37CHAPTER 5
Innovative Approaches to Simulation-Based Faculty Development
The demands for meeting the needs of 21st-century students, especially in the health professions, are increasing exponentially. A method of using technology, simulation, has been recognized as a valuable tool for the development of critical thinking and clinical reasoning and competence in nursing students (Adamson, 2015; Cant & Cooper, 2010; Carter, Creedy, & Sidebotham, 2016; Chau et al., 2001; Dreifuerst, 2012; Fero et al., 2010; Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014; Jeffries, 2005; Nehring, Lashley, & Ellis, 2002; Peteani, 2004; Rauen, 2004). Although students tend to favor the use of simulation in teaching (Gillan, Jeong, & van der Riet, 2014), the faculty can be resistant to this complex teaching methodology recognizing the investment in time and resources and the learning curve it involves (Nehring & Lashley, 2004). Even so, it is feasible to increase faculty capacity in the use of simulation without negative impacts on faculty work life or student outcomes (Richardson, Goldsamt, Simmons, Gilmartin, & Jeffries, 2014). Because of the high costs associated with the use of patient simulators in nursing education (Harlow & Sportsman, 2007; Metcalfe, Hall, & Carpenter, 2007), care must be taken in the planning, implementation, and evaluation of simulation-based programs and in the preparation of faculty for its integration and use.
As mentioned in Chapter 3, faculty buy-in is of the utmost importance in a successful integration of simulation and technology into the nursing curriculum. With all the advances in education and technology, nursing faculty can feel overwhelmed with the increasing expectations. They need time to integrate these new teaching tools and receive assistance with the actual process. The chapter in the second edition of this text described the “faculty learning community” that was created at Fairfield University School of Nursing—it was novel at the time and the facilitator for that group helped write the chapter (Shea, Campbell, & Miners, 2013). In this edition, this chapter outlines some innovative methods for developing faculty and even interprofessional opportunities for increasing the use, effectiveness, and excitement of simulation pedagogy in health care professional education. Examples from two universities in British Columbia (BC), Canada, will be provided as well as a global perspective of the “state of faculty development.”
Traditionally, faculty who are early adopters and take on the initiative of incorporating simulation into their courses may at best receive course release time to revise a course on their own. Usually, it is another “expected addition” to the faculty role. The equipment is purchased, a lab director oversees its use, and faculty are expected to work this out. To provide optimum student learning experiences, changes in educational practices need to be incorporated with pedagogic principles, which in turn guide the development and implementation of simulation activities and the integration of technology (Jeffries, 2005). Faculty need to be given the opportunity to reflect on connections between simulation and (a) their individual teaching philosophy and (b) the attainment of student competency in core areas.
With the many changes occurring in the health care delivery system, it is important to develop resilience in the nursing faculty so that they can feel confident in their ability to educate the next generation of learners. As one of the authors and editors of this book, I have had the privilege of 38traveling around the globe and meeting colleagues from nursing and a multitude of disciplines who are struggling with similar challenges—the need to educate more health professionals with fewer resources and fewer faculty. Socializing students into the profession of nursing, helping them gain the foundational knowledge they need, yet be able to apply it in real time to constantly changing situations is the goal and passion of nursing faculty. Using creative teaching methods and experiential learning allows for that transition and growth, and often faculty and students come to find that it helps them dig deeper and learn more. In planning for simulation, I have seen many schools with good intentions order all the equipment and not take into consideration the faculty development needed to learn to use it and the pedagogy needed to integrate it into the curriculum. The university administration has recognized the need for “flipped classrooms,” flexible and experiential learning, yet may not recognize the commitment needed to make it happen. Learning to integrate technology and new learning styles into one’s teaching requires time, guidance, and support. The rest of this chapter introduces two different ways of moving forward with innovative methods to develop health professional faculty in their ability to integrate technology, experiential learning, and be excited in their role. We hope the insights provide you with ideas for your own programs.
