WEBVTT 00:00:05.180 --> 00:00:08.300 position:50% align:middle - [Angela] If it's okay, I'm gonna follow up just to the question that was 00:00:08.300 --> 00:00:09.310 position:50% align:middle posed to Dr. Moore. 00:00:09.310 --> 00:00:12.170 position:50% align:middle So, what should someone look for? 00:00:12.170 --> 00:00:20.090 position:50% align:middle I always feel like a bit of an imposter when I talk about simulation because I use simulation because it 00:00:20.090 --> 00:00:27.060 position:50% align:middle helps me answer a question, or it helps me to somehow address a problem. 00:00:27.060 --> 00:00:34.710 position:50% align:middle But I have thankfully been indoctrinated because my good friend and current boss happens to be 00:00:34.710 --> 00:00:38.520 position:50% align:middle Pam Jeffries, who has been on some of these landmark studies. 00:00:38.520 --> 00:00:41.620 position:50% align:middle And of course, she has the Jeffries Simulation Model. 00:00:41.620 --> 00:00:48.190 position:50% align:middle She's a member of INACSL and IH, whatever. 00:00:48.190 --> 00:00:52.350 position:50% align:middle IMSH happened last week. 00:00:52.350 --> 00:01:00.220 position:50% align:middle If you look at her work, she has a wonderful model for, how do we make this pedagogically sound? 00:01:00.220 --> 00:01:05.580 position:50% align:middle We make sure that it's learner centered, student centered, that you're measuring outcomes. 00:01:05.580 --> 00:01:14.460 position:50% align:middle She has lots of tools, INACSL has a whole beautiful website for measurement. 00:01:14.460 --> 00:01:17.350 position:50% align:middle And then, of course, a big piece of it is debriefing. 00:01:17.350 --> 00:01:24.980 position:50% align:middle And I will proudly say I am a proud mama because one of my doctoral students was Kristina Dreifuerst who is 00:01:24.980 --> 00:01:28.410 position:50% align:middle also on what I'm reporting out today. 00:01:28.410 --> 00:01:33.750 position:50% align:middle And Kris did debriefing for meaningful learning, so DML. 00:01:33.750 --> 00:01:40.510 position:50% align:middle It's just one approach to debriefing after a simulation, but it's been...it's had a profound impact 00:01:40.510 --> 00:01:47.080 position:50% align:middle on the simulation world, been translated into numerous languages. 00:01:47.080 --> 00:01:50.020 position:50% align:middle But that's just my pitch for simulation. 00:01:50.020 --> 00:01:56.040 position:50% align:middle Now, I'm gonna talk about a simulation study I did, but again, I always feel a bit like an imposter because 00:01:56.040 --> 00:01:59.970 position:50% align:middle by background in training, I'm a child and adolescent psych CNS, 00:01:59.970 --> 00:02:04.100 position:50% align:middle so I'm doing a study on FNPs. 00:02:04.100 --> 00:02:10.870 position:50% align:middle However, one of the things that I heard repeatedly when I was leading our psych program was that our students 00:02:10.870 --> 00:02:17.630 position:50% align:middle were coming back and they were telling me they are not getting the clinical rotations and experiences that 00:02:17.630 --> 00:02:24.360 position:50% align:middle they were looking for and that they thought prepared them for lifespan practice with psych 00:02:24.360 --> 00:02:25.900 position:50% align:middle mental health patients. 00:02:25.900 --> 00:02:33.210 position:50% align:middle And so, when I started really doing this work, and again, influenced by the work of Pam and Dr. Smiley 00:02:33.210 --> 00:02:39.120 position:50% align:middle and all the other wonderful people who have done this work, we started saying, "Gosh, 00:02:39.120 --> 00:02:40.570 position:50% align:middle we really need to look at that. 00:02:40.570 --> 00:02:44.490 position:50% align:middle We need to look at what's happening in clinical, what's not happening in clinical." 00:02:44.490 --> 00:02:51.410 position:50% align:middle And we chose FNPs predominantly because they're the largest practitioner across the country. 00:02:51.410 --> 00:02:56.650 position:50% align:middle And almost every program across the U.S. also has FNP programs. 00:02:56.650 --> 00:03:02.660 position:50% align:middle So, I am really excited to share some of this with you today. 00:03:02.660 --> 00:03:04.260 position:50% align:middle So, this study was funded in 2020. 00:03:04.260 --> 00:03:09.960 position:50% align:middle It was supposed to go to 2022, but like everything that the pandemic interrupted, 00:03:09.960 --> 00:03:11.840 position:50% align:middle we had to have a no-cost extension. 00:03:11.840 --> 00:03:21.160 position:50% align:middle So, thank you to NCSPN for both funding this and giving us a little bit more time to get the sample size 00:03:21.160 --> 00:03:22.290 position:50% align:middle that we needed. 