Many of us learn skills by practicing as many times as we need to get it right – whether it's touch-typing, hammering in nails, reversing a truck, cracking an egg or learning to use a new cellphone. But what if practicing has serious consequences? What if you can’t just restart if you make a mistake? What if you might damage something - or harm someone?
This is the challenge that healthcare educators face. Medical students can’t just inject hundreds of needles into patients until they get it right, or 'try out' even more complex surgical skills on living people!
Professor John Windsor* at the University of Auckland tackled this problem and found a risk-free remedy for healthcare professionals-in-training to learn clinical and operative procedures.
Along with two colleagues, he developed the concept of integrated cognitive simulation as a solution to this challenge.
Integrated cognitive simulation refers to a life-like, experiential learning process that utilizes a variety of media to develop the necessary thinking, decision-making and procedural skills for performing a technical procedure.
Professor Windsor focused on cognitive simulation because learning to perform a procedure involves cognitive skills, not just technical or psychomotor skills. He recognized that cognitive learning can be achieved through online simulation, without needing a physical environment or access to equipment.
The cognitive aspect involves the thinking and decision-making skills: understanding what needs to be accomplished, the context, which instruments to use and when, what anatomy will be encountered, and ordering the steps correctly in the process of performing the task.
You don’t have to actually perform the procedure in order to master these cognitive skills. Simulation-based eLearning allows students to embed these skills in their brains before they need to focus on the technical aspects of a medical procedure.
The technical aspect is the hands-on process where the student must physically practice a skill with real instruments, equipment and models. The cognitive, procedural knowledge must now be applied in a physical scenario.
The term integrated refers to providing a variety of media to create a flexible learning experience. Students can learn different skills in different ways through different media. The learning modules might include illustrations with explanatory text, interactive two and three dimensional anatomical models for each procedure and videos of experts performing each procedure to demonstrate best practice.
The final medium is the simulation, which should be provided in two modes: 1) learning mode includes prompts and reinforcements to guide the learner, and 2) test mode, where the learner's performance is scored to reflect their level of mastery. There is no assistance in testing mode, requiring the learner to demonstrate their current competence.
Simulation-based learning drives deeper learning than conventional training as it allows students to make a series of decisions as they go through the steps of a procedure. If they make good choices, they will progress through the lesson. If they make a bad decision, in learning mode they will receive instant feedback and prompts to help them correct and learn from the mistake. Research has shown that this instant feedback is one of the factors that makes simulation learning so powerful.
Online simulation-based training is an essential part of developing the required cognitive skills for medical care. The simulations enable the learners to master each step and the necessary decisions in a procedure before they practice in a lab, on each other or on real patients. Once they have mastered the cognitive skills online, they can focus on improving their technical skills during the hands-on training.
Professor Windsor explains, "The web is democratizing learning. Students don’t need to live close to their institution to practice their cognitive procedural skills. Students now have access to learning support and feedback whenever and wherever they choose.”
This learning ‘anytime and anywhere’ also offers other advantages for students:
1. asynchronous learning - integrated cognitive simulations allow students to learn at their own pace with unlimited opportunities for practice and repetition.
2. develops confidence and competence - learners can practice repeatedly without the stress of being observed by peers or instructors. They can fail without embarrassment and practice until they are both confident and competent.
3. self-monitoring – online learning allows the learner to recognize the skills they need to focus on, which means their interactions with their instructor can be more focused and productive.
4. makes students comfortable using technology – since technology is increasingly being used in healthcare, online learning ensures that healthcare professionals are competent and comfortable using digital tools.
For instructors, there are also benefits:
1. optimizes time with students in the laboratory – by monitoring students' progress online, instructors can identify challenges and use class time to focus attention on these topics or dedicate more time to higher-level learning.
2. easy to update – learning resources can easily be updated with new evidence-based guidelines. While text books can become outdated quickly, online materials can easily be modified to stay current and compliant.
3. cost-effective – compared to other training methods, online simulation technology can be low cost, flexible and very effective at training healthcare students and professionals
4. students are more engaged - instructors report that learners complete more lessons with a more positive attitude as learning is fun and interactive. They say that simulation-based training supercharges their healthcare education.
What impact will simulation-based training have on future healthcare education?
At SimTutor we are excited about the future of technology in healthcare education. Online simulation has a significant part to play in supporting personalized medicine, where learning simulations can be integrated with artificial intelligence. Using patient-specific data, customized treatment for an individual patient’s scenario could be modeled more realistically and with greater accuracy. Healthcare professionals will then be able to practice both their decision-making and procedural skills, within those specific parameters.
As virtual and augmented reality become more widely used, integrated cognitive simulation training will become even more important for procedural learning. Simulation-based learning is already a vital component of healthcare training and it will continue to be essential for equipping students for their careers in the future.
*Professor Windsor has a personal chair in Surgery at the University of Auckland and is a Consultant Surgeon at Auckland City Hospital. He is a co-founder of SIMTICS, a subsidiary of SimTutor Inc that provides simulation technology that assists in healthcare learning. SimTutor is the sister company that provides the content authoring tool used by SIMTICS to create interactive eLearning simulations for medical education.