OVERVIEW OF FACULTY DEVELOPMENT AT THE UNIVERSITY OF BRITISH COLUMBIA SCHOOL OF NURSING—MAURA MACPHEE
In 2013, the University of British Columbia (UBC) began a campus-wide flexible learning initiative to enhance educational outcomes for students by enabling more flexible access to learning and improving teaching effectiveness through new learning models. Flexible learning encompasses pedagogical and logistical flexibility in higher education, typically facilitated by technology (Arfield, Hodgkinson, Smith, & Wade, 2013). Pedagogical flexibility includes flexible delivery, interaction, and media instruction; and logistical flexibility refers to flexibility of location, time, and pace of learning. Flexible learning approaches address the needs of diverse learners, and these approaches optimize the use of faculty time, expertise, and available resources (e.g., simulation lab space).
The faculty at the School of Nursing received a UBC Teaching and Learning Enhancement Fund (TLEF) award to facilitate flexible learning goal attainment, beginning with transformation of the undergraduate curriculum. We began by focusing on our practice-based education courses. A project team of undergraduate faculty members worked with two dedicated course and curriculum design experts from the UBC Centre of Teaching and Learning Technology (CTLT). With the TLEF award, we also hired a project manager to help us develop a 3-year project plan, timeline, budget, and evaluation strategies.
The overarching purpose for our TLEF award was to create an integrated learning model encompassing each component of our practice-based courses. Before the award, we had notable problems or “disconnects” between the theory and practice components of these courses. Our students learned about concepts in large lecture classes and often failed to have timely follow-through in the simulation lab and in practice. Our intention, therefore, was to use flexible learning strategies to make better linkages among existing course components, and to introduce flipped or blended learning to our curriculum.
Our integrated flexible learning model:
Online learning → active case-based learning → simulation → practice
The project team held a number of CTLT-led workshops to introduce nursing faculty to pedagogical and technological concepts associated with flexible learning. The purpose of these sessions was to better engage faculty in a community of teaching and learning, and to create a real 39institutional commitment to flexible learning. These sessions were particularly popular with our practice-based faculty and clinical instructors.
The TLEF award was also used to purchase a license for 1 year of unlimited use of an online nursing education resource for self-directed learning. The resource consists of “Master Educator” modules that demonstrate educational strategies and techniques. Faculty members could register via email and view and complete the online modules in their own time. Our Professional Practice Team, a faculty-led team of our clinical instructors, established regular sessions to view the modules together, and they developed a number of applications for preclinical student briefings, “teachable moments” during the clinical experience, and postclinical debriefing. Module content was also used to enhance orientation for new clinical instructors.
During the first year of our TLEF award, the project team focused on integration of online, modularized delivery of theory content within our six practice-based courses. These courses are:
• Foundations of Professional Practice (6 credits)
• Introduction to Professional Practice for Adults/Older Adults (8 credits)
• Professional Nursing Practice for Childbearing Women, Infants, and Their Families (6 credits)
• Professional Nursing Practice for Children and Their Families (6 credits)
• Professional Nursing Practice for Adults Living With Mental Illness and Their Families (6 credits)
• Professional Nursing Practice With Communities and Populations (6 credits) and
• Professional Nursing Practice With Adults/Old Adults and Their Families (6 credits).
Our first-year goal was to convert or “flip” approximately one third of traditional classroom seat time. Flipped classrooms offer pedagogical and logistical flexibility, and well-designed online learning can set the stage for more active engagement of students in class, in simulation labs, and in practice (McLaughlin et al., 2014; O’Flaherty & Phillips, 2015).
Faculty “champions” from the practice-based courses worked closely with our CTLT design experts to identify content in their curriculum that could be converted to online modules. To avoid the “talking head” phenomenon, CTLT experts taught the faculty how to create short, engaging modules with embedded questions. Case-based learning activities were developed to link online module prework to classroom dialogue and small-group work.
The next phase of our project is focused on linkages between online or in-class learning, simulation lab learning, and experiential learning in practice settings. The CTLT experts have helped us ensure that our redesigned curricular content and delivery will facilitate students’ transformative learning experiences—and better induce a sense of thinking like a nurse (Benner, Sutphen, Leonard, & Day, 2009; Mezirow & Taylor, 2011).