00:03:22.290 --> 00:03:29.260 position:50% align:middle So, the study purpose here was that we wanted to test the effects of using screen-based virtual sim 00:03:29.260 --> 00:03:37.270 position:50% align:middle on attaining mastery of concepts in the domains of assessment, diagnosis, treatment, and evaluation, 00:03:37.270 --> 00:03:42.480 position:50% align:middle and across the populations of peds, adults, and gero, because again, these were FNPs and these 00:03:42.480 --> 00:03:46.350 position:50% align:middle are graduate expectations. 00:03:46.350 --> 00:03:52.070 position:50% align:middle And similarly to Dr. Moore, you know, we're facing some of the same issues in the U.S. 00:03:52.070 --> 00:03:56.670 position:50% align:middle as she noted abroad, and those are lack of clinical sites, 00:03:56.670 --> 00:03:58.430 position:50% align:middle lack of preceptors. 00:03:58.430 --> 00:04:02.940 position:50% align:middle And especially at the time the study was launched, we didn't know that it was going to happen, 00:04:02.940 --> 00:04:09.760 position:50% align:middle but the huge disruption and interruption that the pandemic caused was also 00:04:09.760 --> 00:04:13.000 position:50% align:middle impacting clinical experiences. 00:04:13.000 --> 00:04:20.470 position:50% align:middle I would say specifically what we were hearing from our students was that they were relegated to standing 00:04:20.470 --> 00:04:22.290 position:50% align:middle up COVID clinics, doing testing. 00:04:22.290 --> 00:04:29.060 position:50% align:middle They weren't getting to see peds almost ever, weren't getting to see gero patients almost ever. 00:04:29.060 --> 00:04:35.730 position:50% align:middle But as you'll see when I get to the results of a previous study, that was already going on, 00:04:35.730 --> 00:04:39.540 position:50% align:middle it just was exacerbated by the pandemic. 00:04:39.540 --> 00:04:47.240 position:50% align:middle But one of the things that really concerned me was that the variability and the lack of experiences in these 00:04:47.240 --> 00:04:52.670 position:50% align:middle clinical rotations created an equitable learning environment. 00:04:52.670 --> 00:05:01.960 position:50% align:middle So, our students weren't all emerging with the things that they knew to have safe patient practices and care. 00:05:01.960 --> 00:05:10.120 position:50% align:middle So, the results from a study that we had just completed where Chris was the PI and I was co-PI, 00:05:10.120 --> 00:05:17.290 position:50% align:middle really showed both the variability and the lack of clinical experiences that was happening nationwide. 00:05:17.290 --> 00:05:21.420 position:50% align:middle So, as a background to understand the current study that I'm gonna share with you, 00:05:21.420 --> 00:05:23.840 position:50% align:middle I really have to go back a step. 00:05:23.840 --> 00:05:31.460 position:50% align:middle So, the purpose of this study, again, thank you, NCSBN, who funded this, was to develop an in-depth 00:05:31.460 --> 00:05:39.350 position:50% align:middle understanding of FNP students' clinical experiences that was occurring during their education. 00:05:39.350 --> 00:05:47.560 position:50% align:middle We recruited students in their final clinical rotations from across the country, from accredited NP programs, 00:05:47.560 --> 00:05:52.089 position:50% align:middle and we had a final sample of 3,946. 00:05:52.089 --> 00:06:04.250 position:50% align:middle We collected data from them on the types, frequency, and depth of direct patient care experiences on the 84 00:06:04.250 --> 00:06:11.040 position:50% align:middle specific tasks across the 4 domains, as well as across the 3 populations. 00:06:11.040 --> 00:06:17.410 position:50% align:middle So, what we found in that study was across the three populations, the most common tasks students 00:06:17.410 --> 00:06:25.700 position:50% align:middle reported never, never experiencing, or rarely, which was one to two, 00:06:25.700 --> 00:06:31.140 position:50% align:middle were performing a mental health assessment, ordering diagnostic tests, 00:06:31.140 --> 00:06:38.660 position:50% align:middle performing primary care procedures like wart removal, and evaluating treatment and educational outcomes 00:06:38.660 --> 00:06:40.660 position:50% align:middle related to chronic pain. 00:06:40.660 --> 00:06:51.100 position:50% align:middle Again, these are kind of pretty normal things that you would think an FNP would be able to do upon graduation. 