From Learning Objectives to Outcomes Assessment During Simulation

From Learning Objectives to Outcomes Assessment During Simulation Paul E. Phrampus Director Winter Institute for Simulation, Education and Research (WISER) University of Pittsburgh

Assessment • Why • What • When • Where • How

The Future of Simulation………

What is a simulation for? 1. 2. 3. 4. Education Assessment Fun 1 and 2

The Simulation Advantage TESTING TEACHING Psychomotor Skills Decision Making Skills and Decisions Individuals Teams

What is “Simulation”…. . Really…. .

The Job of Healthcare Educators Psychomotor Skills Base Knowledge Decision Making Communications Skills Teamwork Skills Professionalism Skills

Why is this so hard?

Learning Objective • You have to have a clear reason of why you are running any simulation.

Lets Watch

• What is most important aspect to debrief?

Where does a simulation fit? • It depends on what your doing!

EACH Sim is part of a bigger plan!

What is this?

Does it belong here?

Course (Global) objectives v sim objectives

Global Objectives • Course Objectives – 1. Demonstrate a proper patient assessment – 2. Demonstrate following the emergency protocol – 3. Demonstrate Airway Management Skills

Course Schedule / Flow • • • Sim 1 Sim 2 Lecture Skills Lab Sim 3 Sim 4 Course Objectives Session Objective 1. Ventilate w BVM 2. Recognize Narcotic Overdose 3. Activate Protocol

How do you determine “success” of a simulation? 1. Students liked it 2. Learning objectives achieved 3. Students passed the scenario 4. Not Sure

How do you determine “success” of a simulation? Instructor Number 1 Instructor Number 2 Instructor Number 3

How do you determine “success” of a simulation? Instructor Number 1 Instructor Number 2 Measure Here Instructor Number 3

You can only keep track of so many things at one time

How many of you feel like this ?

Tools for Success • Make it easy for your faculty to stay on track • “In my opinion…. . ”

Assessment Methodology – Identify methods for measuring core aspects in simulation education / assessment – Discuss development and deployment of measurement tools

Student Learning Outcomes Curriculum Teaching & Learning Assessment Evaluation

Assessment and Evaluation • Assessment and Evaluation often used interchangeably • Assessment – learner outcomes • Evaluation – course or program outcomes

Performance Assessment

Rate the Performance • Pass or Fail • Score Performance • Procedural Check

Assessment • Why • What • When • Where • How Rosen, MA et al. Measuring Team Performance in Simulation-Based Training: Adopting Best Practices for Healthcare. Sim Healthcare 3: 2008; 33– 41.

Assessment of clinical skills/competence/performance ACTION PERFORMANCE COMPETENCE KNOWLEDGE Miller GE, The assessment of clinical skills/competence/performance. Academic Med. 1990 Sep; 65(9): S 63 -7.

Performance Assessment • Basic to performance – Do they know it and know how? • Competence – Can they do it? • Performance – Do they do it?

Assessment of clinical skills/competence/performance DOES SHOWS HOW KNOWS HOW Knows When KNOWS Miller GE, The assessment of clinical skills/competence/performance. Academic Med. 1990 Sep; 65(9): S 63 -7.

Assessment of clinical skills/competence/performance DOES SHOWS HOW KNOWS HOW Knows When KNOWS Practice Review Audits, Video, UC-SP, 360 O Performance Tests OSCE, Task. Demo, SIM/SP Clinical Based Tests Pt Mgt Qs, Essay, Oral Knowledge Tests MCQs, Essay, Oral exam Miller GE, The assessment of clinical skills/competence/performance. Academic Med. 1990 Sep; 65(9): S 63 -7.

