Some resources just stand out in their innovation, quality and delivery, and Academic Life in Emergency Medicine (ALiEM) has to be one of the best for education. This organisation is part of the free open access to medical education (#FOAMed) movement, so its all accessible. It shows if you don’t have access to journals, books or higher education, that the online world can still help supplement your education theory and development with peer reviewed resources. Take a look at the incubator project, is this the start of challenging the traditional education pathways? If the doctors can do it, surely nurses can be inspired to create a community of learning away from the traditional sources of knowledge and make learners as co-designers and change the agility in knowledge translation and evidence based practice?
“The ALiEM Faculty Incubator Project is a year-long professional development program for educators, which enrolls members into a mentored digital community of practice. This small, 30-person, exclusive community will stoke the fires of creative engagement through mentorship and collaboration. We aim to strengthen your educational skills and produce tangible works of scholarship. Our goal is to construct a curriculum, delivered to you in a closed digital platform, and help you launch and accelerate your career development.”
Lacking in academic integrity I hear you say, take a look at the publication list around learning, education and social media from their team.
Determining what is important in the aspects of debriefing within simulation based learning.
Background
The importance of remembering the adult learner, and all the experience they bring through knowledge, assumptions and feelings. Active participation and leveling (#Heutagogy) of the traditional hierachies between teacher and learner are part of the adult learning philosophy. The adult learner is seen as self-directed, motivated and learns from meaningful and work related education that can applied in workplace.
“Adults learn best when they are actively engaged in the process, participate, play a role, and experience not only concrete events in a cognitive fashion, but also transactional events in a emotional fashion. The learner must make sense of the events experienced in terms of their own world” (pg. 115).
“The concept of reflection on an event or activity and subsequent analysis is the cornerstone of the experiential learning experience.” (pg. 116).
Origins of debriefing in simulation were from critical stress incident debriefing and to do this in a timely manner post incident, with the aim to stimulate group cohesion and empathy.
The Debriefing Process
Supportive climate; open, sharing, honest, free to learn.
Environment of trust; the pre-brief to explain the purpose of the simulation and what is to be expected.
The roles of debriefer and those to be debriefed.
Models of Debriefing
The aim of the debrief is to make sense of the event. The structure of the simulation may be:
Experience the event,
Reflect on the event,
Discuss the event with other participants,
Learn and modify behaviour learnt from the experience.
Objectives
As ever match learning such as the debriefing to the learning objectives. Allow emergent and evolving learning that occurs throughout the simulation process. “Two main questions:
Which pieces of knowledge, skills, or knowledge are to be learned?
What specifically should be learned about each of them?”
Role of The Facilitator
The facilitator will be a Co-learner in the simulation with the aim to guide and direct, rather than a traditional lecture based authoritarian approach. Debriefing is a skill and requires training and development. Resources such as the support from experts to guide and develop are important in developing simulation skills.
Debriefing
Dismukes & Smith (2017) describe three levels of facilitation:
High: High level facilitation actually requires low level of involvement from the facilitator. “Participants largely debrief themselves with the facilitator outlining the debriefing process and assisting by gently guiding the discussion only when necessary, and acting as a resource to ensure objectives are met” (pg 119).
Intermediate: “An increased level of instructor involvement may be useful when the individual or team requires help to analyze the experience at a deep level, but are capable of much independent discussion” (pg 119).
Low: “An intensive level of instructor involvement may be necessary where teams show little initiative or respond only superficially” (pg 120).
Summary
The debrief is described as ” the heart and soul of the simulation”.
Resources
Dismukes, R. K., & Smith, G. M. (2017). Facilitation and debriefing in aviation training and operations. Routledge.
Lederman, L. C. (1991, July). Differences that make a difference: Intercultural communication, simulation, and the debriefing process in diverse interaction. In Annual Conference of the International Simulation and Gaming Association, Kyoto, Japan (pp. 15-19).
Petranek, C. (1994). A maturation in experiential learning: Principles of simulation and gaming. Simulation & Gaming, 25(4), 513-523.
Thatcher, D. C., & Robinson, M. J. (1985). An introduction to games and simulations in education. Hants: Solent Simulations.
Book Club: Hattie, J. (2012). Visible learning for teachers: Maximizing impact on learning. Routledge.