00:06:51.100 --> 00:06:57.040 position:50% align:middle And just a quick aside, at the time, I had a doctoral student who was an FNP, who had, 00:06:57.040 --> 00:07:03.730 position:50% align:middle upon graduation, immediately started working with pediatric mental health patients, 00:07:03.730 --> 00:07:06.850 position:50% align:middle and he felt completely unprepared to do that. 00:07:06.850 --> 00:07:09.350 position:50% align:middle And so, this all resonated very much with him. 00:07:09.350 --> 00:07:14.740 position:50% align:middle And so, he did a secondary data analysis of our dataset. 00:07:14.740 --> 00:07:22.010 position:50% align:middle And what he found was that almost 30%, it was almost nearly 1200 people, 00:07:22.010 --> 00:07:28.190 position:50% align:middle these FNP students who were at the end of their clinical rotations, at the ends of their programs, 00:07:28.190 --> 00:07:34.930 position:50% align:middle getting ready to graduate in the next couple of weeks, reported experiencing 2 or fewer pediatric mental 00:07:34.930 --> 00:07:38.340 position:50% align:middle health assessments during their entire clinical rotation. 00:07:38.340 --> 00:07:44.730 position:50% align:middle And more than half of these happen to have been required to set up their own clinical rotations. 00:07:44.730 --> 00:07:47.420 position:50% align:middle So, just kind of a aside. 00:07:47.420 --> 00:07:54.940 position:50% align:middle So, anyway, based on these findings as well as the research literature, what we proposed to NCSBN, 00:07:54.940 --> 00:08:02.320 position:50% align:middle and was funded, was that we were going to evaluate the use of 70 hours of screen-based clinical 00:08:02.320 --> 00:08:07.320 position:50% align:middle simulation experiences, and compare those to 70 hours of traditional 00:08:07.320 --> 00:08:09.340 position:50% align:middle precepted clinical experiences. 00:08:09.340 --> 00:08:13.850 position:50% align:middle And we are going to measure a mastery of assessment, diagnosis, treatment, 00:08:13.850 --> 00:08:17.880 position:50% align:middle and evaluation across the lifespan. 00:08:17.880 --> 00:08:19.860 position:50% align:middle So, these were our research questions. 00:08:19.860 --> 00:08:24.730 position:50% align:middle Are there differences in improvement on those domains? 00:08:24.730 --> 00:08:35.820 position:50% align:middle And what was the likelihood of attaining proficiency in those domains and in those populations? 00:08:35.820 --> 00:08:40.320 position:50% align:middle We used a quasi-experimental design with pre and post-intervention measures, 00:08:40.320 --> 00:08:47.070 position:50% align:middle and students volunteered for either the experimental or control arm, and they entered the study 00:08:47.070 --> 00:08:50.610 position:50% align:middle after completing their required 500 hours for certification. 00:08:50.610 --> 00:08:54.390 position:50% align:middle So, we didn't touch those 500 hours. 00:08:54.390 --> 00:09:02.200 position:50% align:middle The program sites or the school sites each had programs that at least included 600 clinical hours, 00:09:02.200 --> 00:09:10.300 position:50% align:middle but not more than 700 so that we could tap into those extra hours and not get [inaudible 00:09:09] at us that 00:09:10.300 --> 00:09:17.680 position:50% align:middle we were trying to in any way take over any of those 500 clinical hours. 00:09:17.680 --> 00:09:24.430 position:50% align:middle So, again, they volunteered and they completed these 70 hours of virtual sim over 5 weeks. 00:09:24.430 --> 00:09:31.390 position:50% align:middle So, we selected 25 patients, and they had 5 patients per week with a 2-hour 00:09:31.390 --> 00:09:34.160 position:50% align:middle debriefing at the end of the week. 00:09:34.160 --> 00:09:41.540 position:50% align:middle We ended up running the intervention 13 times, starting in the spring of 2021 and finishing in spring 00:09:41.540 --> 00:09:44.390 position:50% align:middle of 2023 to obtain our sample. 00:09:44.390 --> 00:09:49.790 position:50% align:middle We had some difficulty in recruiting for the virtual component, which we were surprised at. 00:09:49.790 --> 00:09:51.790 position:50% align:middle We figured people would love it. 00:09:51.790 --> 00:09:54.900 position:50% align:middle They can learn from their home, they can do it. 00:09:54.900 --> 00:10:00.970 position:50% align:middle You know, we said you had to have the cases done between Sunday and Thursday so that we could have the 00:10:00.970 --> 00:10:05.460 position:50% align:middle data analytics for our debriefers for Friday debriefing. 