Transcript Debra A. Allan Danforth, MS, ARNP FAANP

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
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.
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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.
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Nursing Objectives:
1. Describe different learning styles
and how different forms of elearning and simulation can
accommodate each of them
2. Discuss simulation design based
on some best practices in simulation
education.
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Faculty Disclosure
I have a partial faculty conflict
– Laerdal paid for travel to conference
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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
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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.
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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.
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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.
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Review of Literature:
Standardized Patients (SPs)
 Utilizing SPs in education allows faculty to develop patientcentered 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.
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Simulators vs. Standardized Patients
Simulators
Standardized
Patients
Communication
Conversing is
difficult
Conversing is easy
Pathology
Programmed
May be difficult to
portray (murmurs)
Consistency of
findings
Standardized
Variable
Procedures
“Unlimited”
Limited
Availability
“Unlimited”
Scheduled
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e-Learning
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How to use Products
 Laerdal provides
eLearning courses
for such products
as:
– VitalSim
– SimMan 3G
– SimNewB
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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 voiceassisted 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
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Hybrid
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Simulation Case
SP
SP
 Interprofessional
 SP (voice of simulator or significant
other)
 SP interviewed and then assess on
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manikin
Case Materials
Time
Monitor
Settings
First 5
Initial
Settings:
HR 88BP
132/80SpO
2 94%Temp
99.9
minutes
SP or
Manikin
(Actions)
Breath
sounds
crackles
bilaterally
Cough (SP
hits button or
coughs)
Peripheral
pulses strong
Wife will ask if
student does
not introduce
SP
M Student Actions
X Should be interviewing
simulator and assessing
vitals and physical exam
X
x
x
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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
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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
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Harvey Utilization
Hybrid Harvey_Sam Jones Video
Clip.wmv
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Infant Simulation
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Utilizing Blended
Learning With The
Female Exam
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Material online
 Students observe
– Camatasia or Elluminate
– Observe a video on clinical
breast exam





Palpation
Pressure
Pattern
Perimeter
Position
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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)
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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.
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Practicing Breast Exam on
Simulated Breast
 Go to the next
room and practice
the techniques on
simulated breast
with lumps
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5 Ps of CBE or SBE
 Practice the 5 Ps
–
–
–
–
–
Palpation
Pressure
Pattern
Perimeter
Position
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Annie practice with positioning
 Practicing placing
Annie in the
different positions
and walking thru
teaching.
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The exam
 When go back in
room women are
already in gowns
and ready for
breast and pelvic
exam
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Results to interpret
 Students will
receive a picture of
what they
observed
 If available will
also give a picture
of a slide to
interpret
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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.
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SP Feedback
Students go back in and SP gives
feedback on procedure, technique
and demeanor.
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Mama Natalie
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Implications for
Healthcare Providers:
Allows students to do on their own time
(adult learners)
Allows assessment of clinical
competence
Allows assessment of curriculum
effectiveness
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Thank You!
Questions????
[email protected]
(850) 645-7123