Teaching of skills

Lab and simulation

Moderator:Dr. Kamlesh K sharma

Lecturer,CON,AIIMS
Presentor:Shailendra
 Objectives
 To understand the concept of teaching skill
 To gain knowledge about:
• lab method of teaching.
• Phases
• Merits & demerits
• Simulation method of teaching
• Types
• Phases
• Merits & demerits
 To know its application in nursing education
Teaching Skills

The teaching skills are defined as

a group of teaching acts or
behaviours intended to
facilitate students learning
directly or indirectly.
 Need of Teaching Skills
• To ensure competency in teaching.
• To make the class interesting.
• To enable the teacher to develop confidence
in teaching.
• To avoid confusion
• To enable the teacher to understand individual
differences in learning.
 et ho d
Lab M
 Introduction
It is a method where a student experiences an
actual use of equipment or materials as he/she
resolves problems and develops concepts, skills
and values.
It is considered as planned learning activity dealing
with original or raw data in the solution of
problems.
 Definition

• The word laboratory was applied originally to the

workroom of the chemist,a place devoted to the
experimental study of natural science.(Webster)
 Lab
• An environment in which we
use simulation.
• A lab has models, computers,
tapes, videos,charts and other
equipments to practice
various skills.
• Teacher-Facilitate learning.
• Learning by doing(philosophy
of Dewey).
Lab in Nursing
• This concept of problem
solving has became an
integral part of nursing
curricula .
• Nursing skills can be
learned only through first
hand experience in clinical
laboratory under careful
supervision.
 Types Of Laboratories In Nursing
Education
• Science lab
(anatomy-physiology,
microbiology, pathology)
• Foundation lab
• Intensive care lab
• MCH lab
• Community health lab
• Nutrition lab
• Mental health nursing lab
 Purposes
• To give first hand experience with
materials or facts in the solution of
problem e.g. science lab
• To provide experiences with actual
situation such as nursing lab &
hospital wards.
• To make student skilled in
manipulating apparatus, practicing
lab technique.
• Helps student to acquire scientific
attitudes & approach in problem
solving.
Phases of lab method
 Contd….
1.Introductory phase/Preparatory phase
• Establishment of objectives and a plan of work.
• Preparation of the teacher and the students.
• Planning may be done in advance.
 Contd...
Student preparation
• Orientation and motivation through proper
instructions and guidance.
• Short instructions – verbally
• Long procedures – writing, Lab manual
• Leave it to the student to formulate a
precise plan of investigation , setting up the
plan and reaching their own conclusions.
 Contd…
Teacher preparation
Teacher should think over
• What the students will be doing.
• What verbal preliminary instructions they
require.
• The difficulties that they likely to encounter.
• How their quality of work can be appraised.
• How their learning experience be improved.
 Contd…
2. Work phase
• Period during which the student do their work
under the supervision of the teacher.
• Teacher guide the student creatively in the
accomplishment of tasks.
• Teacher should gauge the students abilities, to
know at what point to offer help and when to
withhold it.
 Contd..

• Student may work individually or in small teams

• Adequate records to be kept
• Provisions for individual differences
• Students finishing assignments quickly can be
given additional assignments to deepen their
knowledge.
 Contd..
3. Culminating phase/ Evaluatory phase
• After finishing the work, the class should meet
together for the discussion of common problems
• Review of the plan for solving the problem.
• Report by student on data gathered or other
findings.
• Presentation of illustration materials or special
contributions by students working on special
problems.
 Contd..
• Organisation of findings and summarisation and
conclusions by the group.
• Exhibits of various projects by students.
• Tests or examinations as a means of measuring
achievement relative to certain outcomes.
 Sample of the Laboratory method of
teaching
• Vitals taking

• Preparation:
• Review on vital signs
• Steps in performing vital signs taking
• Expected learning outcomes
• Planning
• Actual work period:
During this period , the students will work under
the supervision of the teacher.
• Culminating activity
Students will report the results of the activity.
 Merits
• Teacher can provide various kinds of learning
experiences to the students, as a result of which
information gained by them turns out to be of
permanent kind.
• Child centred method i.e. individual differences
and interest of all the students are taken into
consideration, also one of the psychological
teaching method.
 Merits contd..
• Students learn to explore various things on their
own, become able to solve out problems on their
own, as they possess of high level of self-
confidence.
• Various kinds of practical skills and proficiency
get developed in them to considerable extent.
 Demerits
• Poor planning & lack of direction of teacher may
result in wasting student time.
• Use of complicated approaches , consumption of
time.
• Lack of budget create insecurity in teacher to
operate them.
SIMULATION
 Introduction
• It presents learners with a more or less life like
model of the real world with which they interact
in solving problems from an adopted role
perspectives.
 Introduction contd..
• It is old as human being on earth, even animals
also use this technique to train their young ones
to teach them to adjust in their physical
environment.
• Its systematic use stated after the 1 st world war
in the training of pilots in air force.
 Definition
• A method of instruction whereby an artificial or
hypothetical experience, that engages the
learner in an activity reflecting real-life conditions
but without the risk-taking consequences of an
actual situation, is created [Bastable, 2008]
 Application of Educational Theories
• Social Learning Theory
Self-efficacy or social change occurs through
modeling and reinforcement learning.
Educator designs a simulation to teach a skill,
pattern, or role play, and then designs
additional simulations where the target
behavior is reinforced.
Simulation provides planned stimuli organized
in a way so as to give the participant
opportunity to respond.
 contd…
• Experiential theory
What the literature tells us simulation

