Simulation with sophisticated manikins or standardized patients has firmly established itself as an effective teaching practice in nursing and medical education (Liaw, et.al., 2015; Shin, Park & Kim, 2015). Although mastering many skills of advanced practice nursing requires high fidelity simulation, the thinking processes – diagnostic reasoning and clinical decision-making – can be successfully learned in low fidelity contexts using case studies and role play (Cant & Copper, 2014). Course instructors and instructional designers can use widely available and easy-to-use technological tools to develop critical thinking exercises based on authentic scenarios. For example, we used a testing tool in the Blackboard course management system to create a series of exercises simulating patient encounters for nurse practitioner students in order to develop diagnostic reasoning skills.
During a patient visit, the provider receives information about the patient’s condition in small installments as the interview progresses. Each step in this process requires analysis, synthesis, and decision-making. So, how did we replicate this in Blackboard?
• We used Blackboard’s testing tool to create exercises titled “Online Patient Visit Simulations.”
• Each question represented a step in the patient-provider encounter. New information about the patient was placed into the stem of each question.
• Questions were written in different formats as appropriate.
• “Simulated patient visits” were based on complex authentic scenarios, which included role play, analysis and synthesis of available information, and decision-making.
• Exercises had a time limit and questions were presented to students one at a time.
• Students were asked to describe their thinking processes.
• Instructor provided feedback in a timely manner and offered opportunities for discussion.
From the faculty perspective – having the student describe and demonstrate the thought process behind clinical decisions is a vital in developing clinical decision-making skills. This activity allows faculty to engage and guide students through the process behind developing diagnostic reasoning in a low cost, web-based exercise. From the student perceptive – the unfolding, step-by-step nature of the case, provides immediate feedback allowing for self-correction and reflection with as they progress though the scenario. The cases are tailored for depth, and complexity further enhancing students reasoning skills in a low risk environment. The development of critical thinking is a common outcome in many disciplines, therefore this type of critical thinking exercises can be used in many disciplines and could be particularly effective in blended and fully online courses.
From the student perspective – the unfolding, step-by-step nature of the case, provides immediate feedback allowing for self-correction and reflection with as they progress though the scenario. In the first semester of introducing these exercises, 100% of the students felt that this approach helped them develop advanced clinical thinking skills expected of a nurse practitioner: focused health assessment, diagnostic reasoning in order to arrive at a correct diagnosis, and selecting appropriate treatment options. In their comments, students expressed appreciation for the authentic nature of these excises and the development of critical thinking skills:
- “The simulation was very much like what you see in the clinical setting because you don’t know what the patient will say or what will happen next.”
- “This patient simulation format is definitely better! Aside from it being realistic, it provides a stepwise approach on how to handle to situation and come up with the correct diagnosis.”
- “I really enjoy the patient simulation. It helps me critically think and give good examples of what I may encounter in clinical.”
The development of critical thinking is a common outcome in many disciplines, therefore this type of critical thinking exercises can be used in many disciplines and could be particularly effective in blended and fully online courses.
Link to example artifact(s)
Artifact 1: Instructions to Students for Online Patient Visit Simulation 1 explains how students are instructed to approach the exercises and shows what these exercises look like.
Artifact 2: Questions to Online Patient Visit Simulation 5 illustrates how the questions are structured to enable development of critical thinking skills as the exercise unfolds.
Link to scholarly reference(s)
Cant, R. P., & Cooper, S. J. (2014). Simulation in the Internet age: the place of web-based simulation in nursing education. An integrative review. Nurse Education Today, 34(12), 1435 – 1442.
Liaw, S. Y. et. al. (2015). Designing and evaluating an interactive multimedia Web-based simulation for developing nurses’ competencies in acute nursing care: randomized controlled trial. Journal of Medical Internet Research,17(1), e5.
Shin, S., Park, J., & Kim, J. (2015). Effectiveness of patient simulation in nursing education: Meta-analysis. Nurse Education Today, 35(1), 176-182.