We live in an age where people want to experience everything. We want to get the most out of life. We want to be immersed in the story, feel like we’re “living” the story, not just reading it - Daniel Newman, Forbes.com
As educators, we can bring our learners into the story to enhance their retention...but only if we creatively embrace the Experience Age & its technology.
Have you ever been frustrated by a wall of text? As an adult who has successfully managed dyslexia all my life, I’ve struggled with text, but have also developed my own adaptive strategies for large volumes of material presented in text only. Most of my strategies include visual cues and chunking. I’ve found that graphic organizers like Venn Diagrams and concept mapping improve my ability to comprehend and synthesize large volumes of information. Teachers use graphic organizers to assist students with or without learning disabilities. (Links to an external site.)
Graphic organizers are terrific, but limited. Technology allows us to enhance any graphic with interactivity.
Following the Substitution, Augmentation, Modification, Redefinition, (SAMR) model (Puentedura, 2009) of using computers to enhance teaching, we can move from walls of text to higher & higher levels of interaction.
I've found a terrific tool that allows embedding of chunks of data into graphic organizers or other images to supplement learning and increase interaction. Below is a simple ThingLink graphic created to support the learning of paradigms in Modeling and Simulation. Hover over the image to find hot spots with more data and video. This graph was built with the free version of ThingLink, so icons are limited.Information embedded in the above graphic was complied by Dr. Barbara Truman for the University of Central Florida course IDS5937 Modeling and Simulation for Instructional Design.
For more fun exploring the possibilities in ThingLink, watch this 360 degree annotated video.site.)
Belowttps://www.thinglink.com/scene/815925130810097665To discover the possibilities of interactive graphics for learning, explore this fun example of what is possible combining 360 degree video with ThingLink.To discover the possibilities of interactive graphics for learning, explore this fun example of what is possible combining 360 degree video with ThingLink. Informationbn
Ciullo, S. P., & Reutebuch, C. (2013). Computer-Based Graphic Organizers for Students with LD: A Systematic Review of Literature. Learning Disabilities Research & Practice (Wiley-Blackwell), 28(4), 196-210. doi:10.1111/ldrp.12017
McKnight, K. (n.d.) Use Graphic Organizers for Effective Learning. Teach HUB.Retrieved 7/29/2016 from http://www.teachhub.com/teaching-graphic-organizers
Puentedura, R. (2009). The SAMR Model: Technological Integration into Higher Education. Ruben R. Puentedura's Blog. Retrieved 7/29/2016 from http://hippasus.com/rrpweblog/archives/2016/07/SAMRModel_TechnologicalIntegrationIntoHigherEducation.pdf
Truman, B. (2016) Modeling and Simulation for Instructional Design. University of Central Florida.
Our world is becoming closer and we are witnessing each other’s tragedy through the nightly news and social media. We’ve been swimming in a stream of grief and concern for more than a month now. And then… Pokémon Go (PoGo)!
The last video game I played was Atari’s Pong, so I’m a neophyte in the gaming world – as are many of my middle-aged friends. The silliness and sense of community we saw happening around PoGo drew us in quickly.
What is Pokémon Go?
PoGo is a mobile simulation game built upon the basic ideas of the original Pokémon game. The idea is to capture ‘bugs’, evolve them, fight them against other players’ Pokémon bugs, and take control of ‘gyms’.
“By using your phone’s ability to track the time and your location, the game imitates what it would be like if Pokémon really were roaming around you at all times, ready to be caught and collected.” The game requires users to get out and explore their real world in order to successfully play. This need to interact with the real environment while playing a simulated game has created a unique user experience.
While PoGo isn't the first mobile augmented reality (AR) game, it is the first widely used. PoGo is quickly becoming a social phenomenon, while also bringing public safety concerns.
The Concerns
Almost immediately, issues with PoGo players became apparent. As AR mobile gaming emerges, we will need to address these issues.
Multiple players have incurred accidental injuries while using the game. These injuries appear to stem from poor decision making in catching Pokémon, combined with the randomness of ‘bug’ appearance in the real environment.
Distracted driving due to players.
Criminals luring players to locations for victimization
Trespassing on private property
Gaming at sites considered sacred
While most players will execute good judgment while gaming, the completive nature of these game appears to bring out poor judgment in some. Future AR games will need to address these issues for the modality to become widely accepted in society.
Community Building
Such a diverse and very nice community coming together to be Pokémon Masters!
The Future: Could fun be the gateway to reconciliation of cultures and races, and even religions?
As many fads, the excitement of PoGo is expected to decline as users resume their normal activities. Our sense of community will have improved, but may not expand. Building true community requires deeper interaction.
