Evidenced-Based Simulation: Fostering Competency through Structured and Multisource Feedback : AACN

Evidenced-Based Simulation: Fostering Competency through Structured and Multisource Feedback

Overview

Simulation experiences designed to deliver performance feedback from multiple sources amplify learning and are well-accepted by students (Burt, Fitz, and Kiser 2024; Fitz and Burt 2023). Multisource feedback may include standardized patients (SPs), peers, faculty, and students themselves. Notable merits of high-quality feedback delivered within simulation-based learning experiences from multiple sources include feedback specificity, structure, and behavioural orientation (Lefroy et al. 2015, Engerer et al. 2016, Engerer et al. 2019). This toolkit gives Nurse Practitioner (NP) educators resources to implement an innovative virtual simulation program within preclinical disease management courses that include purposeful and structured multisource feedback. It has also been shown to foster learning in the competency domain of person-centered care relevant to communication and disease management abilities (American Association of Colleges of Nursing, 2021).

How to Use

1. Access “Multisource Feedback Simulation Toolkit” resources on universal drive/

2. Review simulation case templates and fill in appropriate addresses, locations, dates, and faculty names as indicated in brackets.

3. Provide appropriate standardized patient (or faculty member) training on (a) simulation scenario portrayal and (b) SP-driven communication feedback. Refer to the SP Feedback Training Manual for guidance on SP-driven communication feedback training.

4. Communicate logistical information to students at least two weeks prior to the scheduled date. Students should be divided into groups of 2-3 students at this time so they can work on pre-work in small groups:

a. Day-of training with students in groups of two to three, leaving one hour at the end of the simulation day for a faculty-led group debriefing session. Refer to Simulation Schedule Template.
b. Video conferencing link for students to log in to complete the telemedicine simulation.

5. Post pre-simulation work for students to complete at least two weeks prior to the scheduled simulation that includes:

a. Patient chart for students to review.
b. Scenario instructions.
c. Pre-simulation worksheet to be completed in small groups. Students are encouraged to give peer-to-peer feedback while completing pre-work.
d. Communication tool for SP feedback. Refer to Communication Tool Options.

6. On the day of the simulation, faculty should facilitate the simulation encounter:

a. Remind students about timing of simulation and debriefing session.
b. Faculty should have cameras off so students may interact with the standardized patient without the faculty on screen. Faculty may observe the interaction with the camera off.
c. Remind the students they are not being graded on disease management knowledge during the encounter. Rather, they are being evaluated on their professionalism and should focus on communication and shared patient-provider decision-making.
d. After participating in the simulation encounter, the student groups then begin the SP feedback session. Refer to SP Feedback Training Manual

i. SP feedback should be grounded in an objective communication tool. Refer to communication tool options.

ii. Immediately after the simulation, the SP should direct students to pause for five minutes. Both the SP and the students should reflect on performance based on the expectations of the specific communication tool. Then, students and faculty can engage in feedback conversation. Refer to SP Training Manual for guidance on SP-driven communication feedback training.

7. Faculty led a 1-hour group debriefing session(s):

a. Faculty should utilize corresponding debriefing scripts to guide conversations. Refer to scenario-specific debriefing scripts.
b. Faculty should utilize an evidence-based debriefing format to enhance conversation and encourage faculty and peer-to-peer feedback. Many options are available.
c. Please note, faculty submitting this resource prefer “The PEARLS Healthcare Debriefing tool” (Bajaj, Meguerdichian et al. 2018).

8. Post-simulation work:

a. After the simulation, students will complete the note template. The note template is a modified SOAP note with only the Assessment and Plan portion. They will turn this in within a day of the simulation encounter. Refer to modified SOAP Note Template.
b. Students should then compare their modified SOAP note with the Exemplar SOAP note by completing a written self-reflection by writing similarities and differences. Refer to the scenario-specific Exemplar SOAP note(s) and Written Self-Reflection Prompts.
c. Faculty should use the provided rubric (checklist) to grade the post-simulation work. Refer to grading rubric.

Integrative Learning Strategies

This simulation is meant to be utilized as an experiential learning encounter with purposeful and structured multisource feedback (Kolb, 2015). Students apply clinical knowledge and therapeutic communication skills in a setting that mimics a real-life patient encounter. Students will then receive feedback from several sources: the standardized patient, peers, faculty, and themselves.

Assessment Strategies

Multisource feedback
a. SP feedback: Feedback conversations based on established communication expectations occur immediately after simulation while students are in small groups.
b. Faculty feedback: Faculty feedback occurs during debriefing sessions using established debriefing format.
c.Peer feedback: Students are encouraged to give peer-to-peer feedback while working on pre-work and during group debriefing sessions.
d. Self-feedback: Students will engage in guided self-reflections when they compare their written modified SOAP note with exemplar modified SOAP note.
Grading

a. Grades are assigned based on engagement and effort as this assignment is intended to be a summative learning experience.
b. Faculty should use the provided rubric (checklist) to grade the simulation experience. Refer to grading rubric.