• Learners retain more information

• Response to live situations improves
• Improves psychomotor skills
• Debriefing is an essential element
• Seen as the future for medical and Nursing
education
 Principles

• SBT Should Focus on Reinforcing and

Promoting the Needed Competencies.
• Adopt a Systems Approach: • Think about
"before," "during," and "after" influences on SBT.
• Prepare the Organization for SBT.
• Set Up Appropriate Presimulation Conditions
 Principles contd..
• Ensure Trainee Motivation
• Apply Sound Instructional Principles to the
Design of SBT
• Develop Performance Measures
• Set Up the Simulation Environment
• Prepare the Transfer Environment
 Characteristics for simulations
• Fidelity
Extent to which the appearance and behavior of
the simulation matches the appearance and
behavior of the simulated system[real lifescenario].
• Engineering fidelity
Extent to which the simulation replicates the
physical characteristics of the actual task.
• Psychological fidelity
Extent to which the skills of the real task are
captured by the simulated task.
 Characteristics contd..
• Reliability-Ability of a simulator to have almost
same outcome with different participants
• Validity is defined as the extent to which a
measurement tool measures the intended
outcome.
• Learning impact revealed by reaction,
learning, behavior, and results.
• Feasibility describes the degree to which the
simulation is affordable and feasible to
implement.
 Levels of simulation
Matthews and Yachmetz described four levels of
simulation fidelity.
• Level one (SF1) art fidelity- computer-aided
mannequin interacts with the trainees.
• Level two (SF2) high fidelity- a complex
scenario that may involve multiple mannequins.
• Level three (SF3) intermediate fidelity-series
of procedures put together to resemble a simple
scenario found in a clinical setting.
• Level four (SF4) low fidelity- is meant to
demonstrate a simple skill.
 Types of simulation
• Simulation exercise

• Simulation game

• Role playing

• Also can be classified as:

o Oral
o Written
o Visual
 Simulation exercises

• A controlled representation
of a piece of reality that
learners can manipulate to
better understand the
corresponding real
situation.
 Simulation exercise Contd...
• High Fidelity
Interactive robotics with programmed cases
• Medium Fidelity
Mannequins with attachments and clinical needs
(wounds, ostomy products, IVs)
• Low Fidelity
Single item simulation, IV arms, pumps[task
trainers]
Interactive computerized case studies [virtual
reality]
 Simulation game
• A game that represents
real life situation in which
learners compete
according to a set of rules
either to win or to achieve
an objective.
• Simulation games
promote problem solving ,
impart information and
motivate pupil.
.
 Simulation game Contd..
• Most games focus upon one of the two areas:
cognitive knowledge or affective
knowledge(content games and process games
respectively).
• Role of teacher-to facilitate learner
Game suitabilty checklists

• Does the game meet

programme objectives?
• Time ,settings,participants
• Funding
• Availability of equipments
or supplies..
• Does the game require
preparation or clean up.
• Does it require
replacement of material
following each use?
 Simulation games
Advantages Disadvantages
• Enhance • Competitive
Critical thinking environment
Motivation • Small group
Psychomotor skills • Room must be more
Problem solving flexible
• Active learning • Physically demanding
• Retention is high[hear • Noise
,see. and do] • Economic barriers
 Role play
• Spontaneous acting out
of roles
• Participants should
have background
knowledge regarding
the simulated context.
• Best method of
simulation in public
health.
• Debriefing and
discussions
 Application of principle & concept of
simulation
Type Example Fidelity Typical use Example of
use
Simulation Manikins Low Demonstrativ Pelvic
e practice examination,
CPR
Oral Problem Low Case Classroom
simulation based discussion discussion on
problem
solving
Written Paper & pen Very low Teach Patient
simulation latent image knowledge management
assessment diagnosis