00:10:05.460 --> 00:10:08.550 position:50% align:middle But we thought, you know, we had it open, you could do it whenever you wanted, 00:10:08.550 --> 00:10:10.070 position:50% align:middle you could do all of them at the same time. 00:10:10.070 --> 00:10:13.800 position:50% align:middle You could do them one each day, however it worked for you. 00:10:13.800 --> 00:10:21.320 position:50% align:middle But what we learned was that the disruption that the pandemic caused was because they were relegated to not 00:10:21.320 --> 00:10:28.610 position:50% align:middle really practicing and learning across the lifespan, they felt like they were not ready for practice and 00:10:28.610 --> 00:10:31.640 position:50% align:middle wanted some additional time with direct patient care. 00:10:31.640 --> 00:10:34.840 position:50% align:middle So, we had to extend the study, but it was fine. 00:10:34.840 --> 00:10:39.230 position:50% align:middle We ended up getting close to the sample size that we wanted. 00:10:39.230 --> 00:10:43.310 position:50% align:middle But again, based on that previous study that I shared at the beginning, we chose our 00:10:43.310 --> 00:10:45.790 position:50% align:middle cases very, very intentionally. 00:10:45.790 --> 00:10:52.910 position:50% align:middle And we ended up with 40% peds, adolescent, 40% gero, and then 20% adult. 00:10:52.910 --> 00:10:59.640 position:50% align:middle And we tried to select also based on those domains that we saw where they were struggling, 00:10:59.640 --> 00:11:05.820 position:50% align:middle if they didn't get assessment, if they didn't have a lot of interaction with EHR, 00:11:05.820 --> 00:11:15.760 position:50% align:middle and the ability to both choose test and then implement an evaluation plan based on what they had decided to do 00:11:15.760 --> 00:11:17.240 position:50% align:middle with their patients. 00:11:17.240 --> 00:11:23.900 position:50% align:middle They also had increasing level of complexity and difficulty as they went through the five weeks. 00:11:23.900 --> 00:11:27.840 position:50% align:middle So, here's where I think nursing sometimes really struggles. 00:11:27.840 --> 00:11:36.160 position:50% align:middle We couldn't find a really good measure to...and we were interested in critical thinking and clinical learning 00:11:36.160 --> 00:11:39.620 position:50% align:middle and reasoning, and we couldn't find a really good measure. 00:11:39.620 --> 00:11:42.690 position:50% align:middle So, we chose the diagnostic readiness test, or DRT. 00:11:42.690 --> 00:11:50.540 position:50% align:middle And if any of you are involved in NP education, you know Berkeley and his whole gamut of products. 00:11:50.540 --> 00:11:52.380 position:50% align:middle It was an okay measure. 00:11:52.380 --> 00:11:54.910 position:50% align:middle If I had to do it again, I probably wouldn't choose this, 00:11:54.910 --> 00:11:56.230 position:50% align:middle but it was an okay measure. 00:11:56.230 --> 00:11:58.760 position:50% align:middle It went across the domains. 00:11:58.760 --> 00:11:59.800 position:50% align:middle It's proctored. 00:11:59.800 --> 00:12:02.360 position:50% align:middle They were wonderful to work with. 00:12:02.360 --> 00:12:04.750 position:50% align:middle They let us have it for free. 00:12:04.750 --> 00:12:08.650 position:50% align:middle And so, I think honestly, that was why we were able to get our control group, 00:12:08.650 --> 00:12:10.610 position:50% align:middle because we did pre-post. 00:12:10.610 --> 00:12:12.820 position:50% align:middle We did it seven weeks in between. 00:12:12.820 --> 00:12:18.140 position:50% align:middle They could use it to direct what their clinical rotations were...what they were doing in their 00:12:18.140 --> 00:12:21.820 position:50% align:middle clinical rotations, said, "Hey, take this to your preceptor. 00:12:21.820 --> 00:12:25.430 position:50% align:middle Show them where you have some areas of concern. 00:12:25.430 --> 00:12:28.660 position:50% align:middle Let them use that as a tool to guide your rotations." 00:12:28.660 --> 00:12:34.370 position:50% align:middle They also took it at the very end of their program along with our intervention group, 00:12:34.370 --> 00:12:38.180 position:50% align:middle and it was a roadmap for getting ready to study for their certification exam. 00:12:38.180 --> 00:12:40.520 position:50% align:middle So, I think that's why we got our control group. 00:12:40.520 --> 00:12:43.350 position:50% align:middle And I'm thankful for Berkeley. 00:12:43.350 --> 00:12:46.860 position:50% align:middle But as a measure, I would not recommend it to others to use. 00:12:46.860 --> 00:12:48.670 position:50% align:middle There's other things that you can use. 00:12:48.670 --> 00:12:54.550 position:50% align:middle So, again, we administered it a week before the intervention and a week after the intervention 00:12:54.550 --> 00:12:56.780 position:50% align:middle to both groups. 00:12:56.780 --> 00:12:58.050 position:50% align:middle So, our sample. 00:12:58.050 --> 00:13:03.290 position:50% align:middle Our final sample was 98 in the experimental, 80 in the control. 00:13:03.290 --> 00:13:09.040 position:50% align:middle And, you know, if you look at the demographics, pretty much it looks like everybody in your own NP, 00:13:09.040 --> 00:13:11.830 position:50% align:middle and specifically FNP programs. 