making the implicit explicit: theories informing simulation-based … · 2017. 10. 18. ·...
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Making the implicit
explicit:
Theories informing
simulation-based education
October 18
Introduction: Debra Nestel
Theory #1: Gabriel Reedy
Theory #2: Peter Dieckmann
November 10
Theory #3: Nancy McNaughton
Theory #4: Walter Eppich
Theory #5: Ryan Brydges
#simtheory
Simulation education and…
Cognitive Load Theory
Installation Theory
November 10
Critical Theory
Cultural-Historical Activity Theory
Normative Theory
World views
World views
Positivism & post-positivism
World views
Positivism & post-positivism
Interpretivism
World views
Positivism & post-positivism
Interpretivism
Critical theory
Behavioural
Constructivist
Social
constructivist
Theories can be seen as frameworks of
ideas… are complex and contestable
Nestel D, Bearman M. Theory and simulation-based education: definitions,
worldviews and applications. Clinical Simulation in Nursing. 2015;11:349-54.
Theories are nets cast to catch
what
we call ‘the world’;
to rationalize, to explain
and to master it.
We endeavor to make the mesh
ever finer and finer.
Popper K. 1959, The Logic of Scientific Discovery, New York
Theories to illuminate
Bordage G. Conceptual frameworks to illuminate and magnify.
Medical Education. 2009;43:312-9.
Theories to magnify
Bordage G. Conceptual frameworks to illuminate and magnify.
Medical Education. 2009;43:312-9.
Theories as lenses
Bordage G. Conceptual frameworks to illuminate and magnify. Medical Education. 2009;43:312-9.
Theories as liquids
Not fixed in time, constantly changing, not fixed in space…
• Skills-based
Source: www.hellenic.simulations.com
January 14-16, 2016 IMSH 2016 - DISCOVER|SHARE|LEAD Source: Michelle Kelly
Source: Debra Nestel
October 18
Introduction: Debra Nestel
Theory #1: Gabriel Reedy
Theory #2: Peter Dieckmann
November 10
Theory #3: Nancy McNaughton
Theory #4: Walter Eppich
Theory #5: Ryan Brydges
#simtheory
Cognitive Load Theory
and Simulation Education
Gabriel Reedy PhD
King’s College London
Simulation and Interactive Learning Centre at
Guy’s and St Thomas’ NHS Foundation Trust
Information Processing Model
• How many items are you faced with?
• How are the items related to each other and to what you
already know?
• What rules (schemata) in your long-term memory can help you
process them?
Intrinsic Load
• How difficult is the task for the learner?– Contextual to task,
situation, learner
– What is the learner’s previous experience with this or similar tasks
– Cannot be lowered, as such – but it can be mitigated and must be considered
Extraneous Load
• Not inherent or necessary to complete a task
• Based on the design of the task or experience
• Adds to intrinsic load
• Can potentially overload working memory
Germane Load
• Sometimes the task is richly
difficult, but working through
it can help the learner
progress – it is germane to
the learning.
• Part of intrinsic load
• Helps to create schemata in
working memory to help
learner be successful in the
long term with other tasks
• Be judicious and thoughtful
Using Cognitive Load in Simulation
• Goal-free learning allows for more specific and appropriate learning
opportunities
– Learner-defined goals
– Safe to make mistakes
• Setting up the simulation tasks appropriately can make for a more
effective learning environment
– Set learners up for success – lower the extraneous cognitive load by
reminding participants of protocols and previous knowledge
– Use confederates judiciously to lower the extraneous cognitive load
• Start with simple tasks and move towards more complex ones
– Develop learners over time, lower intrinsic load by preparing learners
• Develop higher fidelity as learners progress
– Too much detail can overwhelm novice learners and is unnecessary
Peter DieckmannPhD, Dipl-Psych
Installation Theoryby Saadi Lahlou, LSE
Why do people do,
what they do?
Person(ality) Situation
Person(ality) Situation
Person(ality) Situation
Person(ality) Situation
Jung
Adler
Kelly
Lave & Wenger
Goffman
Lewin
Kurt Lewin
(1890 – 1947)
The whole as starting point
Dynamic of situations
Psychological aspects
http
://w
ww
.tavin
stitu
te.o
rg/
P. D
ieckm
an
n, D
IMS
B=f(P,E)
PWishes
KnowledgePerception
Anticipation
Memories
Habitserson
Life Space
+P
Life Space
+
+
+
++
--
Affordances describe the value of elements
for a person in the life space
P. D
ieckm
an
n, D
IMS
P
Life Space
+ +
++
--+
Not all is achieveable (easily)
Borders have different strengths
P. D
ieckm
an
n, D
IMS
P
Material Aspects
Social and
Organisational Aspects
Installation
Material Layer
Embodied Competence
Societal andorganisational control
Saadi Lahlou
P.
