- Email: [email protected]
Pursuing Excellence Through Creative Education
PRESIDENT’S MESSAGE Pursuing Excellence Through Creative Education VICTORIA M. STEELMAN PhD, RN, CNOR, FAAN, AORN PRESIDENT
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ursuing excellence in perioperative education, either academic or clinical, requires a combination of expertise in the subject matter and effective learner engagement. Expertise in the subject matter requires that the educator continually review current literature and base the content presented on the best available evidence. Textbooks are often written two to three years before publication and may not include the most up-to-date evidence. Also, textbooks often do not identify the strength of the evidence underlying a recommendation, which may give the misperception that all evidence is equal or may promote outdated practices. Understanding how to search the published literature is a skill required of educators. This may be seen as a burden, particularly to clinical educators who are busy with other priorities in the practice setting. Fortunately, most hospitals have a librarian who can be a valuable resource for performing literature searches. Framing education around the AORN recommended practices1 is another way that the educator can use content that has been synthesized with the strength of the evidence rated. One might think that expertise in the subject matter is more important than skill in delivering the content. However, engaging the learner is at least equally important. If not engaged, the learner may not adequately retain the information for use at a later time. This can be very serious when responding to uncommon emergencies. Lack of engagement also can negatively affect the educator. For example, when
personnel are not engaged during competency assessment, the educator may need to prompt them several times to complete the required review and take the competency examination. This can be a dissatisfier for both the learner and the educator. If the learners are more actively engaged, then the learning process might be considered more enjoyable and less of a burden. Recently, some creative strategies have been developed to assist with this active engagement in learning for health care workers, including simulation, spaced education, and educational gaming. SIMULATION Simulation-based learning is being rapidly adopted by academic and clinical educators as a safe method for students and clinicians to learn and practice technical skills (eg, IV insertion) and how to use equipment (eg, IV pump, Doppler ultrasound). Learners can practice these skills in a risk-free environment and receive feedback before using the skill with a patient. This type of skills development and feedback has been associated with improved patient outcomes. For example, researchers used simulation to teach residents to insert central lines, resulting in a 60% decrease in central lineeassociated bloodstream infections.2 Multidisciplinary simulation has been effectively used to teach nontechnical skills, such as teamwork and crew resource management in perioperative patient care. Multidisciplinary simulation has been
http://dx.doi.org/10.1016/j.aorn.2014.06.008
Ó AORN, Inc, 2014
September 2014
Vol 100
No 3
AORN Journal j 235
September 2014 Vol 100
No 3
PRESIDENT’S MESSAGE
Although the use of spaced education in periopfound to improve communication and teamwork in 3 erative nursing is in its infancy, it has enormous pothe OR. It has been used to enhance preparation for 4 tential. AORN past president Paula Graling, DNP, cardiac emergencies and response in the OR to care 5 RN, CNOR, FAAN, uses spaced education for annual for a patient with a ruptured aortic aneurysm. Recompetency assessment for nurses, surgeons, and searchers at the University of Pennsylvania studied anesthesiologists, and the effects of simudescribes the experilation on team performance during a We should embrace the changes in education ence as overwhelmingly positive (oral surgical exsanguinathat emphasize evidence-based content and 6 tion emergency. The creative strategies for engaging learners as an communication, May 2014). She says, “We simulation resulted in opportunity to make perioperative education more effective and rewarding. can no longer rely on better understanding our historic methods of team members’ of educating learners. roles, activation of Don’t be afraid to try something new. I encourage the massive transfusion protocol, and improvement perioperative nursing educators to develop modules in time spent performing eight clinically significant using [spaced education], and to share lessons tasks. This year, the AORN Simulation Task force learned.” will develop a template for multidisciplinary simulations and a set of simulations on major patient safety topics. EDUCATIONAL GAMING The NMC Horizon Report for higher education identified game-based education as one of six emerging SPACED EDUCATION technologies likely to have a large effect on education