00:13:11.830 --> 00:13:16.340 position:50% align:middle Mean age was just at 34 years, mostly female. 00:13:16.340 --> 00:13:19.320 position:50% align:middle Highest degree was predominantly bachelor's. 00:13:19.320 --> 00:13:26.100 position:50% align:middle We had a few masters prepared, predominantly white and non-Hispanic. 00:13:26.100 --> 00:13:28.470 position:50% align:middle So, back to my first research question. 00:13:28.470 --> 00:13:33.140 position:50% align:middle I want to know if there was gonna be differences in improvement scores on the domains and 00:13:33.140 --> 00:13:35.270 position:50% align:middle in the populations. 00:13:35.270 --> 00:13:38.040 position:50% align:middle So, this is a busy table, and I apologize. 00:13:38.040 --> 00:13:43.570 position:50% align:middle But what it shows is that there were no statistically significant differences between the experimental and 00:13:43.570 --> 00:13:47.850 position:50% align:middle control groups for change in the domain scores from pre to post. 00:13:47.850 --> 00:13:55.340 position:50% align:middle The strongest effect you see was in the lab diagnostic domain with an adjusted Cohen's d of 0.18. 00:13:55.340 --> 00:14:01.680 position:50% align:middle What I want to point out is that both groups did improve over time. 00:14:01.680 --> 00:14:08.500 position:50% align:middle However, neither group means fell in the category of strong performance according to the DRT. 00:14:08.500 --> 00:14:11.870 position:50% align:middle That would indicate mastery of material. 00:14:11.870 --> 00:14:17.280 position:50% align:middle And again, these are people getting ready to graduate within a couple of weeks. 00:14:17.280 --> 00:14:25.360 position:50% align:middle And most post scores were at or just below fair performance. 00:14:25.360 --> 00:14:31.900 position:50% align:middle This table shows that there was a small statistically significant difference from pre to post for the 00:14:31.900 --> 00:14:38.930 position:50% align:middle adolescent population with the control group improving more than the experimental group. 00:14:38.930 --> 00:14:41.760 position:50% align:middle And again, an adjusted Cohen's d of 0.33. 00:14:41.760 --> 00:14:50.100 position:50% align:middle Again, if you look, both groups improved over time, and in the adolescent population, 00:14:50.100 --> 00:14:56.280 position:50% align:middle both group means fell in the category of strong performance indicating mastery. 00:14:56.280 --> 00:14:58.460 position:50% align:middle They started high and stayed high. 00:14:58.460 --> 00:15:05.890 position:50% align:middle So, whatever was going on in those clinical rotations, they were seeing more adolescents than other groups. 00:15:05.890 --> 00:15:09.770 position:50% align:middle We're not 100% sure what was going on, but they stayed high. 00:15:09.770 --> 00:15:15.750 position:50% align:middle The post scores in the pediatric and adult populations were at or just below fair performance, 00:15:15.750 --> 00:15:23.160 position:50% align:middle but geriatric scores fell in the extremely deficient category. 00:15:23.160 --> 00:15:27.650 position:50% align:middle So, the second research question was, are there difference in the likelihood of attaining 00:15:27.650 --> 00:15:32.070 position:50% align:middle proficiency in the domains and in the populations at post-test? 00:15:32.070 --> 00:15:38.460 position:50% align:middle This is another busy slide, but it shows that the likelihood of attaining 00:15:38.460 --> 00:15:46.150 position:50% align:middle proficiency in the domains and populations between the experimental and control groups on this FNP 00:15:46.150 --> 00:15:48.150 position:50% align:middle diagnostic readiness tests. 00:15:48.150 --> 00:15:54.740 position:50% align:middle So, relative to the control group, the experimental group was likely to attain proficiency 00:15:54.740 --> 00:15:57.250 position:50% align:middle in assessment and diagnosis. 00:15:57.250 --> 00:16:04.820 position:50% align:middle And with adults, the experimental group was likely to attain proficiency in adolescents and geriatrics. 00:16:04.820 --> 00:16:10.120 position:50% align:middle So, these are just likelihoods. 00:16:10.120 --> 00:16:11.780 position:50% align:middle So, what's this all mean? 00:16:11.780 --> 00:16:17.430 position:50% align:middle So, given that the purpose of this study was to compare screen-based simulation and traditional precepted 00:16:17.430 --> 00:16:22.680 position:50% align:middle clinical experiences, what we think is our results indicate that there's no 00:16:22.680 --> 00:16:28.430 position:50% align:middle evidence that simulation is less effective than traditional clinicals in mastering the four 00:16:28.430 --> 00:16:31.240 position:50% align:middle domains and populations. 