Post INACSL thoughts

Tuesday, July 7, 2009
My name is Allen, formally known as Dr. Hanberg. For years I have been wanting to create a blog based around my work with simulation. I began teaching nursing in 2002, and simulation became the obvious fit for my academic and research career. You see, I'm a Gen-X'er, early adopter, and fascinated with technology and cognition. I began studying best practices for simulation utilization early, and have attempted to prioritize that. Now, after 7 years in higher education, the pains and perils of doctoral studies, grant writing, and research endeavors, I am finally building my blog. I originally started it in 2007. Now, two years later, I am finally taking the steps to make this blog an immersive and real experience. My first official post welcomes you and I would like to take this opportunity to reflect on us nurse's recent INACSL conference. Please join me, follow along, and comment as you see fit. I will make every attempt to up-date at least once a week. Here we go... here is my first post to "The Simulation Nation."

The 8th Annual INACSL conference was held this year in St. Louis, Missouri. It was a huge success, and I am grateful to have been a part of it. I also attended the SSiH conference this year as well, which was held in Orlando during the month of January. Both conferences present some very valuable and useful information, and both are unique.

After having attended both, the realization of one of the greatest challenges regarding simulation and education struck me like a bolt of lightening. It was simple really. As educators using simulation technologies, we're not all speaking the same language. Even the term "simulation" seems to be interpreted differently from state to state, school to school, educator to educator. This concerned me. At both conferences, I heard Dr. Sharon Decker, amongst others, discuss the need for setting standards of practice within simulation learning, methodology & practice. That must also address some basic definitions that guide users in the methodology and delivery of the learning experiences they are offering.

One of the round table discussions, that I was a part of, discussed utilizing high fidelity simulation for high stakes testing. It was this discussion where the glaring lack of consistent definitions struck me so profoundly. Based on that discussion, I identified 5 key terms that appear to have inconsistent and vague definitions. These were the top 5 (based on this discussion) that I feel need clarity and defining.
  1. High Fidelity Simulation
  2. Mid Fidelity Simulation
  3. Low Fidelity Simulation
  4. Immersive Simulation Experiences
  5. High Stakes Testing
As I mentioned previously, the round table was initially planned to look at using more high-fidelity/immersive simulation experiences for high stakes testing (something similar to what aviation does). The three of us on the panel each shared our ideas and beliefs about why it should or should not be used, then the discussion was turned over to the audience. I was shocked to hear how many people advocated FOR it, but then I understood why. They were defining high fidelity/immersive simulation experiences as being equal to task training and lecture animation, where skill checklists and rubrics could be used to check the learners off and allocate points based on skill performance. In my mind, this is not high-fidelity immersion. Rather, it's merely using a high fidelity simulator to do the same thing we've been doing for the past 40+ years; skills pass off's. It fails to take into account the broader perspective of nursing practice, the skills that students are really exiting our programs without; behavioral, cognitive, communication, leadership, prioritzation, and team working skills. As the discussion progresssed I began to hear, that many were perceiving high fidelity and immersive to be synonymous, that since they were using a "high fidelity" simulator then it instantly becomes immersive. That simply is not the case, technology will never trump methodology. What I failed to hear was the application of appropriate simulation methodology that would make high-fidelity simulators truly valuable in immersive experiences thus making it possible to use them in high stakes testing in nursing. To this day, I have yet to see how (with our current resources and shortages) nursing education can successfully use it for high stakes testing.

With that in mind, I remind you that when it comes to using any pedagogical tool emphasis must be placed on the methodology not the technology. Simulators are merely the vehicle, it's the faculty member that drives the vehicle. High fidelity, immersive experiences can, and do, occur without high fidelity "simulators". On the other hand, they more commonly don't occur with them.

So what do I mean when I say "high-fidelity, immersive experience"? By no means is this a refined definition, but in essence it's the closest thing to real the student can experience outside of reality. These experiences are planned, the objectives are clear, the content is well aligned. The learners experience pre, intra, and post experiences. Debriefing is key, well planned and delivered in a methodologically sound manner. The experience does not focus on skills and/or task training, but includes cognitive, behavioral, and psychomotor skill. These are just some of the elements that quickly come to mind as I think about this. I am certain that as I continue blogging about it, and writing about it, that some of these ideas will become more concrete.

In the mean time, I am going to stand firm in my belief that high-fidelity, immersive simulation experiences should not be used for high stakes testing in nursing education at this point in time. Is it possible? I certainly believe anything, with the right circumstances, resources, and approach is possible. Should we use it for high stakes testing today? Not until the methodology can be validated and the resources exist to make the experience ethical and equitable to all participants. When that is accomplished, then truly new nurses will emerge practicing as safely as new pilots flying passenger planes.


nersprof said...

As a fellow Gen-Xer I share your passion and interest with technology and nursing education. I believe you have made some excellent "food-for-thought" comments with high stakes simulation. I am looking forward to being a part of the generation of nurse educators that investigates to transcend the use of simulation. Thanks for the blog, I believe it will provide a valuable avenue of simulation networking for each of us.

Patty Ravert said...

I am not one of the Generation X (much more of a Baby Boomer)- I have had to work hard to understand and use technology but I too know that immersive simulation is of great benefit in nursing education. I have to agree that as nurse educators we are not ready for high stakes testing.

cathy_king, from st. pete... said...

Allen, thanks for creating this blog. It will give us passionate sim users/believers a new place to share "our opinions".

I agree that we have to work hard on creating a standard sim language. Perhaps that should be the focus of our work over the next year.... and have 'work groups' at next years INACSL conference!

Dr. Marilyn Smith-Stoner said...

I agree that we have a long way to go in playing immersive simulation experiences. We are all in steep learning curve now. The technical staff (who sometimes due the programming) and the clinical skills lab staff who often monitor the sim lab need our help to design scenarios that are immersive. Using Jeffries Model is an essential step (or another learning model). I also think those of us who do design immersive simulations could broadcast them and help others understand the difference. There are many web-based tools that we can use to help others, all free. Perhaps some broadcasts via could be added to the blog to show others what you think.

Anonymous said...

Baby-boomer here and I agree that there are users of simulation manikins, etc that have not changed their approach to educating the students.

How about writing down your definition of "high stakes". Airline pilots and other high risk occupations use "high stakes" testing prior to licensure.
At one point, high stakes was noted to be simply giving a grade concerning the student nurse's abilities to show their cognitive, behavioral, and psychomotor skill. Now, after the INACSL Conference in St. Louis, there is another group of individuals who use the definition of "high stakes" as a performance which would seem more appropriate for the state board of nursing's licensure responsibility. This type of simulation testing would not be the same type as you have in the summative evaluations in schools of nursing.
Can you provide us with your definition of "high stakes simulation'? Rita Coggins