Simulations in paramedical training

The Justice Institute of British Columbia (JIBC) offers a range of applied and academic programs that span the spectrum of safety – from prevention to response and recovery. The JIBC offers Canada’s only Bachelor’s Degree in Fire and Safety Studies, which had 80 students enrolled from across Canada and other countries in 2007/08. In 2007/08, JIBC instructors were in more than 160 communities in BC delivering basic and advanced programs to 11 BC Government ministries and 200 municipal agencies. Student numbers are over 32,000 annually, with more than 6,000 students in online programs. Although its headquarters is in New Westminster, just south-east of the City of Vancouver, 47% of JIBC students live outside Metro Vancouver and Victoria.

JIBC has a long history of online and distance learning. In particular it has a lot of experience in developing low cost digital simulations. I invited Ron Bowles, a specialist in JIBC’s School of Health Care, to describe some of the work he is doing.

Ron Bowles

Curriculum, in its traditional sense, refers to the structure and documents that describe a course – its goals, objectives, content, lessons, and evaluations. William Pinar (2004) changed the way we look at and talk about curriculum when he posed curriculum as an active process –the lived experience, the course (or path) that we run. In this sense, our learning activities, including simulations, are the paths that we, as instructors and course designers, create – the roads that lead our learners from where they are to where we want them to be.

Simulations are constructed experiences which replicate, in some fashion, selected elements of authentic or “real” worlds. Educational simulations often focus either on contextualizing or integrating previously-learned skills and knowledge. In other words, whatever “it” is – simulations help us put “it” all together and/or try “it” out in a more or less realistic way. In many applied fields, simulations are critical steps on the path to professional practice.

Online simulations use multiple forms of media to create “virtual” worlds where users (learners) “perform” actions. The range of online simulations is vast, from simple text-based case studies to avatars interacting in immersive 3D environments. Indeed, when we hear about online simulations, we tend to think of complex multimedia environments.  But online simulations need not be rich, extensive, nor expensive to be effective. Simple simulation-based online activities can dramatically enhance learners’ engagement with content and foster significant learning.

The School of Health Care at the Justice Institute of British Columbia (JIBC) develops and delivers recruit and ongoing education programs for paramedics. Paramedics in Canada must master the assessment and management of over 200 injuries and conditions. Generally, learners study these conditions in texts, then practice assessing and managing selected “calls” in classroom-based simulations before encountering “real” patients in a hospital setting. Finally, in the practicum, recruit paramedics put “it” all together in “real” ambulance calls under the direct supervision of experienced practitioners.

While this path is certainly effective, it is also somewhat narrow. Recruit paramedics perform perhaps 50 simulations in their programs, and participate as partners or patients in another 100 or so. They encounter a few dozen patients in their clinical rotation and perform somewhere between 50 and 150 ambulance calls in their practicum. The selection of simulations in the curriculum necessarily focuses on common types of calls (such as heart attacks) or uncommon calls that have high consequence of error (such as emergency child-birth). Thus, learners do not get opportunities to practice many of the 212 conditions they study. Put in the context of the pathway metaphor – simulations in our curriculum pretty much stick to the main roads (as “effective” and “efficient” curricula should, some might argue).

Online simulations provide an opportunity to both enrich the learners’ overall journey and create “side trips” to explore more fully the range of injuries and conditions paramedic recruits must master. The JIBC has developed a number of integrative simulations that focus on overall management of common injuries and conditions <click here for a sample: http://access.jibc.bc.ca/logic/programs/pcp/06_CC_250/06_CC_250e_LA_01_p9a.htm > , including, even, management of a multiple patient situation <click here to view: http://access.jibc.bc.ca/logic/MCI/MCI_Media/MCI.htm >. These simulations use a “turned-based” architecture in which learners encounter multimedia information followed by an action-based question: “what would you do next?” The scenarios have a “preferred path” with branching at critical decision points. Critical errors lead to poor outcomes (e.g. the patient deteriorates or dies).  Incorrect or suboptimal choices between these branch points trigger “wrong-answer feedback” then loop learners back to make better choices. These online simulations parallel classroom simulations, both in their emphasis on integration and contextualization and in focusing on common calls and high-risk situations.

These simulations are relatively simple and inexpensive to develop. However, their cost becomes prohibitive when implemented across the breadth of the paramedic curriculum. The Primary Care Paramedic program currently has over 20 of these simulations. While they have enriched the learners’ journey, they have merely widened the existing path. Learners are still left on their own to explore the fields and forests of their discipline.

Even simpler simulations, however, can be used to practice precursor components of a complete ambulance call. For each injury or condition, paramedics must memorize a definition, internalize a list of signs and symptoms, be able to recognize and distinguish these key features on “real” patients, and adapt the principles of managing each condition to the situations in which they encounter it in the field. Each of these steps lends itself to short online “mini-simulations” – similar to the skill stations and drills that learners use to master the psychomotor skills they employ in classroom-based “full simulations.”

The JIBC has developed a series of these short, repetitive case-based learning activities, including term/definition drills, < click here for sample drills: http://access.jibc.bc.ca/logic/programs/pcp/08_CC_252/08_CC_252e_LA_04_08.htm >. case-based application drills, and, finally, short scenarios in which the learners identify the condition and choose an appropriate set of management actions. <click here for sample drills: http://ccess.jibc.bc.ca/logic/programs/LaOGIC/PCP220/03PrimaryDrills/220Drill2Launch.htm >.

Simple, cost effective learning activities such as these enrich the learners’ journey and provide opportunities that simply aren’t available in a time-constrained classroom. These online “drills” provide footpaths and stepping stones to the areas in-between the main roads of the curriculum. While they are, on their own, relatively simple learning activities, they encourage learners to better explore, engage, and seek connections across the breadth and depth of their disciplines. Such opportunities allow us to see learning as more than a journey and consider curriculum as a potential space of exploration that includes, but is not bounded by the paths we create.

References

Pinar, W. F. (2004). What is Curriculum Theory? Mahwah, NJ: Lawrence Erlbaum and Associates.

Many thanks to Ron for this. If you have any questions about this, please contact Ron directly at: rbowles@jibc.ca