Use of simulations as a learning tool for all tasks
In medical education, discussions around the effectiveness of “global learning” have recently increased. When teaching very complex tasks, this approach offers an alternative to atomistic models that divide topics into elements taught in isolation.
Complete task templates treat an area of learning as a coherent and interconnected whole that is taught in its entirety, in stages of ever-increasing complexity. Thus, this approach tries solve three fundamental problems in education: (1) fragmentation, indicating that students are often unable to effectively combine elements they have learned separately; (2) compartmentalization, implying that learners often struggle to integrate their acquired knowledge, skills and attitudes; and (3) poor transfer of learning, indicating that students often have difficulty applying what they have learned to new problems and situations.
Ideally, full-task learning models should:
- rely on real, authentic and professional tasks to help students acquire knowledge, skills and attitudes in an integrated way;
- contain different tasks in a multitude of dimensions, because this the variability of the practice will promote the transfer of learning;
- be spaced throughout the curriculum from relatively simple to increasingly complex tasks until the level of complexity is comparable to that encountered in professional practice; and
- be combined with the support and guidance of teachers and educational resources that gradually diminish over time via a scaffolding process until students can independently perform complex tasks without any supervision.
In a traditional school curriculum, each component can be assessed separately. This is not the case in comprehensive task studies programs, because at the heart of learning comprehensive tasks ranging from simple to complex is an assessment system in which knowledge, skills and attitudes are assessed in an integrated manner, in a simulated or real professional environment. environment, and the progress of each learner is monitored.
In our recent ASSIMILATE ExCELLENCE study, we simulated the entire doctor-patient clinical encounter using scripted narratives and new wearable technology that provided abnormal clinical signs when the simulated patient was examined. After the combined clinical history and physical examination, students were asked to integrate their findings and make a real-time diagnosis. Three goal-based, comprehensive task scenarios were developed by iterative expert consensus for different clinical presentations of valvular heart disease. In the crossover study, students received multimodal instruction from an expert trainer, undertook peer assessment using a novel quantitative grading checklist, and received feedback on their own performance of from peers and expert teachers.
Goal-based scenarios represent “a learning-by-doing simulation in which students pursue a goal by practicing target skills and using relevant content knowledge to help them achieve their goal,” write Schank et al. . in Instructional design theories and models. An effective goal-based scenario includes the following essential elements:
1. Objective. Two categories of learning objectives are well established – namely, process knowledge, which reflects the skills and attitudes needed to solve a problem; and content knowledge, which considers the knowledge needed to achieve a goal. A goal-based ideal scenario uses both categories.
2. Assignment. The mission of an objective-based scenario is closely related to its objectives and represents the actual task the student must accomplish. The assignment should be realistic and motivating and resemble a real task that would be undertaken for an important reason in professional practice.
3. Cover article. The cover story engages students and should encourage them to practice their skills and attitudes, seek out information, and acquire the knowledge that is reflected in the learning objectives.
4. Role. The role defines the perspective the student will adopt in the cover story and should motivate them to achieve their learning goals by being both realistic and engaging.
5. Scenario operations. These are the activities that a student will perform to achieve the learning objectives. Each objective-based scenario should prompt many scenario operations that contain decision points so that students can understand the consequences of their actions and decisions.
6. Resources. There should be well-organized and easily accessible resources that contain all the information required by students to achieve the learning objectives.
7. Feedback. Timely and situational feedback, i.e. quantitative, qualitative or both, should be provided by expert peers, trainers or professors. Additionally, stories from domain experts drawn from similar real-world experiences should be contained in the resources.
Thus, goal-based scenarios integrate knowledge, skills, and attitudes into meaningful wholes. It is important to note that teachers can set various goals in their design to allow learners with different background knowledge and interests to achieve the same results. Objective-based scenarios are less concerned with the sequence of instructions; rather, they focus on performing real tasks in authentic contexts to facilitate learning. Learning is enhanced when learners are engaged in solving real-world problems, when their existing knowledge is activated as the foundation for new knowledge, and when this new knowledge is demonstrated to them, applied by them, and then integrated into their own world. As we learned through our full-task simulation study, sequential goal-based scenarios, combined with timely feedback, can lead to measurable improvements in learning, job performance, integration of knowledge, real-time decision-making, and confidence as students approach the real future. -experiences of the world.
Michael Daly is a postdoctoral researcher in medical education and simulation at the RCSI SIM Center for Simulation Education and Research and RCSI University of Medicine and Health Sciences.
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