Board 307 - Research Abstract Examining Learning-in Action

Abstract

Introduction/Background Scenario-based simulations have been described as beneficial because they provide learners with an intermediate step between learning a skill in isolation and performing it in clinical practice because scenarios represent some of the complexities and contexts of the actual clinical setting.1, 2 How scenarios support this intermediate step is poorly understood. The purpose of this qualitative pilot study is to analyze the activities that occur during scenario-based simulations in an effort to expand our understanding of how complex scenarios mediate learning in these environments. Our research questions were: 1) What are the subjects, goals, tools, roles, and rules found in complex scenario-based simulations that learners use to construct knowledge during scenario-based simulations?; 2) How do learners use the, goals, tools, roles and rules to construct knowledge during a scenario-based simulation? Methods Activity theory (AT) is a theoretical framework that we used to create a descriptive narrative of the activities that occurred during four scenario-based simulations captured on video during a pre-licensure nursing the childbearing family course.3.AT was selected because it is a useful tool for analyzing complex situations.4 In order to examine information-rich cases, we used purposeful sampling,5 analyzing four videos in which participants had prior simulation experience and, thus, make fuller use of the roles, tools and rules in the scenario. We analyzed videos, memos and AT diagrams. We first organized 34 videos in our broader study by clinical situation depicted and identified what roles were present (such as nurse, physician, or support person). Then we purposefully selected four videos (N=4) that ranged from less complex to more complex. Complexity was determined by consensus between researchers based on clinical presentation and roles. We included an uncomplicated post-partum assessment, post-epidural hypotension, a postpartum hemorrhage and a fetal demise scenario. We then constructed a narrative accounting of each video, drawing from restorying Methods,6 making sure to account for roles, rules, tool and goals. Because we used AT, we constructed visual diagrams to represent associations among roles, rules, tools and goals.7 Validity strategies included researcher and data source triangulation and rich data.8 Results Our analysis revealed two major goal categories - those aimed at identifying or searching for issues or problems, or problem solving. When learners sought to identify a problem, they used information gathered through use of designated protocols (rules), diagnostic tools or simulated tools (e.g. vital signs, lab Results, physical findings) and social tools (interactions with patients or other participants playing a role) to mediate their assessments. Participants also used systematic approaches (rules) to conduct their assessments. When participant goals were related to solving a problem, they used designated protocols (rules) social tools (interactions with each other, the patient, other clinical roles) and added new tools to the scenario to achieve their goals (e.g. placement of a foley). In less complex scenarios, participants interacted with patients more frequently, rather than on social others such as student playing the tech. In simulations with more complex clinical presentations, students relied heavily on collaboration with social others (social tools) to achieve their goals. In simulations which were emotionally taxing, participants relied heavily on the use of social interactions (social tools) with patient roles and nonverbal gestures. Conclusion By extending our focus beyond identifying that a particular task was performed, we illuminated how participants used rules, roles and tools to achieve their goals. We learned that participants engaged in joint problem solving when presented with scenarios which embed a variety of rules, roles and tools.9 Scenarios such as these may also be ideal settings for learners to develop metacognitive skills.