Assessment • Formative Assessment – – Lower stakes assessment One of several assessments over time of course or program May be evaluative, diagnostic, or prescriptive Often results in remediation or progression to next level • Summative Assessment – – Higher stakes assessment Generally final course or program assessment Primary purpose is performance evaluation Often results in a Go-No Go outcome

Assessment • Assessment data sources – Live observation – Video recording – SIM device logs • Instruments – – AV annotation Pencil/Paper Scantron form Tablet. PC or PDA • Assessors – – – Instructors Observers SIM/Patients Peers Participants

Variables in Assessment STUDENT PATIENT ASSESSMENT EVALUATOR

Assessment Validity • Validity – – Degree to which an assessment tool measures what it is intended to measure – Construct validity – Accuracy of tool to measure intended construct • Concurrent validity • Content validity • Predicative validity

Assessment Reliability • Test Reliability – – consistency of a test to yield the same measure over time (does not assure validity) – Test-Retest Reliability consistency among different administrations – Parallel Forms Reliability to assure that memory effects do not occur use a different pre- and posttest – Inter-Rater Reliability two or more observers rate the same subjects with strong positive correlation of their ratings

Variables in Assessment STUDENT PATIENT ASSESSMENT EVALUATOR

Assessment Improvement • Improving Reliability and Validity – Base assessment on outcome/objectives > event triggers > observable behavior > behavioral rating > assess against competencies – Define <low – medium – high> performance – Use of Rubric or rating metric – Use (video) training examples of performance – Employ a quality assurance/improvement system

Assessment Based on Objectives and Events Rosen, MA, et al A measurement Tool for Simulation –Based Training in Emergency Medicine: The Simulation Module for Assessment of Resident Targeted Event Responses (SMARTER) Approach. Sim Healthcare 3: 2008; 170 -179.

Event – Behavior – Scale - Report Rosen, MA, et al. Measuring Team Performance in Simulation –Based Training: Adapting Best Practices for Healthcare. Sim Healthcare 3: 2008; 33 -41.

Assessment Metrics • Procedural or Check List assessment • Global Rating assessment

Assessment Metrics • Procedural or Check List assessment BCLS Y N Open Airway Check Breathing (< 5 sec of LOC) (< 5 sec of Airway) BCLS Y N A Open Airway Check Breathing Rating Score +1 -1 0 *Assist

Assessment Metrics • Global Rating assessment Code Blue P F Code Blue CPR and CPR ACLS <1(low) - 5(Hi)> points <1(low)- 5(Hi)> points Code Blue H M L CPR ACLS Rating Score +1 -1 0 Pts.

Assessment Metrics • Procedural or Check List assessment • Global Rating assessment < EXAMPLES> • Pros and Cons to each • Multiple modes & points vs. Single assessment • QA/QI Metric – collective vs single assessment

Brett-Fleegler, MB et al. A simulator-based tool that assesses pediatric resident resuscitation competency. Pediatrics 121(3): 2008; 597 -603.

Gaba, DM et al. Assessment of Clinical Performance during Simulated Crises Using Both Technical and Behavioral Ratings. Anesthesiology, 89(1)July 1998: 8 -18.

Guise, JM et al. Validation of a Tool to Measure and Promote Clinical Teamwork. Sim Healthcare 3: 2008; 217– 223.

Interrater Reliability

Interrater Reliability of Data Collected with Sim. Man Andrus, Phrampus, Wang During Difficult Airway Simulations Evaluator 9 Evaluator 1 Evaluator 2 Novices Evaluator 8 5 Scenario Videos Evaluator 3 Evaluator 4 Evaluator 7 Evaluator 6 Evaluator 5

Interrater Reliability of Data Collected with Sim. Man During Difficult Airway Simulations Andrus, Phrampus, Wang

Interrater Reliability of Data Collected with Sim. Man During Difficult Airway Simulations • CONCLUSIONS: – Simulation instructors exhibited good overall inter -rater agreement but showed poor agreement for some key airway tasks. – Variability in instructor ratings may influence realtime evaluation of simulation performance. – Likely could be improved with careful instructor orientation / training Andrus, Phrampus, Wang

Evaluation • Individual Trainee Evaluation – Per episode performance – Course of the Day

Evaluation • Group Trainee Evaluation – Benchmark

Evaluation • Instructor Evaluation – Per episode performance – Measure Against Benchmarks

Testing Points T IM E

Behind the Scenes

Summary • • Know why you are doing the sim Each sim is part of a bigger picture Design tools for consistency Make it easy for your faculty!

Questions and discussion