If I had no budgetary or technology limits, I would create an AR game that encouraged multiple levels of interaction, deepening the real world elements as the player progressed. The Unitarian Universalist Association has a framework in place for building community through games. Their Deep Fun: Games and Activities platform outlines five steps to community building.
Bonding
Opening Up
Affirming
Energy Breaks
Stretching
Deeper Sharing and Goal Setting
I would use the Deep Fun framework to develop a simulated AR game that encouraged interaction, bonding through group goals and accomplishments. Relationships are the basis of community. As our sense of community widens, our understanding of others' points of view widen. Technology has the potential to build bridges through common experiences and goals.
On June 12,, 2016, staff at Orlando Regional Medical Center (ORMC) put their emergency preparedness training to use. It is a testament to the staff and leadership of ORMC that within 15 hours, without intervention or assistance from other hospitals, they were able to resume normal operations. (ORMC, 2016) The trauma team at ORMC worked continually for 30 hours (McKenzie, 2016) to manage the influx of injured. Throughout the crisis, the public was kept informed and leadership at ORMC worked diligently to communicate with families of the injured. Healthcare and emergency response communities will learn much over the next months from the experiences of June 12th, and these lessons will surely be incorporated into community disaster response plans.
Orlando Trauma Surgeons Discuss Chaos After Shooting
Improving Individual Disaster Response Through Supplemental Computerized Mass Casualty Exercises
“History has proven that one of the best ways to prepare for the future is by learning from the past.” (Florida Division of Emergency Management)
Each year, hospitals around the country participate in disaster preparedness exercises, both as individual entities, and in coordination with their greater community. Communities test emergency response plans and resources through live, interdependent modeled simulations. In situ simulations are thought to provide a sense of realism and to support transfer of skills learned in the simulation to real situations (Gardner, DeMoya, Tinkoff, Brown, Garcia, Miller,…Sachdeva, 2016) supporting their use as training tools.
In my own practice, I’ve noted that large, live mass casualty simulations provide great insight into institutional needs and are effective in training high level incident command staff. These events, however, are limited in their effectiveness as a training tool for front-line staff for the following reasons:
Staff participation is limited to the day/shift of the event
Highly trained healthcare staff are asked to overlook their own triage and assessment skills of a healthy volunteer, in favor of written data & moulage
Monitoring of large scale events does not allow feedback to most individuals about their performance within the simulation
Computerized simulation, modeled from findings of actual events or proposed situations, may provide reasonable remedies for the above challenges. Individual or team participation in a virtual environment immediately resolves the issue of limited staff participation by allowing for flexible delivery across days and shifts. By replacing the live, healthy human with an injured avatar, the healthcare provider no longer needs to override their senses to triage victims. Triage through virtual reality was recently tested and determined to be just as effective as live triage assessment (Luigi Ingrassia, 2015). Finally, in a well designed simulation, learner feedback is built into the environment.
Simulated training for mass casualty or potential disaster situations should incorporate local possibilities and resources. The example below represents a simulated challenge, for a Level II Trauma Center, of a mass shooting at a music festival nearest the event. All census numbers and resources would be adjustable based on facility. Night shift and day shift situations would require variable adjustment based on availability of additional staff and leadership support during daytime hours.
Mass Casualty Event in 2D Virtual World
Setting – Level II Trauma Center Community Hospital
Situation – Call from local Emergency Services announcing multiple gunshot victims from local music festival. Number of victims is undetermined at initiation of the event. Victims arrive by ambulance, police car, and private vehicle in various states of injury.
Goals – Throughput, effective triage, activation of resources
Effective triage of victims to be placed in trauma rooms, treatment rooms, operating suites, minor treatment rooms, or waiting area
Activation of appropriate codes
Clear communication to staff and community
Security of staff and victims
Avatars – Physicians, Nurses, Leaders, Media Director, Security Officers
Once the simulated environment is created, adjustments to the variables can provide continuing challenges to learners. This capability creates a flexible platform to provide for continual improvement of skills.
Adding computerized, individual or team simulated mass casualty and disaster exercises, such as the example above, to the established practice of large scale, live exercises will allow individual responders to learn and practice their role in these events.
Gardner, A. K., DeMoya, M. A., Tinkoff, G. H., Brown, K. M., Garcia, G. D., Miller, G. T., & ... Sachdeva, A. K. (2016). Using simulation for disaster preparedness. Surgery, doi:10.1016/j.surg.2016.03.027
Luigi Ingrassia, P., Ragazzoni, L., Carenzo, L., Colombo, D., Ripoll Gallardo, A., & Della Corte, F. (2015). Virtual reality and live simulation: a comparison between two simulation tools for assessing mass casualty triage skills. European Journal Of Emergency Medicine : Official Journal Of The European Society For Emergency Medicine,22(2), 121-127.