One evidence-based online methodology is spaced within the next two to three years.12 By incorporating education. Spaced education involves delivering periodic e-mails that contain clinical scenarios and active learning experiences, educational games stimmultiple-choice questions. Immediately after submitulate higher thinking, such as analysis, synthesis, and ting answers, the learner receives the correct answer evaluation. Educational gaming fosters engagement in with an explanation of the topic. The question is then critical thinking, creative problem solving, and teamplaced into a cycle and repeated in eight to 42 days to work. Educational games range from puzzles and reinforce the content. When the learner answers a board games to sophisticated electronic apps and onquestion correctly twice, the question is retired. line challenges. A low-tech example of educational Spaced education is based on educational psygaming in perioperative nursing is using a scavenger chology theories about spacing education and testing hunt to find emergency equipment for orientation and learning and retention. In randomized trials, spaced annual competencies. AORN has a series of quizzes education has been found to improve knowledge called “What’s Wrong With This Picture?” to teach the acquisition and boost learning as well as improve concepts of aseptic practice, safety, patient care, and 7-11 retention of knowledge for up to two years. sterilization and disinfection.13 Users have found it to be a well-accepted means of The Institute for Healthcare Improvement has an delivering and receiving content. QstreamÒ (https:// electronic Jeopardy!Ò game to teach quality imapp.qstream.com) has some apps of interest to periprovement, teamwork and communication, and operative educators (eg, anatomy, cardiopulmonary leadership.14 Jeopardy games also can be used to resuscitation, heart rhythms). Educators also may teach other perioperative content (eg, malignant create their own courses in Qstream (eg, fire safety, hyperthermia, anaphylaxis, chemotherapy, sharps positioning, prevention of hypothermia). safety). The Institute for Healthcare Improvement 236 j AORN Journal
PRESIDENT’S MESSAGE also has a game that involves responding to wrong-site surgery.15 With the overwhelming adoption of smartphones and tablets, the use of electronic educational games has increased dramatically, and the sophistication of educational gaming is rapidly advancing. Stanford University School of Medicine, Stanford, California, developed the Surgical Improvement of Clinical Knowledge Ops (SICKO) program,16 a web-based simulation game in which general surgeons make critical decisions in ORs. Another resource for educational gaming is the Ebing Library, which has an inventory of games and simulations for health care.17 SUMMARY Education is rapidly changing, with increasing emphasis on both evidence-based content and creative strategies for engaging learners. We should embrace these changes as an opportunity to make perioperative education more effective and rewarding. Resources are available to assist with identifying best practices based on current evidence. Yet, the quality of the content is only one part of learning. Active engagement of learners is equally important. We need to use the creative vision of students, clinicians, and educators to design new strategies for effective education in our pursuit of excellence.
www.aornjournal.org
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Editor’s notes: Qstream is a registered trademark of Spaced Education, Inc, Burlington, MA. Jeopardy! is a registered trademark of Jeopardy Productions, Inc, Culver City, CA.
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References 1. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014. 2. Barsuk JH, Cohen ER, Potts S, et al. Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections. BMJ Qual Saf. March 14, 2014 [Epub ahead of print]. 3. Paull DE, Deleeuw LD, Wolk S, Paige JT, Neily J, Mills PD. The effect of simulation-based crew resource management training on measurable teamwork and communication among interprofessional teams caring for postoperative patients. J Contin Educ Nurs. 2013;44(11):516-524. 4. Garbee DD, Paige J, Barrier K, et al. Interprofessional teamwork among students in simulated codes:
a quasi-experimental study. Nurs Educ Perspect. 2013; 34(5):339-344. Van Herzeele I, Sevdalis N, Lachat M, Desender L, Rudarakanchana N, Rancic Z. Team training in ruptured EVAR. J Cardiovasc Surg (Torino). 2014;55(2):193-206. Acero NM, Motuk G, Luba J, et al. Managing a surgical exsanguination emergency in the operating room through simulation: an interdisciplinary approach. J Surg Educ. 2012;69(6):759-765. Kerfoot BP, Baker H, Pangaro L, et al. An online spacededucation game to teach and assess medical students: a multi-institutional prospective trial. Acad Med. 2012; 87(10):1443-1449. Kerfoot BP, Baker H. An online spaced-education game for global continuing medical education: a randomized trial. Ann Surg. 2012;256(1):33-38. Kerfoot BP, Lawler EV, Sokolovskaya G, Gagnon D, Conlin PR. Durable improvements in prostate cancer screening from online spaced education a randomized controlled trial. Am J Prev Med. 2010;39(5):472-478. Kerfoot BP, Shaffer K, McMahon GT, et al. Online “spaced education progress-testing” of students to confront two upcoming challenges to medical schools. Acad Med. 2011;86(3):300-306. Kerfoot BP, Fu Y, Baker H, Connelly D, Ritchey ML, Genega EM. Online spaced education generates transfer and improves long-term retention of diagnostic skills: a randomized controlled trial. J Am Coll Surg. 2010; 211(3):331-337.e1. Johnson L, Adams BS, Estrada V, Freeman A. NMC Horizon Report: 2014 Higher Education Edition. Austin, TX: The New Media Consortium; 2014. What’s {WRONG} with this picture? series. AORN, Inc. http://www.aorn.org/whatswrong. Accessed June 9, 2014. Jeopardy game. Institute for Healthcare Improvement. http://www.ihi.org/education/IHIOpenSchool/resources/ Pages/Activities/ActivityChapterJeopardyGame.aspx. Accessed June 9, 2014. Responding to error. Institute for Healthcare Improvement. http://www.ihi.org/education/ihiopenschool/resources/ Pages/Activities/ChapterActivityRespondingToError .aspx. Accessed June 9, 2014. SICKO - Surgical improvement of clinical knowledge ops. Stanford School of Medicine. http://go.nmc.org/sick. Accessed June 9, 2014. Games & simulation for health care: deep brain simulation surgery. University of Wisconsin-Madison. http://health caregames.wisc.edu/detail.php?simID¼446&vendorID¼ 150. Accessed June 9, 2014.
Victoria M. Steelman, PhD, RN, CNOR, FAAN, is the AORN President and an assistant professor at The University of Iowa College of Nursing, Iowa City. Dr Steelman has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
AORN Journal j 237
P
ursuing excellence in perioperative education, either academic or clinical, requires a combination of expertise in the subject matter and effective learner engagement. Expertise in the subject matter requires that the educator continually review current literature and base the content presented on the best available evidence. Textbooks are often written two to three years before publication and may not include the most up-to-date evidence. Also, textbooks often do not identify the strength of the evidence underlying a recommendation, which may give the misperception that all evidence is equal or may promote outdated practices. Understanding how to search the published literature is a skill required of educators. This may be seen as a burden, particularly to clinical educators who are busy with other priorities in the practice setting. Fortunately, most hospitals have a librarian who can be a valuable resource for performing literature searches. Framing education around the AORN recommended practices1 is another way that the educator can use content that has been synthesized with the strength of the evidence rated. One might think that expertise in the subject matter is more important than skill in delivering the content. However, engaging the learner is at least equally important. If not engaged, the learner may not adequately retain the information for use at a later time. This can be very serious when responding to uncommon emergencies. Lack of engagement also can negatively affect the educator. For example, when
personnel are not engaged during competency assessment, the educator may need to prompt them several times to complete the required review and take the competency examination. This can be a dissatisfier for both the learner and the educator. If the learners are more actively engaged, then the learning process might be considered more enjoyable and less of a burden. Recently, some creative strategies have been developed to assist with this active engagement in learning for health care workers, including simulation, spaced education, and educational gaming. SIMULATION Simulation-based learning is being rapidly adopted by academic and clinical educators as a safe method for students and clinicians to learn and practice technical skills (eg, IV insertion) and how to use equipment (eg, IV pump, Doppler ultrasound). Learners can practice these skills in a risk-free environment and receive feedback before using the skill with a patient. This type of skills development and feedback has been associated with improved patient outcomes. For example, researchers used simulation to teach residents to insert central lines, resulting in a 60% decrease in central lineeassociated bloodstream infections.2 Multidisciplinary simulation has been effectively used to teach nontechnical skills, such as teamwork and crew resource management in perioperative patient care. Multidisciplinary simulation has been
http://dx.doi.org/10.1016/j.aorn.2014.06.008
Ó AORN, Inc, 2014
September 2014
Vol 100
No 3
AORN Journal j 235
September 2014 Vol 100
No 3
PRESIDENT’S MESSAGE