Exemplars

N/A

Appropriate Courses

Adult disease management courses which occur before students enter preceptor-led clinical rotations.
- Courses should include didactic content covering simulation topics (for example, cardiovascular risk, hypertension management, chronic obstructive pulmonary disease, etc).
- Didactic content should be timed before corresponding simulation experience.

Additional Resources/Publications

Bajaj, K., M. Meguerdichian, B. Thoma, S. Huang, W. Eppich, and A. Cheng. 2018. "The PEARLS Healthcare Debriefing Tool." Academic Medicine 93 (2): 336.

Burt, L., S. Fitz, and B. Kiser. 2024. In press. *JAANP*.

Engerer, C., P. O. Berberat, A. Dinkel, B. Rudolph, H. Sattel, and A. Wuensch. 2016. "Integrating 360° Behavior-Orientated Feedback in Communication Skills Training for Medical Undergraduates: Concept, Acceptance and Students' Self-Ratings of Communication Competence." BMC Medical Education 16 (1): 271.

Engerer, C., P. O. Berberat, A. Dinkel, B. Rudolph, H. Sattel, and A. Wuensch. 2019. "Specific Feedback Makes Medical Students Better Communicators." BMC Medical Education 19 (1): 51.

Fitz, S. M., and L. Burt. 2023. "Preclinical Simulation Integrated into a Nurse Practitioner Disease Management Course: Student Perceptions and Learning Outcomes." Journal of the American Association of Nurse Practitioners 35 (8): 461-467.

Kolb, D. A. 2015. Experiential Learning: Experience as the Source of Learning and Development. Upper Saddle River, NJ: Pearson Education, Inc.

Lefroy, J., C. Watling, P. W. Teunissen, and P. Brand. 2015. "Guidelines: The Do's, Don'ts and Don't Knows of Feedback for Clinical Education." Perspectives on Medical Education 4 (6): 284-299.

Sub-competencies for entry-level professional nursing education:

2.1a Demonstrate qualities of empathy.
2.1c Establish mutual respect with the individual and family.
2.1d Promote caring relationships to effect positive outcomes.
2.2b Consider individual beliefs, values, and personalized information in communications.
2.2c Use a variety of communication modes appropriate for the context.
2.2f Demonstrate emotional intelligence in communications.
2.4a Synthesize assessment data in the context of the individual’s current preferences, situation, and experience.
2.4b Create a list of problems/health concerns.
2.4c Prioritize problems/health concerns.
2.4d Understand and apply the results of social screening, psychological testing, laboratory data, imaging studies, and other diagnostic tests in actions and plans of care.
2.5a Engage the individual and the team in plan development.
2.5b Organize care based on mutual health goals.
2.5c Prioritize care based on best evidence.
2.5d Incorporate evidence-based intervention to improve outcomes and safety.
2.5e Anticipate outcomes of care (expected, unexpected, and potentially adverse).
2.5f Demonstrate rationale for plan.
2.5g Address individuals’ experiences and perspectives in designing plans of care.
2.8c Educate individuals and families regarding self-care for health promotion, illness prevention, and illness management.
2.8d Respect individuals and families’ self-determination in their healthcare decisions.

Sub-competencies for advanced-level professional nursing education:

2.1d Promote caring relationships to effect positive outcomes.
2.2g Demonstrate advanced communication skills and techniques using a variety of modalities with diverse audiences.
2.2i Apply individualized information, such as genetic/genomic, pharmacogenetic, and environmental exposure information in the delivery of personalized health care.
2.3h Demonstrate that one’s practice is informed by a comprehensive assessment appropriate to the functional area of advanced nursing practice.
2.4f Employ context driven, advanced reasoning to the diagnostic and decision-making process.
2.4g Integrate advanced scientific knowledge to guide decision making.
2.5h Lead and collaborate with an interprofessional team to develop a comprehensive plan of care.
2.5i Prioritize risk mitigation strategies to prevent or reduce adverse outcomes.
2.5j Develop evidence-based interventions to improve outcomes and safety.
2.8f Develop strategies that promote self-care management.
2.8h Employ counseling techniques, including motivational interviewing, to advance wellness and self-care management.
2.8i Evaluate adequacy of resources available to support self-care management.

Posted: June 4, 2024

Submitted by:

Leah Burt, PhD, Clinical Assistant Professor and Director, Adult-Gerontology Primary Care NP Program, University of Illinois Chicago College of Nursing and University of Illinois College of Medicine, Simulation and Integrative Learning (SAIL) Institute

Sarah Fitz, DNP, Clinical Assistant Professor and Director, Adult-Gerontology Acute Care NP Program, University of Illinois Chicago College of Nursing

Olga Amusina, DNP, Clinical Assistant Professor, University of Illinois Chicago College of Nursing

Bob Kiser, Associate Director, University of Illinois College of Medicine, Simulation and Integrative Learning (SAIL) Institute