6 signposts towards education excellence:
Teachers are one of the most powerful learning influencers,
Teachers need to be passionately engaged,
Teachers need to provide effective individualistic feedback,
Both student and teacher need to know and understand the learning intentions,
The learners construction of knowledge and ideas is critical,
Safe learning environments where mistakes are encouraged and exploration of knowledge occurs.
Education Holy Grail improving education and interactions between student and teacher.
What are the core attributes to schooling that make the difference? The focus is not the buildings or programs but on the practice of teaching. Students learn to become their own teacher, to exhibit attributes of self-monitoring, self-evaluation, self-assessment and self-teaching.
Visible teaching and learning occurs when there is feedback given and sought, and when there are active, passionate, and engaging people (teacher, students, peers) participating in the act of learning” (pg 18).
“The act of teaching requires deliberate interventions to ensure that there is a cognitive change in the student” (pg 19).
Safe Environment
Idea rich environment where experimenting can occur and sharing ideas.
“A safe environment for the learner (and for the teacher) is an environment in which error is welcomed and fostered” (pg 19).
The Challenge
“When students become their own teachers, they exhibit the self-regulatory attributes that seem desirable for learners (self-monitoring, self-evaluation, self-assessment, self-teaching)” (pg 19).
Deliberate practice needs to occur and the student to be challenged in this safe environment, to aid the construction of knowledge.
“It is challenge that keeps us investing in pursuing goals and committed to achieving goals” (pg 57).
Preparing Lessons
4 critical parts in planning:
“Students starting levels of performance (prior),
The desired level of performance (target),
Rate of progress (progression),
Teacher collaboration and critique in planning” (pg. 41).
Best Practice Lesson Plans
Know the learning intentions (the teacher),
Understand expected standards of performance (the student),
Build commitment and engagement in the learning task.
Guide for the teacher on best delivery of the lesson (guided delivery),
Guided practice for students to complete a task and receive constructive feedback,
Closure provides clear cues when students are at important points in learning,
Independent practice follows mastery of a topic.
Structured of Observed Learning Outcomes (SOLO)
SOLO taxonomy: Levels of understanding can be grouped as surface, deep and conceptual and the use of SOLO taxonomy can integrate them into learning intentions and achievement criteria.
Starting The Lesson
The climate of the classroom is a critical factor in promoting learning. A high level of relational trust and respect for each person’s role in learning. The classroom is a place for the student to dominate, not the teacher where there is a “need to talk, listen and do”.
Learning
Start with the desired results and then work backwards, the focus is then on the gap. This knowledge gap is where the teachers focus on the student and how they learn. The importance of motivation on goal setting and strategies to close the gap, and to recognise motivation varies at any given time. Deliberate practice allows learning to meaningful and a meta-cognitive approach to instruction allows multiple opportunities for practice.
Journal Club Article: Isaacs, W. (1999). Dialogic leadership. The Systems Thinker, 10(1), 1-5.
“Human beings create, refine, and share knowledge through conversation.”
The Concept of Dialogue
“In the new knowledge-based, networked economy, the ability to talk and think together well is a vital source of competitive advantage and organizational effectiveness.
Think Together
A hallmark for many of us is that there are “no surprises” in our meetings. Yet this is the antithesis of dialogue. In dialogue people learn to use the energy of their differences to enhance their collective wisdom.
Dialogue Versus Discussion
Dialogue signifies a flow of meaning while “discussions are conversations where people hold onto and defend their differences. The hope is that the clash of opinion will illuminate productive pathways for action and insight. Yet in practice, discussion often devolves into rigid debate, where people view one another as positions to agree with or refute, not as partners in a vital, living relationship. Such exchanges represent a series of one-way streets, and the end results are often not what people wish for: polarized arguments where people withhold vital information and shut down creative options.”
Dialogic Leadership
“Dialogic leadership” is the term given to a way of leading that consistently uncovers, through conversation, the hidden creative potential in any situation. Four distinct qualities support this process, the abilities:
to evoke people’s genuine voices,
to listen deeply,
to hold space for and respect as legitimate other people’s views, and
to broaden awareness and perspective.
Four-Player Model
Four distinct kinds of actions that a person may take in any conversation:
Move
Follow
Oppose
Bystand
Balancing Advocacy & Inquiry
To advocate well, you must move and oppose well; to inquire, you must bystand and follow.