00:16:31.240 --> 00:16:33.580 position:50% align:middle Now, while some people might say, "Ah, that's not good. 00:16:33.580 --> 00:16:40.410 position:50% align:middle You want to show difference," sometimes we need to make the argument that it is as good as, 00:16:40.410 --> 00:16:43.840 position:50% align:middle and so we're really comfortable with these findings. 00:16:43.840 --> 00:16:48.390 position:50% align:middle So, simulation is as good as traditional clinical precepted. 00:16:48.390 --> 00:16:53.700 position:50% align:middle And not only were there no differences between the groups, but I did want to point out that both 00:16:53.700 --> 00:16:54.760 position:50% align:middle improved over time. 00:16:54.760 --> 00:16:58.190 position:50% align:middle So, that's also positive. 00:16:58.190 --> 00:17:07.550 position:50% align:middle So, in conclusion, we think that we would argue that simulation can be used as a substitute. 00:17:07.550 --> 00:17:09.390 position:50% align:middle Right now it is not. 00:17:09.390 --> 00:17:18.190 position:50% align:middle It can be used as adjunct, it can be used as add-on, but it can't be used as a substitute for NP education. 00:17:18.190 --> 00:17:25.810 position:50% align:middle But given the limited access to quality clinical sites, quality preceptors, all that shrinking, 00:17:25.810 --> 00:17:29.600 position:50% align:middle we have people who live and learn in very rural areas. 00:17:29.600 --> 00:17:34.420 position:50% align:middle They don't have access to either preceptors or clinical sites. 00:17:34.420 --> 00:17:39.940 position:50% align:middle Simulation provides an opportunity, and especially screen-based simulation where all you're 00:17:39.940 --> 00:17:46.520 position:50% align:middle doing is plugging in your computer and you are spending time with that patient, it is accessible. 00:17:46.520 --> 00:17:49.520 position:50% align:middle Moreover, I would argue that it's equitable. 00:17:49.520 --> 00:17:56.960 position:50% align:middle So, simulation, particularly any kinds of simulation, but I would say these kinds of simulation experiences 00:17:56.960 --> 00:18:03.690 position:50% align:middle provide an equitable opportunity for learning, and faculty can create a standardized and consistent 00:18:03.690 --> 00:18:06.800 position:50% align:middle learning environment for all students. 00:18:06.800 --> 00:18:11.430 position:50% align:middle So, finally, the data derived from simulation platforms also can be used. 00:18:11.430 --> 00:18:14.900 position:50% align:middle And that's where I say if I had to do it over again, I would. 00:18:14.900 --> 00:18:15.760 position:50% align:middle We happen to use i-Human. 00:18:15.760 --> 00:18:22.770 position:50% align:middle I don't know if any of you have used the i-Human platform before, but literally every keystroke, 00:18:22.770 --> 00:18:29.100 position:50% align:middle every time you pause and you get into the EHR, every time you look up a lab or a test, 00:18:29.100 --> 00:18:31.540 position:50% align:middle that gets captured. 00:18:31.540 --> 00:18:38.830 position:50% align:middle So, I can go in and I can see exactly how a student navigated the simulation. 00:18:38.830 --> 00:18:45.570 position:50% align:middle The other beautiful thing about this is that all the students saw the same five patients. 00:18:45.570 --> 00:18:51.980 position:50% align:middle And when the faculty debriefed with them at the end of the week, they had also seen those patients. 00:18:51.980 --> 00:18:55.320 position:50% align:middle So, everybody had the same kind of conversation. 00:18:55.320 --> 00:19:01.870 position:50% align:middle It wasn't like, "I was trying to talk to you about, you know, I saw Mrs. Jones and she had, you know, 00:19:01.870 --> 00:19:07.500 position:50% align:middle a cardiac issue and all my peers have no idea what was going on with Mrs. Jones." 00:19:07.500 --> 00:19:09.250 position:50% align:middle It equals the playing field. 00:19:09.250 --> 00:19:11.790 position:50% align:middle It makes really deep conversations. 00:19:11.790 --> 00:19:15.900 position:50% align:middle And anecdotally, I will tell you, our students said that the debriefing, 00:19:15.900 --> 00:19:19.800 position:50% align:middle the 2-hour debriefing each week, so they had a total of 10 hours, 00:19:19.800 --> 00:19:24.150 position:50% align:middle was the most meaningful part of this learning experience for them. 00:19:24.150 --> 00:19:24.880 position:50% align:middle Not surprising. 