For a long time, hospital educators have whispered about our frustrations. We've known that engagement & retention of knowledge are lacking in our industry. We're working diligently, but our results are inconsistent & mediocre.
"Nobody told me about that policy"
"We need education on..."
These are frequent comments we hear within months of deploying education.
Hospitals are spending billions of healthcare dollars on staff education, but it doesn't seem to stick.
Wait, billions?
A hospital nurse spends approximately 3.5% of worked hours
participating in educational activities (Suby, 2009). Inservice and mandatory education, for
hospital based nurses alone, is responsible for approximately $3.3 billion dollars of healthcare
spending each year (Peckman, 2015 & Nursing Fact Sheet 2011).
And, hospital nurses are only between 58-61% of the nurse
workforce (Nursing Fact Sheet 2011). Healthcare workers, in general, represent 12% of U.S. employment (Bureau of Labor
Statistics, 2015). With healthcare costs out of control, we have a responsibility
to assure education dollars are spent on effective processes and
tools that improve staff knowledge, skills, and abilities (KSA’s) and improve
patient outcomes.
But it isn't really that bad, is it?
Let's look at one study on fire safety in the operating room setting:
The study examined pre and post training test results
of experienced healthcare providers for fire safety in the operating room, and found that mean pretest scores were 66% (Fisher 2015). Post training test scores of 92.8% (Fisher 2015). Sounds great, huh? Success! Well, maybe not. Let's look at the data through the lens of annual training. These were experienced staff. Fire safety training is a required, annual event. If, after years of training, the experienced staff
had pre-test scores of only 66%, we know they are not retaining the KSA's taught.
We are doing something wrong.
For billions of dollars
each year, we can do better than 66% KSA retention. Think about it, is this an isolated example?
Modifying Our Approach:
Once upon a time, we educated staff by handing out Self-Learning Packets and tests. That day has passed. Now, we assign computer-based
training (CBT) through learning management systems (LMS), quickly & efficiently distributing learning modules. We can easily track completions and provide reports to hospital leadership
and accrediting bodies. We can show passing grades to surveyors &
demonstrate that a high percentage of staff have completed the required
training.
That sounds great,
but we know the numbers we report don’t translate to knowledge & competence. We know that staff often click-through the
educational slides without reading or engaging with them. Click-through is especially
prevalent during annual education due to the repetitive nature of required material. In addition, these
simplified learning modules rarely support critical thinking and clinical
reasoning skill development.
What’s missing?
What has been missing in hospital based education is systematic
instructional design (ID). As experts in our fields, we fall prey to the common assumption of “If I teach it they will learn it.” We put our
knowledge in a shiny package & then are disappointed if staff do not
learn. We're missing the basics of ID, which, surprisingly, are similar to the Nursing Process:
http://denvercoloradotraining.com
While the process is similar to the nursing process, it doesn't seem to be used frequently in hospital education. Unfortunately, we often skip the Analyze, Design and Evaluate
steps, and are prone to jump directly into Development & Implementation.
Analysis helps us to realize the true gaps in KSA’s.
A quick analysis of hospital training, reveals that engagement is an issue. We spend a lot of time & resources on education that is
disengaging, rather than engaging. We provide repetitive information, often in
click-through formats, like PowerPoint embedded into our LMS.
“Oh look, another PowerPoint.”
Click….click….click…open test…guess at answers.
Death By PowerPoint
Without learner engagement we miss the mark on retention of KSA's.
Good education design is based on adequate analysis of organizational needs, learners' needs, and available resources. Without an analysis, we cannot adequately design training. Once designed, developed & implemented, we must return to evaluate the effectiveness of our training, making adjustments as needed. These are best practices in education.
If engagement is the issue, how can we fix it? Returning to our Fire in the OR education situation, a modification to the education from standard CBT click-through to interactive modalities is a relatively quick & easy solution to increase engagement. Software, such as Adobe Captivate, can be used to create hard stop quizzes and choices within the education module. A well designed, interactive lesson brings some increase in engagement, but we can improve from there. Can Simulation Improve Retention? Looking to other industries, we can see the trends towards immersive training and serious games. These engaging modalities have shown to be superior for retention of key KSA’s (Chittaro & Buttussi 2015).