Four Practices for Dialogic Leadership
Listening: the ability to listen together
Respecting: true respect enables genuine inquiry
Suspending: to bystand with awareness
Voicing: courageous speech
Changing the Quality of Action
Dialogic leadership focuses attention on two levels at once: the nature of the actions people take during an interaction and the quality of those interactions. Dialogic leadership implies being a living example of what you speak about – that is, demonstrating these qualities in your daily life.”
Using analytics and big data in education can provide patterns of communication and connectivity when engaging on social media platforms. Following a hashtag from a conference, online journal club, Tweetchat or online forum can open up a new community of practice around various healthcare specialities. As a facilitator wouldn’t you want to look at the trending words, discussion themes, the number of connections (network analysis) and members of the community (and the influencers)?
Tools such as Symplur can provide social media analytics.
Across nursing and healthcare, the supervision of students is an important component of training and learning. Clinical placements and the experiential learning experience are essential for developing and applying learned theoretical knowledge in the clinical environment. Undergraduate, graduate, postgraduate and new staff are all some of the unique supervision opportunities for nurses to support. Not every nurse will be interested in formal education, but it is likely they will be a preceptor or supervisor. Therefore it is important nurses understand the skills required for effective supervision. Skills such as reflective practice, assessment and feedback are part of this supervision. Being made to feel welcome and recognised as an important part of the team, just basic socialisation aspects to the nursing team.
Supervision
Supervision is defined “as a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, and is acknowledged to be a life-long process” (Martin, Copley, & Tyack, 2014, p. 201).
“Clinical Supervision is regular, protected time for facilitated, in-depth reflection on clinical practice” (Bond and Holland,1998 p. 12)
Models of Supervision
Proctor’s model of supervision is perhaps the most commonly used within health care. “Supervision towards reflective practice” (Proctor, 2010). Proctor’s framework focuses on 3 areas of supervision:
Normative: managerial aspect of practice and learning, such as professional CPD and core mandatory training.
Formative: educative aspect of developing knowledge and skills in professional development and use self reflection for self awareness development. The aim is “to become increasingly reflective upon practice” within the supervision process (Proctor 2001, p.31).
Restorative: supportive aspect for personal development, improving stress management and burnout prevention.
Delivering continuous ST-segment monitoring for those at risk of myocardial infarction can provide a dynamic approach to cardiac monitoring, picking up changes in the ST-segment. This can supplement the continuous bedside ecg monitoring, static 12 lead ecg and monitoring the trend of cardiac enzymes such as Troponin’s, CK, CK-MB.
This is not new technology, its been around since the mid-1980s. Take a read of the resources below on the theory, how to set up, best lead for monitoring of suspected occluded coronary artery for monitoring of ischaemia.
ST and STEMI Maps
Keywords: ST Elevation; J-Point; Myocardial Infarction; AMI; STEMI; NSTEMI
Note: This post is not sponsored or endorsed by an products or companies, it’s purely focused on understanding monitoring technology and potentially enhancing the level of care delivered in acute coronary care situations. Please share any other monitoring methods or technologies in the comment section below.
Comparing the lessons learnt and development of team training approaches in the aviation industry to the complex needs of the Intensive Care Unit (ICU). The importance of teamwork and the coordination of behaviours in terms of patient care provided and subsequent outcomes. Higher levels of doctor-nurse collaboration improve safety and mortality rates. The recognised importance of poor communication which has been identified as a factor in medical error.
Team input and team processes = team output
Teamwork
“Team skills are important for maintaining safety in both domains, as multidisciplinary teams must work effectively under highly complex, stressful, and uncertain conditions. ”
Active & Latent Failures
“team-related ‘active failures’ (for example, failures to communicate the proximity of nearby aircraft) and ‘latent failures’ (for example, lack of team training, poor ergonomic design, and organizational culture) that influence behavior and error in the cockpit.”
Decision Making Under Stress
“Techniques include exposing teams to high-stress situations, training pilots to facilitate team discussions before and after stressful team activities, and cross-training aircrew team members to understand the demands and needs of one another’s role. Teams are trained in a multidisciplinary environment…….”
Hierarchical Team Structures
The ability to understand other roles, so in stressful events still work together as a team and negative behaviours and attitudes don’t effect performance.
Environmental Factors
“Fatigue and stress are known to negatively influence performance in the ICU, and non-technical factors such as team communication, situation awareness, and decision making frequently underlie error.”