00:19:24.880 --> 00:19:27.830 position:50% align:middle I mean, we know that from the literature as well. 00:19:27.830 --> 00:19:36.030 position:50% align:middle So, again, if you use the analytics from the platform, it can really drive how you interact 00:19:36.030 --> 00:19:43.390 position:50% align:middle with your students, how you can market and create improvement plans both for your individual students 00:19:43.390 --> 00:19:45.210 position:50% align:middle as well as your program. 00:19:45.210 --> 00:19:53.140 position:50% align:middle And your positive performance can be enhanced and errors can be identified and corrected in the moment. 00:19:53.140 --> 00:19:55.970 position:50% align:middle So, what are the policy implications? 00:19:55.970 --> 00:20:05.350 position:50% align:middle FNP clinical experiences need to have breadth and depth across domains and populations. 00:20:05.350 --> 00:20:10.210 position:50% align:middle And, you know, all the studies that I've done, all the studies that I've read in literature, 00:20:10.210 --> 00:20:15.540 position:50% align:middle we can't assume that students are experienced in learning in traditional clinical settings. 00:20:15.540 --> 00:20:24.690 position:50% align:middle And academic programs need to have valid and reliable competency assessments across these domains and 00:20:24.690 --> 00:20:29.450 position:50% align:middle in patients across the lifespan, and simulation affords us the ability to do that. 00:20:29.450 --> 00:20:38.530 position:50% align:middle So, the competency assessments that come out of simulation data platforms include both cognitive 00:20:38.530 --> 00:20:43.590 position:50% align:middle as well as performance data that we can use to drive change and drive improvement. 00:20:43.590 --> 00:20:50.640 position:50% align:middle And so, finally, I would advocate that simulation should be allowed for and advocated by others, 00:20:50.640 --> 00:20:57.810 position:50% align:middle including the board of nursing, to prepare safe and competent practitioners. 00:20:57.810 --> 00:21:02.780 position:50% align:middle So, a couple pubs from our first study, we're still analyzing the data from our second, 00:21:02.780 --> 00:21:05.130 position:50% align:middle but of course, the first one will be in JNR. 00:21:05.130 --> 00:21:06.410 position:50% align:middle So, look for it. 00:21:06.410 --> 00:21:11.980 position:50% align:middle And thank you to NCSBN for supporting both studies. 00:21:17.987 --> 00:21:20.160 position:50% align:middle Any questions? 00:21:22.756 --> 00:21:28.478 position:50% align:middle - [Woman 1] In your personal opinion, what would you see for percentage of simulation 00:21:28.478 --> 00:21:32.308 position:50% align:middle versus traditional in the programs? 00:21:34.527 --> 00:21:35.060 position:50% align:middle - Oh, yeah. 00:21:35.060 --> 00:21:35.810 position:50% align:middle - [Man] [crosstalk] 00:21:35.810 --> 00:21:37.090 position:50% align:middle - Will do. Here. 00:21:37.090 --> 00:21:38.780 position:50% align:middle - [Woman] Do you mind repeating it? - No. 00:21:38.780 --> 00:21:46.660 position:50% align:middle She asked what percentage that I personally thought should be used in programs. 00:21:46.660 --> 00:21:47.600 position:50% align:middle I don't think... 00:21:47.600 --> 00:21:55.480 position:50% align:middle If any of you were in Linda Aiken's presentation right before lunch, it's not a one-size-fits-all. 00:21:55.480 --> 00:22:01.100 position:50% align:middle And I think it really is demographically driven and probably programmatically driven. 00:22:01.100 --> 00:22:06.350 position:50% align:middle They're going to be some programs that are aligned with, you know, an academic health center and they have 00:22:06.350 --> 00:22:09.940 position:50% align:middle access to all sorts of clinical sites. 00:22:09.940 --> 00:22:17.260 position:50% align:middle There are going to be other learners in rural areas that, you know, they may never see certain types 00:22:17.260 --> 00:22:19.510 position:50% align:middle of patients or certain types of illnesses. 00:22:19.510 --> 00:22:21.440 position:50% align:middle So, I think it's very specific. 00:22:21.440 --> 00:22:29.040 position:50% align:middle And I would say that, you know, assessment needs to be done and look at where students 00:22:29.040 --> 00:22:34.040 position:50% align:middle are having clinicals, where they aren't, what they're learning, what they're not, 00:22:34.040 --> 00:22:37.410 position:50% align:middle and then be able to bring this in. 00:22:37.410 --> 00:22:42.800 position:50% align:middle I don't have the golden answer, but at least it needs to be entertained and thus far 00:22:42.800 --> 00:22:46.890 position:50% align:middle it hasn't been. 00:22:46.890 --> 00:22:49.170 position:50% align:middle Any other questions? 00:22:49.170 --> 00:22:49.530 position:50% align:middle Yes. 00:22:53.774 --> 00:22:56.000 position:50% align:middle - [Michelle] Thank you very much for your presentation. 