Although the use of spaced education in periopfound to improve communication and teamwork in 3 erative nursing is in its infancy, it has enormous pothe OR. It has been used to enhance preparation for 4 tential. AORN past president Paula Graling, DNP, cardiac emergencies and response in the OR to care 5 RN, CNOR, FAAN, uses spaced education for annual for a patient with a ruptured aortic aneurysm. Recompetency assessment for nurses, surgeons, and searchers at the University of Pennsylvania studied anesthesiologists, and the effects of simudescribes the experilation on team performance during a We should embrace the changes in education ence as overwhelmingly positive (oral surgical exsanguinathat emphasize evidence-based content and 6 tion emergency. The creative strategies for engaging learners as an communication, May 2014). She says, “We simulation resulted in opportunity to make perioperative education more effective and rewarding. can no longer rely on better understanding our historic methods of team members’ of educating learners. roles, activation of Don’t be afraid to try something new. I encourage the massive transfusion protocol, and improvement perioperative nursing educators to develop modules in time spent performing eight clinically significant using [spaced education], and to share lessons tasks. This year, the AORN Simulation Task force learned.” will develop a template for multidisciplinary simulations and a set of simulations on major patient safety topics. EDUCATIONAL GAMING The NMC Horizon Report for higher education identified game-based education as one of six emerging SPACED EDUCATION technologies likely to have a large effect on education One evidence-based online methodology is spaced within the next two to three years.12 By incorporating education. Spaced education involves delivering periodic e-mails that contain clinical scenarios and active learning experiences, educational games stimmultiple-choice questions. Immediately after submitulate higher thinking, such as analysis, synthesis, and ting answers, the learner receives the correct answer evaluation. Educational gaming fosters engagement in with an explanation of the topic. The question is then critical thinking, creative problem solving, and teamplaced into a cycle and repeated in eight to 42 days to work. Educational games range from puzzles and reinforce the content. When the learner answers a board games to sophisticated electronic apps and onquestion correctly twice, the question is retired. line challenges. A low-tech example of educational Spaced education is based on educational psygaming in perioperative nursing is using a scavenger chology theories about spacing education and testing hunt to find emergency equipment for orientation and learning and retention. In randomized trials, spaced annual competencies. AORN has a series of quizzes education has been found to improve knowledge called “What’s Wrong With This Picture?” to teach the acquisition and boost learning as well as improve concepts of aseptic practice, safety, patient care, and 7-11 retention of knowledge for up to two years. sterilization and disinfection.13 Users have found it to be a well-accepted means of The Institute for Healthcare Improvement has an delivering and receiving content. QstreamÒ (https:// electronic Jeopardy!Ò game to teach quality imapp.qstream.com) has some apps of interest to periprovement, teamwork and communication, and operative educators (eg, anatomy, cardiopulmonary leadership.14 Jeopardy games also can be used to resuscitation, heart rhythms). Educators also may teach other perioperative content (eg, malignant create their own courses in Qstream (eg, fire safety, hyperthermia, anaphylaxis, chemotherapy, sharps positioning, prevention of hypothermia). safety). The Institute for Healthcare Improvement 236 j AORN Journal
PRESIDENT’S MESSAGE also has a game that involves responding to wrong-site surgery.15 With the overwhelming adoption of smartphones and tablets, the use of electronic educational games has increased dramatically, and the sophistication of educational gaming is rapidly advancing. Stanford University School of Medicine, Stanford, California, developed the Surgical Improvement of Clinical Knowledge Ops (SICKO) program,16 a web-based simulation game in which general surgeons make critical decisions in ORs. Another resource for educational gaming is the Ebing Library, which has an inventory of games and simulations for health care.17 SUMMARY Education is rapidly changing, with increasing emphasis on both evidence-based content and creative strategies for engaging learners. We should embrace these changes as an opportunity to make perioperative education more effective and rewarding. Resources are available to assist with identifying best practices based on current evidence. Yet, the quality of the content is only one part of learning. Active engagement of learners is equally important. We need to use the creative vision of students, clinicians, and educators to design new strategies for effective education in our pursuit of excellence.
www.aornjournal.org
5.