It is time to embrace the emerging technologies of virtual reality (VR) for
improved engagement and retention. VR can be either 2D or 3D, animated or video-based. These exciting and immersive technologies are being used in military training, and other industries. The applications for our industry are boundless & exciting.
At present, immersive technology comes with a hefty price tag that can feel out of reach. In the current climate of healthcare costs, we are all aware of the need to be good stewards of the resources we have. If each hospital,
independently, attempts to convert to immersive technology, the price and labor costs involved would soar. Realistically, investing in immersive technology for staff education at the hospital level may not be wise.
How can we accomplish this leap to our future?
We need to look at ways to collaborate & cooperate, capitalizing on each other's work and resources. Working together to create amazing, immersive
education through well designed simulation that is easily modified from one set
of KSA’s to another is a lofty goal. Cooperation and collaboration are often foreign concepts in the competitive world of
hospital business, but our patients and our staff deserve our best efforts.
Can we do it? Are we ready to bring our profession into the immersive education age? I hope so!
Chittaro, L., & Buttussi, F.
(2015). Assessing Knowledge Retention of an Immersive Serious Game vs. a
Traditional Education Method in Aviation Safety. IEEE Transactions On
Visualization And Computer Graphics, 21(4), 529-538. doi:10.1109/TVCG.2015.2391853 Employment Projections: 2014-2024 Summary. (2015) United States Department of Labor Bureau of Labor Statistics. Accessed July 3, 2014 at http://www.bls.gov/news.release/ecopro.nr0.htm
Nursing Fact Sheet. (2011). American Association of Colleges of Nursing.
Accessed July 2, 2016 at
http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-fact-sheet
Peckham,
C. (2015) Medscape Nurse Salary Report 2015. Medscape.
Accessed July 2, 2016 at http://www.medscape.com/features/slideshow/public/nurse-salary-report-2015#page=2
Suby, C. (2009). Indirect Care: The Measure of How We Support Our Staff. Creative Nursing, 15(2), 98-103.
The most powerful lessons I've learned in my 20+ years of nursing have been as a patient, a daughter, a mother, & a wife.
Experiencing healthcare from these perspectives, drives all my interactions with patients. & their families.
Sadly, over the years, I've witnessed colleagues treat patients & families with disrespect, disdain, & complacency; and it has broken my heart. Often, I've wished & said, "I believe every doctor & nurse need to spend time as a patient once a year."
I firmly believe that walking in another's shoes drives empathetic & compassionate care.
Unfortunately, the costs & logistics of having every healthcare provider spend time as a patient are prohibitive. So, I put my wish away, deep inside my mind, comforting myself that at least patients were getting quality care.
Of course, I wasn't the only one concerned with the experiences patients & families were having while receiving care. In 2005, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCCAPS) patient satisfaction survey was born. Hospitals began to survey patients in 2007 at the direction of the Centers for Medicare and Medicaid Services (CMS), & public reporting of Patient Satisfaction scores began in 2008.
Since 2005, we've been teaching to the HCCAPS questions.
"During this hospital stay, how often did nurses treat you with courtesy and respect?"
Hospital educators all over the country have been teaching scripting to emphasize the keywords of the survey, consulted experts, & have even held acting classes for nurses. All this in an effort to drive Top Box scores from patients answering "always" to questions about how doctors & nurses performed during their stay. This approach has resulted in little progress for many hospitals; others have seen great progress with little sustainability. We've ended up with frustrated administrators, educators, & staff.
What if we stopped teaching to the survey & began to focus on developing empathy & compassion in hospital staff?
This thought was percolating in my mind as I drove to work listening to a podcast. The moment I heard Morgan Spurlock say to Tim Ferris, "VR (Virtual Reality) has the ability to become an empathy machine," I knew we could have every healthcare provider become a patient!
"Empathy is at the core of health care. VR is an empathy hack." Susannah Fox
Healthcare has been experimenting with VR in medical schools & nursing schools for a while now, but there's been little discussion about using virtual situations to stimulate empathy. Content developers, however, have glimpsed the future. The United Nations has teamed up with Vrse.works & Vice Media to bring immersive experiences to those who can help.
So, VR is here & has the ability to create empathy. But can healthcare afford it?
Before you answer, snap your VR viewer to your smart phone (if you have them, it's ok if you don't) & jump over to The Patient Journey to watch a sample of what is possible, but come right back for some other great examples.
Maybe not now, but I see this happening in the future. It makes me wonder, though...what might we do now to bridge that gap between scripting and feeling?
The examples below are best viewed in the Within App & with a VR viewer & from the Here Be Dragons website. For conventional views, click the videos below.