Not surprising, our successes have depended on professional development and mentoring support for our clinical and tenured faculty. The constant evolution of new educational technology can challenge all of us. Release time and expert facilitation (e.g., CTLT) is needed to thoroughly engage faculty in the hard work of redesign, particularly the uptake of new technology. We are currently piloting commercially packaged online products to augment our own, faculty-designed modules. We would like to totally replace textbooks with online learning resources for students. Our project team hosted faculty sessions to preview new products with different vendors. We agreed to pilot two online products, and we committed some of our TLEF award to purchase the license for these products. We wanted to ensure a “fit” between our student–faculty needs and these products. Students, therefore, were not expected to purchase the program during the pilot phase. In both instances, these online products are United States’ based. We were able to successfully adapt or “Canadianize” one product for our curriculum, and we are using the product in our introductory course for adult or older adult care. Students view online patient–nurse vignettes and complete group assignments in an online discussion forum. Although there was initial pushback from students, the second iteration of this course has gone more smoothly. We discovered that it was essential to engage with students right away, providing an overview of our flexible learning model. Including students as partners in the redesign process has helped us win over their skepticism.
40With respect to the simulation lab and practice components of our model, we are limited by our physical space. We have been seeking out agreements with our practice partners to use their simulation space. We recently acquired another grant to develop a practice–academic collaboration for student–nurse simulation education. We codeveloped a range of simulation exercises (low to high fidelity) with nurse educators from nearby health care organizations. Our faculty also provided simulation training workshops for these nurse educators. Our faculty members have access to these sites’ simulation labs during students’ postclinical conference time. Our goal was to codevelop and corun simulations in practice sites for students and nursing staff, but we have had numerous scheduling challenges.
Evaluation strategies include annual student surveys and focus groups. We are tracking deliverables according to our project plan and timeline. Some of our key outcome indicators include the percentage of flipped content per course as well as the numbers of newly developed online modules, case scenarios, simulations, and pre-and postclinical briefing and/or debriefing packets. We are also determining whether there are explicit linkages among components of our model, based on course syllabus reviews by our Undergraduate Programs Committee. We have a number of research projects underway that are related to our flexible learning initiative. One collaborative research project is with Queensland University of Technology. We are developing screening tools for simulation lab and practice to assess students’ clinical reasoning skills, based on a model by Levett-Jones and colleagues (2010).
In closing, one of the most notable outcomes of this initiative has been a culture shift among faculty with respect to pedagogical innovation. Flexible learning is a common term among faculty members, and use of online learning resources and simulation are becoming integral components of curriculum delivery. Students’ resistance has been replaced by their desire to participate in more simulations. In fact, they are urging us to explore the new world of virtual simulation.
OVERVIEW OF FACULTY DEVELOPMENT AT THE UNIVERSITY OF VICTORIA: THE INTERPROFESSIONAL SIMULATION EDUCATOR PATHWAY—MAUREEN RYAN
In contemporary health care dialogues about health professional graduates, educators often hear that despite the best efforts of universities to ensure that their graduates are “practice ready,” employers’ call attention to a lack of job readiness. We suggest that one area of job readiness that is difficult for health professional students to learn during their education program concerns the executive skills necessary for teamwork (e.g., understanding roles, team communication, shared decision making) particularly in urgent patient care situations. Our collective experiences as clinical educators lead us to believe that health professional students do not have access to repeated, effective “hands-on training” in teamwork during their prelicensure education as a result of challenges associated in clinical placements. In other words, we question whether effective teamwork is consistently role-modeled in practice. As a result, our prelicensure students may have few executive skills in either leading or being part of collaborative team efforts that lead to safe and evidence-informed patient care on entry to the workforce. There is a call to attention to this problem in preparing health care professionals for interprofessional teamwork from the health care industry (Kohn, Corrigan, & Donaldson, 2000), and from Canada’s National Steering Committee on Patient Safety (2002). We believe that waiting until students graduate and are on the job is almost too late for true effectiveness of team-based interprofessional education.
