Abstract
This chapter aims to enhance the ability of healthcare educators to identify learner skill levels, develop and implement an appropriate simulation or scenario-based learning technique, and provide optimal feedback to refine clinical reasoning and decision-making development of the learner. The concept of problem-based learning is outlined and applied to the creation of virtual patient cases to augment clinical experiences for healthcare students amidst the COVID-19 pandemic. Through the use of appropriately targeted learning objectives, case design, and feedback strategies, students will be able to continue their professional and academic development in a post-pandemic landscape.
TopIntroduction
The landscape of clinical education across all disciplines of healthcare is at a crossroads as the need for clinicians continues to rise while the educational opportunities for face-to-face, hands-on learning diminished in the midst of a pandemic. Despite hope that the world will return to pre-pandemic conditions, the reality is post-pandemic education has already been forever changed. Clinical sites have been forced to drastically alter the number and type of opportunities for healthcare students due to capacity and policy changes secondary to COVID-19. Throughout the pandemic educators in every discipline of healthcare have had to re-imagine ways in which students can still obtain the clinical skills necessary to become competent, entry level professionals who can demonstrate critical thinking, clinical reasoning, and sound clinical decision making as healthcare professionals.
The theoretical basis for this chapter stems from evidence regarding simulation and clinical development found within a variety of healthcare educational settings, including nursing, athletic training, physical therapy, and others. There is evidence within the literature of various healthcare fields to support clinical skill development using simulation and telemedicine (Silberman et al, 2016; Winkelmann & Eberman, 2020). These types of techniques also allow for improvements in the self-efficacy of students who participated in these alternative clinical learning techniques (Nicol & Macfarlane, 2006). Furthermore, the ability to move learners from novice to competent healthcare providers using online simulation techniques is well supported (Galloway, 2009). The recent pandemic has forced healthcare educators to become innovative in the delivery of the curriculum while leaning on the current body of knowledge around simulation and online methods of teaching that aim to improve clinical performance. The need for innovation, however, is limited by the financial realities of the post COVID-19 economic impact on higher education. This reality has forced educators to critically consider the financial efficiency of their pedagogical modifications to maximize learner benefits within the budgetary constraints of the institution, which forced educators to be focused on the value added in pedagogical additions. The post-pandemic literature will need to highlight the evolving pedagogical strategies and fresh perspectives on the delivery of healthcare education.
The objective of this chapter is to describe the evidence and efficacy behind simulation-based education and provide key strategies for the use of virtual scenarios in healthcare education, particularly in the development of clinical reasoning and clinical decision making. The initial objectives of this chapter are to define and apply the concepts of clinical reasoning and decision making in the context of the stages of student clinical development. Furthermore, this chapter will synthesize the current state of the evidence in clinical skill development in a virtual environment from across various healthcare fields. Following this fundamental understanding, educators will be able to implement that knowledge base moving forward in the design of clinical scenarios to meet the desired outcome based on the current clinical development level of the student.
Key Terms in this Chapter
Feedback: The provision of information regarding the performance of a specific task.
Clinical Reasoning and Decision Making: The process of systematically obtaining and synthesizing key information to determine and provide evidence-based care relative to a specific patient encounter.
Formative Assessment: Feedback that is provided with the primary purpose of a change in the learner’s behavior with no specific consequences based on the performance.
Clinical Education: A broad term to describe learning opportunities that prepare students for clinical practice. This can include face-to-face, simulation, or other forms of supplemental learning experiences.
Problem-Based Learning: An instructional strategy that requires the learner to actively engage in solving an issue in a progressive manner. This is typically accomplished using small group work and includes the use of prior knowledge and critical thinking to address a complex situation.
Fidelity: The realism and interactivity of a technique. This is frequently used to describe simulation types.
Summative Assessment: Feedback that is provided with the purpose of comparing to a normal value with the intent of making a determination and subsequent consequence based on performance.
Simulation: The intentional emulation of a real-world situation within the context of a particular discipline.
Virtual Patient Cases: A low fidelity, asynchronous, problem-based technique which leverages individual and team responses to a simulated clinical scenario.