Die
ckm
an
n, C
AM
ES
Installation
Material Layer
Embodied Competence
Societal andorganisational control
Saadi Lahlou
P.
Die
ckm
an
n, C
AM
ES
P
E
E
Installation
ML
EC
SC
Saadi Lahlou
P.
Die
ckm
an
n, C
AM
ES
Compensations
Installation
ML
EC
SC
Saadi Lahlou
P.
Die
ckm
an
n, C
AM
ES
Compensations
Declining
Eyesight
Installation
ML
EC
SC
Saadi Lahlou
P.
Die
ckm
an
n, C
AM
ES
Compensations
Declining
Eyesight
Extend
Arm
Increase
Light
Reluctance to
buy glases
Installation
ML
EC
SC
Saadi Lahlou
P.
Die
ckm
an
n, C
AM
ES
Compensations
Software
Bugs
Ask your colleague
Restart Computer
Inform programmer
Find workaround
Installation
ML
EC
SC
Saadi Lahlou
P.
Die
ckm
an
n, C
AM
ES
Compensations
„Unworkable“
Guidelines
“Violations“
Hide Folders
Feedback to designers
Block implementation
Complain to colleagues
ML
EC
SC
Clinical Practice
ML
EC
SC
Simulation / EducationalPractice
Connection
P.
Die
ckm
an
n, C
AM
ES
Work as imagined / Work as done.(Erik Hollnagel)
Formula for Impact
MedicalScience
Educational
Efficiency
Local
OrganizationSafety
Quality of care
Adapted from Resuscitation 59 (2003) 11-43
Human Factors
Ergonomics
Process sceience
…
P. D
ieck
man
n, C
AM
ESP.
Die
ckm
ann
, CA
MES
Standardized
Teaching
Variable
Learning
Variable
Teaching
“Standardized”
Learning
Thank you
Peter Dieckmann
Peter.dieckmann@regionh.dk
@pdieckmann
P. D
ieck
man
n, C
AM
ES
Making the implicit
explicit:
Theories informing
simulation-based education
October 18
Introduction: Debra Nestel
Theory #1: Gabriel Reedy
Theory #2: Peter Dieckmann
November 10
Theory #3: Nancy McNaughton
Theory #4: Walter Eppich
Theory #5: Ryan Brydges
#simtheory
Simulation education and…
Cognitive Load Theory
Installation Theory
November 10
Critical Theory
Cultural-Historical Activity Theory
Normative Theory
Thank you
Debra Nestel
AMEE Simulation Committee
Further reading (DN)
• Battista, A., Activity theory and analyzing learning in simulations. Simulation and Gaming, 2015. 46(2): p. 187-196.
• Battista, A., & Nestel, D. (In press). Simulation in medical education. In T. Swanwick (Ed.), Understanding Medical Education: Wiley.
• Bearman, M., N. McNaughton, and D. Nestel, Theories informing healthcare simulation practice, in Healthcare Simulation Education: Evidence, Theory & Practice, D. Nestel, et al., Editors. 2018, John Wiley & Sons Ltd.: Chichester. p. 9-15.
• Eppich, W. and A. Cheng, Cultural historical activity theory (CHAT) - informed debriefing for interprofessional teams. Clinical Simulation in Nursing, 2015. 11: p. 383-389.
• Fenwick, T. and M.A. Dahlgren, Towards socio-material approaches in simulation-based education: lessons from complexity theory. Med Educ, 2015. 49(4): p. 359-67.
• Husebo, S., S. O'Regan, and D. Nestel, Reflective practice and its role in simulation.Clinical Simulation in Nursing, 2015: p. 368-375.
• Kneebone, R., Simulation in surgical training: educational issues and practical implications.Medical Education, 2003. 37(3): p. 267-77.
• Nestel, D. and M. Bearman, Theory and simulation-based education: definitions, worldviews and applications. Clinical Simulation in Nursing, 2015. 11: p. 349-354.
• Reedy, G., Using cognitive load theory to inform simulation design and practice. Clinical Simulation in Nursing, 2015. 11: p. 350-360.
gabriel.reedy@kcl.ac.uk
weppich@gmail.com
ryan.brydges@utoronto.ca
nmcnaughton@michener.ca
mail@peter-dieckmann.de
debra.nestel@monash.edu
dnestel@unimelb.edu.au
#simtheory
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