We believe that there should be a coherent and integrated interprofessional education (IPE) component of prelicensure education that places the patient in the center of focus. Such a program can provide opportunities for students from at least three different health professional education programs to work collaboratively on patient care teams on matters of mutual clinical concern. The benefits of an IPE program approach to teaching and learning about teamwork includes improving those professional practices and, as a result, patient outcomes (Vyas, McCulloh, Dyer, 41Gregory, & Higbee, 2012; Zwarenstein, Goldman, & Reeves, 2009). Moreover, we suggest that if interprofessional student teams receive the necessary knowledge and practice before prelicensure examinations, they are better prepared for the realities of patient care practices (e.g., teamwork) in health care or “job ready” (Zwarenstein, Reeves, & Perrier, 2005).
Our collective experiences as simulation educators and our turn to literature informs us that simulation-based training is at the leading edge for teaching critical assessment; interprofessional team communication; and clinical judgment, reasoning, and reflective skills necessary for safe and effective patient care (Schwartz, Fernandez, Kouyoumijian, Jones, & Compton, 2007; Steadman et al., 2006; Ten Eyck, Tews, & Ballster, 2009). Concurrently, we acknowledge that one of the cited challenges in implementing effective and sustainable interprofessional education programs is faculty development (Gilbert, 2005; Steinert, 2005). Similarly, faculty development is required for implementing simulation education programs (Hallmark, 2015; McGaghie, Issenberg, Petrusa, & Scalese, 2010). However, the challenge that lay before us was how to develop simulation education for facilitators that would address the interprofessional competencies called for to prepare health professional prelicensure students for entry to practice, and, at the same time, honor the diversity of disciplinary perspectives. In the following paragraphs, we share the process that we have undertaken to design and implement an interprofessional simulation facilitator education pathway as a necessary first step to preparing for interprofessional education of health professional students and employees. We will begin by describing our context of simulation education practice at the Center for Interprofessional Clinical Simulation Learning (CICSL) at the Royal Jubilee Hospital, Victoria, BC, Canada. We share the framework that we used to unify our academic and clinical simulation educators and the ways in which we are currently evaluating the effectiveness of our program elements.
Interprofessional Simulation Education Context
In 2011, a provincial initiative through the Ministry of Advanced Education and Technology commenced that served to guide the advancement of patient simulation Centres on Vancouver Island. At the core of this movement was the ideal of cross-organizational collaboration. As a result of this initiative, a simulation center in Victoria was envisioned and the development was led by deans and Health Authority executive directors from three partner organizations (University of Victoria School of Nursing, UBC Island Medical Program, and the Vancouver Island Health Authority). A Governance Committee was formed to oversee the building and organizational structuring of what would be known as the CICSL. At the same time, a curriculum-working group (CWG) was formed with a faculty lead from the School of Nursing and the Island Medical Program and a lead from the Professional Practice Office at the Island Health Authority. The work of the CWG was to demonstrate within its respective curriculum or professional practice committees how patient simulation would be used. In addition, the CWG members were trained as simulation trainers through a certificate program at the Centre for Excellence in Simulation Education and Innovation (CESEI), Vancouver, Canada, with a view of creating a community of practice in simulation education through a train-the-trainer approach to simulation educator development.
The CICSL pioneers a simulation teaching and learning center with three key stakeholders: Vancouver Island Health Authority, UBC’s Island Medical Program, and the University of Victoria’s School of Nursing. Indeed, the mission of CICSL is to:
• Provide a sustainable, safe, and supportive learning environment
• Foster interprofessional and interinstitutional collaboration
• Improve simulation education through evidence-informed practice
The CICSL opened in September 2015 with four simulation laboratories, a debrief room, two observation rooms, three clinical skills rooms, and a videoconference space. We also had the data 42collected from disciplinary and interprofessional pilot projects through the work of the CWG, which we believed would inform our next directions in operationalizing simulation education in Victoria. What we had learned by 2014 is that our respective students were embracing simulation learning events and demanding more and more opportunities. At the same time, our faculty and clinical educators were telling us that faculty development opportunities were necessary; this was important to note, because our educators were not fully comfortable teaching and learning in a simulation environment. Thus, how could we introduce yet more content in the form of interprofessional simulations when our educators were not yet fully comfortable teaching within their own professional context?