Developing a workplace culture based upon safety requires supporting and valuing staff in the high risk environment of ICU, with models of training and supervision that focuses not only on the norms of practice (normative) and educative training, but on restorative and supportive resources to improve stress and burnout, and aid personal development.
Keywords: Intensive Care Unit; Team Performance; Human Factors; Team Training; Aviation Industry; Cognitive Load; Situation Awareness.
Relevant additional resources around some of the themes identified in this articles to aid collaborative educational teamwork:
‘Why’ is the question to gain understanding. Don’t stop thinking: Ask questions, challenge orthodox thinking and be curious. Thinking like a scientist sounds an ideal approach for nursing education for a dynamic, critical thinking and evidence based curriculum. Feynman provides an energy and enthusiasm for teaching, and breaks down complex topics into relevant and meaningful content. Bill Gates on the great teaching skills of Feynman- The Best Teacher I Never Had.
“Feynman opposed rote learning or unthinking memorization and other teaching methods that emphasized form over function” (Wikipedia, 2018).
The Feynman Problem-Solving Algorithm
Fun To Imagine
Resources
Feynman, R. P., Leighton, R. B., & Sands, M. (2011). Six easy pieces: Essentials of physics explained by its most brilliant teacher. Basic Books.
I am currently learning how to use SPSS for statistical analysis to enable some basic statistical analysis to be conducted in nursing research projects. The aim is to be able to run initial data analysis on small clinical focused projects and try to support other nursing colleagues in their project ideas (#community of practice). Understanding more about the data process and how to choose the correct statistical method is a complex process and an ongoing learning objective. Below are some introductory resources that may help you plan your project and provide helpful tips on how to save your data set, analyse the data, create demographic and result tables. Access to a statistician remains key, as they provide so much expertise and understanding around data analysis, and they provide a robustness to the results process. If you have useful research resources please post them in the comment section below and we can develop this post as an ongoing research resource for nurses. As I use SPSS on further projects, more resources will be added into this page.
The Research Question
Consider something that inspires, interests or annoys you- motivation is key, especially if the project is done in own time. Or a quality measure that will help change and enhance practice.
Background
Conduct a literature review to explore the background scientific findings on your topic and then provide a rationale for your study. Why is it important to conduct? Set out your aims and objectives, also any hypothesis if required. When analysing the evidence base, use expert resources such as Joanna Briggs Institute critical appraisal tools.
Study Design
Consider your topic and what data needs to collected to meet the aims and objectives. Will this be a quantitative or qualitative study?
Ethics
Before your collect any data, check in with your hospital or university ethics committee to see what level of ethics your project sits under. Be prepared for some form filling and some unique wordology. If you delve further into the history of ethical standards, be prepared for some moving and challenging cases.
Data Collection
Prepare a data file, this will depend on the software you have access to. So far the easiest and cheapest way I have found is to use Xcel that can then normally be uploaded into a stats software package (accessed on a University computer) and you can use formula’s from this program to obtain most of the basic stats you will need for a first draft data analysis. Remember, have the variable along the x axis (across the top) and participant number along the y (down the side). Determine and define your variables, also create a code book to label any values. Borrow a book that can guide you through the research steps and the software program. This is the one I used: Pallant, J. (2013).SPSS survival manual. McGraw-Hill Education (UK). If you are a student, check with your university IT team to see what software you can access or download onto your personal computer.
Statistics
Get inspired by Florence Nightingale, who was much more than just the lady and the lamp. You will need to describe the setting, participants and statistical methods. Again a book with statistical advice on how to choose, run and review your result findings will be required, such as Tabachnick & Fidell (2007) Using multivariate statistics. Ideally have a statistician to mentor you through the process.
Results
Return to your literature review and see what types of figures and tables were published in the results sections and replicate this format so you can then compare your results to previous literature. Do the same with the demographic tables, helps determining if mean or median should be used (median more robust I hear you say).
Add these key results and link in with context of background discussion. What are the implications from your findings, and also any limitations of the study.
Publication Time
Thinking around the bigger picture of healthcare research and publications. Positive or negative data results, we only see a biased picture in that often only positive trials are published so they are what influence healthcare practice.
Pick a journal that fits in with your topic or methodology. Check in with the publisher author guides if you aim to publish, and they will provide clear outlines for structure, content and referencing style.