Computerised Trained actor Very high Teach Simulated

simulation role play interpersonal burns
skills patients
 Features of simulation
• Video or animated clinical situation
• Assessment and interaction embedded
• Reporting and tracking
• Student controlled
• Branching logic
• Multiple characters
• Multiple settings
 Application of simulation
 Clinical Cases
• Maternal Child Mental Health
• Medical Surgical
• Trauma
• Pediatrics
 Soft Skills
• Communication
• Leadership
• Wellness and Self Care
 Application Contd…
 Assessment Skills
e.g.-Hospital resuscitation teams trained in
advanced life support using simulation can
improve patient outcomes
 Pharmacological concepts
e.g.-Drug recognition unit allows simulator to
respond physiologically
 Developing and demonstrating critical
thinking skills
e.g.-Scenarios require students to use classroom
knowledge, incorporate assessment skills, and
create and implement a plan
 Purposes of simulation
To help students
• Practice decision making and problem solving
skills.
• Develop human interaction skills.
• Achieve cognitive,affective and psychomotor
outcomes.
• Transfer knowledge gained through simulation
to real life situations
 Role of teacher in simulation
• Planning

• Facilitating

• Debriefing
 Planning
• Purchase or develop simulation package.
• Ensure the usefulness of it.
• Prepare the students- other references &
sources for subject
• Plan to involve each student in one way or other.
• Encourage shy/ reluctant students to participate.
 Facilitating
• Observe behavior of the students carefully
• Takedown the important pieces of conservation
among them for proper debriefing.
• Maintain non judgmental attitude
• Don’t interfere in between
 Debriefing
• Conduct immediately after simulation
• Summarize the whole event
• Participant self analysis
• Observers analysis and suggestions.
• Explanation of concepts and principles applied
in simulation.
• Explain how the participant are benefitted from
the experience gained.
Evaluation of the Effectiveness of
Simulation

Does this simulation offer an

Are the desired
appropriate measure of Does the student
instructional outcomes
realism for my group of demonstrate an
well defined?
students? understanding of
his/her role?

Are problem solving Is the level of ambiguity

techniques in evidence? manageable for this group?

Does the student

provide meaningful
Is cooperation between Has the student been able to answers to probing
participants in evidence? resolve the issue satisfactorily? questions?

Will follow-up activities be necessary?

 Benefits of simulation
• Simplifies complexity of real life situation.
• Highly student centered.
• Helps to learn from mistakes.
• Helps to acquire concrete meaning of abstract
• terms
• Fosters critical thinking and problem solving
skills.
• Increase psychomotor skills.
 Disadvantages of simulation
• Expensive in terms of time ,money and energy.
• Emotional based simulations cause mental
trauma sometimes.
• Chance of under evaluating real life situations
• Small group.
 Simulated Learning vs. Traditional
Classroom Learning
Class room Simulation
• Hands-on experience
• Conceptual in nature
• Teaching of skills
• Good for conveying
fact based information • Learner actively
• Passive learning engaged
• Teacher –facilitator
• Teacher centered
• Learning by hearing,
• Learning by hearing
seeing and doing
• Retention is low
• Retention is high
 Ziv Classification
 Simulations available for nursing in the following
manner:
• Simple models or mannequins
• Simulated/standardised patients
• Computer screen based clinical simulators
• Realistic high tech procedural simulators( task
trainers)
• Virtual reality
• Realistic, high tech interactive patient simulaors
 Simulation in nursing
• A large body of research shows that simulation
is incredibly effective as a teaching methodology
and can contribute both to better patient
outcomes and a culture of safety among nursing
staff.
• Nurses participating in simulation activities
improve skills in areas like recognizing a
deteriorating patient, triaging emergency
patients more accurately, managing stroke
patients, working collaboratively in an obstetrics
setting, and more.
 Contd...
• The future of nursing education may be in the
area known as high-fidelity simulation: the use of
computerized mannequins that exhibit a wide
range of patient conditions.

• There’s currently a need for nurse educators

who can bring transformational leadership to the
field, through an understanding of simulation
and other new curriculum models. Developing a
simulation program – for nursing school or for an
institution that has specific training and
improvement goals.
 Summary
• Definition
• Importance
• Phases of lab method
• Types of lab and simulation
• Advantages and disadvantages of lab and
simulation
• Role of teacher in conducting teaching of skills.
• How it differ from normal classroom teaching
• Simulation in nursing
 Question time
1) Name some lab used in nursing education
2) What are the phases of lab method of teaching.
3) What are the characteristics of simulation
teaching.
4) What are the types of simulation .
5) What are specific roles of teacher in simulation.
 Conclusion
Lab & simulation , both are effective teaching skills
, especially when dealing with live situations e.g.
clinical practice. It has also been established by
many research studies.
 Bibliography
• Bastable.S.B. Principles of learning and teaching for
nursing practice . 2nd edition:Canada. Jones and Bartlett
publishers;2003.
• Sankaranarayan B Learning and teaching nursing 4th
edition.Jaypee brothers.2012
• Basavanthappa B.T. Nursing Education 2nd edition
Jaypee brothers 2013
• http://www.medscape.com/viewarticle/780819.
• https://scholar.google.co.in/scholar?
q=simulation+in+nursing&hl.
• http://www.ncbi.nlm.nih.gov/pubmed/6319640
Thank you