Interprofessional Simulation Educator Pathway
The idea of faculty development commonly refers to those activities and programs designed to improve instruction. As such, historically, the individual faculty member’s development in teaching and learning has been at the forefront. Recently, the notion of faculty learning communities has emerged, suggesting that teaching and learning development goes beyond the individual’s self-reflection to group thinking based on the engagement with a valued teaching and learning method (e.g., simulation and/or interprofessional education in simulation). Amundsen and colleagues (2005) outline four conceptual categories to faculty development: skill focus, method focus, process focus, and discipline focus. Moreover, there are differences in the expectation of the individual instructor in each of the previously listed four categories, that is, the difference between developing a skill, integrating a method into your own teaching approach, understanding the processes of self-reflection that contribute to pedagogical growth in teaching communities, and recognizing the values and assumptions about the development of knowledge and learning within your discipline. With this understanding of a faculty development framework, we recognized that development in simulation education would be twofold. First, our educators would need to learn the skills and methods of simulation education within their own discipline. Within their own curricula, they would need to establish a level of comfort with the role of simulation educator. We believed that when a comfort level with skills and method was reached, faculty would be open to look at processes of simulation education, such as the pedagogical shifts associated with interprofessional education and the move outside of disciplinary thinking to embrace the multiple ways in which patient care is understood in an interdisciplinary team. We also learned from our readings on interprofessional education that role clarity was an important construct in interprofessional collaboration. Simply, until the learner understands, embraces, and feels comfortable executing the role offered through early education experiences (e.g., year 1 and 2 in nursing education) they will struggle in a team setting, focusing on their individual learning needs, and not fully able to self-reflect on the interprofessional collaboration.
Currently, faculty and clinical leadership have developed an introduction to facilitating simulation programs at the CICSL. All simulation educators receive introductory workshops and are signed off as having the basic knowledge and skill in simulation education necessary for teaching. The first workshop is cotaught by a member of their faculty or institution alongside a technologist, who provides information on how to operate the equipment and what resources are available in the center. The second workshop or other education materials are offered within their institution. For example, in nursing a simulation education community of practice exists in which instructors receive opportunities to engage with simulation pedagogy as it is understood within the undergraduate nursing curriculum. They have the opportunity to devise a simulation education development plan setting their own individualized goals and meeting the objectives of their role as set forth by the School of Nursing. Thus, from the instructor comes a goal to engage in collaborative learning across disciplines with a view to interprofessional education. In the next section, we describe the interprofessional development currently in place at the CICSL.
The Interprofessional Simulation Educator Pathway follows the tenets of the National Interprofessional Competency Framework (NICF) developed by the Canadian Interprofessional 43Health Collaborative (Bainbridge, Nasmith, Orchard, & Wood, 2010; Canadian Interprofessional Health Collaborative [CIHC], 2007, 2010). The framework describes six domains of practice that highlight the knowledge, skills, attitudes, and values essential to interprofessional collaboration. Within each domain are a set of competencies that may be used as an educative guide for prelicensure students and an assessment of competency in the transition to practice. These domains are:
1. Role clarification
2. Team functioning
3. Patient/client/family/community-centered care
4. Collaborative leadership
5. Interprofessional communication
6. Interprofessional conflict resolution
A full tutorial of domains, competencies, and the quality indicators within each domain goes beyond the scope of this chapter. You may wish to visit www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf for a full introduction to this framework.
Our intent in developing the pathway is to increase the number of faculty or clinician interprofessional simulation facilitators, and, as a result, the number of interprofessional simulation-based educational opportunities for students or employees of the three partner organizations. We believe that the achievement of this goal will contribute to a sustainable community of practice in interprofessional simulation education. To achieve this goal, we have outlined three phases of development for faculty.
Phase I
Participants will work through UBC’s online module series “Interprofessional Collaboration on the Run” (www.ipcontherun.ca). This online learning resource provides an overview of concepts and principles related to interprofessional collaborative practice. Each module is based on one of the domains identified in the NICF described in the previous paragraphs, and has a self-assessment component built into the content. This self-assessment introduces the participants to the strengths they may already have in their knowledge and skill of interprofessional collaborative practices. In addition, they can outline their own individual learning needs to ready them for Phase II of the pathway. Each module takes about 30 minutes to complete.
