rater Reliability two or more observers rate the same subjects with strong positive correlation of their ratings

41. STUDENT EVALUATOR ASSESSMENTPATIENT Variables in Assessment

42. Assessment Improvement Improving Reliability and Validity – Base assessment on outcome/objectives > event triggers > observable behavior > behavioral rating > assess against competencies – Define performance – Use of Rubric or rating metric – Use (video) training examples of performance – Employ a quality assurance/improvement system

43. Assessment Based on Objectives and Events Rosen, MA, et al A measurement Tool for Simulation –Based Training in Emergency Medicine: The Simulation Module for Assessment of Resident Targeted Event Responses (SMARTER) Approach. Sim Healthcare 3:2008;170-179.

44. Event – Behavior – Scale - Report Rosen, MA, et al. Measuring Team Performance in Simulation –Based Training: Adapting Best Practices for Healthcare. Sim Healthcare 3:2008;33-41.

45. Assessment Metrics Procedural or Check List assessment Global Rating assessment

46. Assessment Metrics Procedural or Check List assessment BCLSYN Open Airway Check Breathing BCLSYN Open Airway (< 5 sec of LOC) Check Breathing (< 5 sec of Airway) BCLSYN Open Airway Check Breathing A Rating Score +1 0 *Assist

47. Assessment Metrics Global Rating assessment Code BluePF CPR and ACLS Code Blue CPR points ACLS points Code BlueHM CPR ACLS L Rating Score +1 0 Pts.

48. Assessment Metrics Procedural or Check List assessment Global Rating assessment Pros and Cons to each Multiple modes & points vs. Single assessment QA/QI Metric – collective vs single assessment

49. Brett-Fleegler, MB et al. A simulator-based tool that assesses pediatric resident resuscitation competency. Pediatrics 121(3):2008;597-603.

50. Gaba, DM et al. Assessment of Clinical Performance during Simulated Crises Using Both Technical and Behavioral Ratings. Anesthesiology, 89(1)July 1998:8-18.

51. Guise, JM et al. Validation of a Tool to Measure and Promote Clinical Teamwork. Sim Healthcare 3:2008;217–223.

52. Interrater Reliability

53. Evaluator 9 Evaluator 8 Evaluator 7 Evaluator 6 Evaluator 5 Evaluator 4 Evaluator 3 Evaluator 2 Evaluator 1 5 Scenario Videos Novices Interrater Reliability of Data Collected with SimMan During Difficult Airway Simulations Andrus, Phrampus, Wang

54. Interrater Reliability of Data Collected with SimMan During Difficult Airway Simulations Andrus, Phrampus, Wang

55. Interrater Reliability of Data Collected with SimMan During Difficult Airway Simulations CONCLUSIONS: – Simulation instructors exhibited good overall inter-rater agreement but showed poor agreement for some key airway tasks. – Variability in instructor ratings may influence real- time evaluation of simulation performance. – Likely could be improved with careful instructor orientation / training Andrus, Phrampus, Wang

56. Evaluation Individual Trainee Evaluation – Per episode performance – Course of the Day

57. Evaluation Group Trainee Evaluation – Benchmark

58. Evaluation Instructor Evaluation – Per episode performance – Measure Against Benchmarks

59. Testing Points T I M E

60. Behind the Scenes

65. Summary Know why you are doing the sim Each sim is part of a bigger picture Design tools for consistency Make it easy for your faculty!

66. Questions and discussion