Developing a Web-Based Patient-Centered Care

Simulation: Lessons Learned

McKeon, Cardell, & NorrisUniversity of Tennessee Health Science Center

QSEN Proposal

• Original Plan– Expose students to different “doses” of PBLI

in a pediatric course and measure learning using a pretest/posttest web-based simulation design.

• Good News/Bad News– After QI workshop, all pediatric faculty wanted

to incorporate PBLI in clinical experience

QSEN Revised Plan

• Is web-based simulation as effective as traditional manikin-based simulation to teach quality and safety skills? – Students (N=60) completed a 10-minute pediatric

patient-centered care web-based simulated test created in Simwriter (pre-test)

– Students participated in a pediatric patient-centered care simulation

• Group 1 (n = 30) web-based • Group 2 (n = 30) traditional manikin based

– Students (N=60) will complete a 10-minute acute care patient-centered care web-based simulated test created in Simwriter (post-test)

Pre-test Simulation Attributes (Gaba, 2007)

• Aim: Performance Assessment (and Training*)• Participant: Individual• Experience Level: Pre-licensure, Term 2 of 3• Healthcare Domain: In-hospital• Health Care Discipline: Nursing• KSAs: Patient-centered Decision-making• Patient Age: Adolescent • Technology: Web-based case scenario• Site: Learners home*• Extent of participation: Remote viewing with debriefing• Feedback: Automatic critique

SimWriter

• Software to develop customized simulation without the expertise of – an instructional designer,– a graphic artist, and – a sophisticated programmer.

• Includes all components necessary to develop a simulation program– Mapping– Writing– Designing– Building– Testing

• Interface is everything– Training the next generation of workers requires interactivity – Complexity of care requires branching scenarios

Karrer, A. & Martin, L. S. (2001). Simulation Levels in Software Training @ http://www.learningcircuits.org/2001/sep2001/karrer.html

Social Simulations

• Also known as decision-based simulations, branching stories, non-technical skills simulations

• Interaction with a character, multiple characters, images, etc. to make decisions that determine what you see next

• Training occurs through decisions, feedback, coaching, and performance reporting

Social Simulation Outcomes

• Allows users to perform the process or work though a situation

• Dynamic, media-rich, and engaging learning• Real-world “learn-by-doing” experiences• Allows people with different learning styles to

interact with their training content at their own pace• Improves knowledge retention and critical-

thinking skills• Allows learning from failure in risk-free environment• Tailored to generation of workers raised as

gamers

Process for Creating Simulation

• Pre-planning• Thinking through situation and set up• Planning characters • Creating the outline

• Mapping• Building the storyboard of the actual simulation• Linking the components together to the sim’s flowchart

• Writing• Character dialog• Decision points• Feedback• Assigning scoring value to the choices within decision

points• Attaching learning outcomes to the decisions

Process for Creating Simulation (cont)

• Designing• Screen by screen visual layout of design components • Functionality and features of the sim

• Editing and Reviewing• Editorial review (spelling and grammar)• Content review (training the right material, realistic scenarios,

etc)• Recording and Editing Media

• Recording sound/video for high-or low-bandwidth sims• Editing media and linking it into the simulation

• Building and Testing• Compiling all the simulation data into a playback engine• Testing the product for errors• Making fixes and updates

Tips and Guidelines for Writing Social Sims

• Keep it conversational• Keep it simple and straight forward• Use character dialog as transition material• Use character dialog to naturally create

opportunities to succeed or fail • Keep choices close to equal length• Use feedback to provide extra information• Play characters off one another

Writing the Case Study

• Selecting patient-centered care competencies• Elicit patient values, preferences to assess, plan, and

evaluate care• Initiate effective treatments to relieve pain and suffering in

light of patient values, preferences, and expressed needs• Assess level of patient's decisional conflict and provide

access to resources• Recognize the boundaries of therapeutic relationships• Facilitate informed patient consent for care• Participate in resolving conflict and building consensus

• Creating a montage of actual scenarios• Establishing content validity • Obtaining expert test construction review

Pediatric Patient-Centered Care Case Study