Phase II
Expert simulation facilitators from academia and nursing, medicine, and allied health professions will facilitate hands-on application of the CIHC competencies using simulation-based learning events for health professional educators in education and practice facilities. The 4-hour learning event provides opportunities for participants to apply knowledge and practice skill in debriefing interprofessional competencies. The development of case scenarios will be informed by our practice leads, who will recount those areas in clinical practice in which interprofessional collaboration is needed and often missing.
Phase III
Our intent in this phase is to evaluate our pathway. We compare and contrast the knowledge, skills, and attitudes of simulation facilitators and student learners about the CIHC Interprofessional Competencies and the benefit of interprofessional education opportunities before and following the implementation of Phase I and Phase II. Data collected will measure the participant’s baseline and predicted increase in knowledge, skills, and attitudes related to the use of IPE competencies. Moreover, we have established local evidence to inform ongoing support for IPE simulation 44education sessions, and we believe, inform and sustain an interprofessional collaboration community of practice.
CONCLUSION
This chapter has outlined some innovative ways of incorporating faculty professional development in the use of simulation and innovative technology to enhance teaching of nursing students and other health professionals. Managing faculty angst while they consider new methods of teaching to enhance their teaching effectiveness requires looking for creative ways to move forward and incorporating simulation so that it fits faculties’ personal teaching philosophy and style. The increased growth in the nontraditional student population in nursing and students’ demand for more use of technology in the classroom to prepare them for health care practice arenas means that faculty need to develop new strategies. Identifying faculty champions, leaders who can role-model and share ideas as well as support faculty in a collaborative and nonthreatening manner is key to the success of integrating simulation and new technologies into the classroom, lab, and clinical sites. Providing faculty the necessary resources is important for success and educating the next generation of nursing faculty in this technology is paramount.
REFERENCES
Adamson, K. (2015). A systematic review of the literature related to the NLN/Jeffries simulation framework. Nursing Education Perspectives, 36(5), 281–291.
Amundsen, C., Abrami, P., McAlpine, L., Weston, C., Krbavac, M., Mundy, A., & Wilson, M. (2005, April 11). The what and why of faculty development in higher education: An in-depth review of the literature. Paper presented at the American Education Research Association, Montreal, QC, Canada. Retrieved from https://convention2.allacademic.com/one/aera/aera05/index.php?click_key=1&cmd=Multi+Search+Load+Person&people_id=185918&PHPSESSID=b2fpor2113pb94bi0u1b8m1i04
Arfield, J., Hodgkinson, K., Smith, A., & Wade, W. (2013). Flexible learning in higher education. New York, NY: Routledge.
Bainbridge, L., Nasmith, L., Orchard, C. & Wood, V. (2010). Competencies for interprofessional collaboration. Journal of Physical Therapy Education, 24(1), 6–11.
Benner, P., Sutphen, M., Leonard, V., & Day, L. (2009). Educating nurses: A call for radical transformation (Vol. 15). San Francisco, CA: Jossey-Bass.
Canadian Interprofessional Health Collaborative. (2007). Interprofessional education and core competencies: Literature review. Retrieved from http://www.cihc.ca/files/publications/CIHC_IPE-LitReview_May07.pdf
Canadian Interprofessional Health Collaborative. (2010). A national interprofessional competency framework. Retrieved from https://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf
Cant, R. P., & Cooper, S. J. (2010). Simulation-based learning in nurse education: Systematic review. Journal of Advanced Nursing, 66(1), 3–15.
Carter, A. G., Creedy, D. K., & Sidebotham, M. (2016). Efficacy of teaching methods used to develop critical thinking in nursing and midwifery undergraduate students: A systematic review of the literature. Nurse Education Today, 40, 209–218.
Chau, J. P., Chang, A. M., Lee, I. F., Ip, W. Y., Lee, D. T., & Wootton, Y. (2001). Effects of using videotaped vignettes on enhancing students’ critical thinking ability in a baccalaureate nursing programme. Journal of Advanced Nursing, 36(1), 112–119.
Dreifuerst, K. T. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education, 51(6), 326–333.
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