6.
7.
8.
9.
10.
11.
12.
13. 14.
15.
Editor’s notes: Qstream is a registered trademark of Spaced Education, Inc, Burlington, MA. Jeopardy! is a registered trademark of Jeopardy Productions, Inc, Culver City, CA.
16.
17.
References 1. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014. 2. Barsuk JH, Cohen ER, Potts S, et al. Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections. BMJ Qual Saf. March 14, 2014 [Epub ahead of print]. 3. Paull DE, Deleeuw LD, Wolk S, Paige JT, Neily J, Mills PD. The effect of simulation-based crew resource management training on measurable teamwork and communication among interprofessional teams caring for postoperative patients. J Contin Educ Nurs. 2013;44(11):516-524. 4. Garbee DD, Paige J, Barrier K, et al. Interprofessional teamwork among students in simulated codes:
a quasi-experimental study. Nurs Educ Perspect. 2013; 34(5):339-344. Van Herzeele I, Sevdalis N, Lachat M, Desender L, Rudarakanchana N, Rancic Z. Team training in ruptured EVAR. J Cardiovasc Surg (Torino). 2014;55(2):193-206. Acero NM, Motuk G, Luba J, et al. Managing a surgical exsanguination emergency in the operating room through simulation: an interdisciplinary approach. J Surg Educ. 2012;69(6):759-765. Kerfoot BP, Baker H, Pangaro L, et al. An online spacededucation game to teach and assess medical students: a multi-institutional prospective trial. Acad Med. 2012; 87(10):1443-1449. Kerfoot BP, Baker H. An online spaced-education game for global continuing medical education: a randomized trial. Ann Surg. 2012;256(1):33-38. Kerfoot BP, Lawler EV, Sokolovskaya G, Gagnon D, Conlin PR. Durable improvements in prostate cancer screening from online spaced education a randomized controlled trial. Am J Prev Med. 2010;39(5):472-478. Kerfoot BP, Shaffer K, McMahon GT, et al. Online “spaced education progress-testing” of students to confront two upcoming challenges to medical schools. Acad Med. 2011;86(3):300-306. Kerfoot BP, Fu Y, Baker H, Connelly D, Ritchey ML, Genega EM. Online spaced education generates transfer and improves long-term retention of diagnostic skills: a randomized controlled trial. J Am Coll Surg. 2010; 211(3):331-337.e1. Johnson L, Adams BS, Estrada V, Freeman A. NMC Horizon Report: 2014 Higher Education Edition. Austin, TX: The New Media Consortium; 2014. What’s {WRONG} with this picture? series. AORN, Inc. http://www.aorn.org/whatswrong. Accessed June 9, 2014. Jeopardy game. Institute for Healthcare Improvement. http://www.ihi.org/education/IHIOpenSchool/resources/ Pages/Activities/ActivityChapterJeopardyGame.aspx. Accessed June 9, 2014. Responding to error. Institute for Healthcare Improvement. http://www.ihi.org/education/ihiopenschool/resources/ Pages/Activities/ChapterActivityRespondingToError .aspx. Accessed June 9, 2014. SICKO - Surgical improvement of clinical knowledge ops. Stanford School of Medicine. http://go.nmc.org/sick. Accessed June 9, 2014. Games & simulation for health care: deep brain simulation surgery. University of Wisconsin-Madison. http://health caregames.wisc.edu/detail.php?simID¼446&vendorID¼ 150. Accessed June 9, 2014.
Victoria M. Steelman, PhD, RN, CNOR, FAAN, is the AORN President and an assistant professor at The University of Iowa College of Nursing, Iowa City. Dr Steelman has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
AORN Journal j 237