00:22:56.000 --> 00:22:56.840 position:50% align:middle Hi, everyone. 00:22:56.840 --> 00:22:58.240 position:50% align:middle I'm Michelle Buck from NCSBN. 00:22:58.240 --> 00:23:06.220 position:50% align:middle You know, there's so much we're hearing about sim, and my question to you is, 00:23:06.220 --> 00:23:11.950 position:50% align:middle if you were able to create a program based on what you've studied, would there be a difference, 00:23:11.950 --> 00:23:18.780 position:50% align:middle do you think, in statistical significance if it were longer length of time of exposure for the students, 00:23:18.780 --> 00:23:20.250 position:50% align:middle a different platform? 00:23:20.250 --> 00:23:26.160 position:50% align:middle What do you think the variables would be to have better s scientific statistical significance? 00:23:26.160 --> 00:23:26.510 position:50% align:middle Thanks. 00:23:26.510 --> 00:23:27.350 position:50% align:middle - Great question. 00:23:27.350 --> 00:23:29.920 position:50% align:middle And that's part of my next study idea. 00:23:29.920 --> 00:23:33.440 position:50% align:middle So, I think it is about timing, it is about dosage. 00:23:33.440 --> 00:23:38.860 position:50% align:middle This one, we happen to only do right at the tail end of people's programs. 00:23:38.860 --> 00:23:44.280 position:50% align:middle And I think that there is opportunity to look when, and where, and how much. 00:23:44.280 --> 00:23:51.340 position:50% align:middle And so, you know, integrating that at the beginning maybe would provide some foundation for, you know, 00:23:51.340 --> 00:23:54.400 position:50% align:middle really strong diagnostic reasoning. 00:23:54.400 --> 00:23:59.750 position:50% align:middle I'm really interested in looking at reducing diagnostic error, and where that has to start, 00:23:59.750 --> 00:24:03.190 position:50% align:middle my guess is we need to start early and often. 00:24:03.190 --> 00:24:06.710 position:50% align:middle And so, both the timing and the dosage would be really important. 00:24:06.710 --> 00:24:09.060 position:50% align:middle We just don't have that evidence right now. 00:24:09.060 --> 00:24:11.010 position:50% align:middle That's the next piece that we... 00:24:11.010 --> 00:24:15.760 position:50% align:middle At least this feels like a starting point to say it's as good as. 00:24:15.760 --> 00:24:19.640 position:50% align:middle And so, from here, now we figure out the rest, we figure out when, where, 00:24:19.640 --> 00:24:24.520 position:50% align:middle and how it works best and with what populations. 00:24:24.520 --> 00:24:25.620 position:50% align:middle Yes. 00:24:25.620 --> 00:24:28.410 position:50% align:middle - [Woman 2] How do you get... 00:24:28.410 --> 00:24:33.789 position:50% align:middle because this is different than pre-licensure program, and I'm very much [inaudible]. 00:24:33.789 --> 00:24:40.270 position:50% align:middle But now that I'm on regulatory side, how do you measure those so that they're are doing 00:24:40.270 --> 00:24:43.010 position:50% align:middle quality simulation, reporting the standards? 00:24:43.010 --> 00:24:48.430 position:50% align:middle That is my biggest worry, is seeing it happen in the program. 00:24:48.430 --> 00:24:51.690 position:50% align:middle But also I know the next session will do more regulation. 00:24:51.690 --> 00:24:59.750 position:50% align:middle How are you making sure that these rules are doing what's prescribed, you know, like, best practice? 00:24:59.750 --> 00:25:05.400 position:50% align:middle - Well, for one, on this study, I selected only schools that I knew who were deeply 00:25:05.400 --> 00:25:12.430 position:50% align:middle embedded in best practices and INACSL, and had adopted a model and had adopted DML. 00:25:12.430 --> 00:25:21.160 position:50% align:middle Then because my co-PI is Chris Dreifuerst, we of course spent a lot of time training, checking. 00:25:21.160 --> 00:25:26.130 position:50% align:middle We did lots of DML training with our faculty debriefers. 00:25:26.130 --> 00:25:31.120 position:50% align:middle We did a lot of spot-checking, you know, throughout the study. 00:25:31.120 --> 00:25:35.460 position:50% align:middle So, I think that's key is that there is an adopted framework. 00:25:35.460 --> 00:25:40.580 position:50% align:middle It doesn't have to be a specific one, but it has to be a standardized one, 00:25:40.580 --> 00:25:44.210 position:50% align:middle an evidence-based one. 00:25:44.210 --> 00:25:50.140 position:50% align:middle You know, one of the things with using a screen-based virtual simulation is that those products are 00:25:50.140 --> 00:25:51.440 position:50% align:middle already out there. 00:25:51.440 --> 00:25:56.670 position:50% align:middle And so, you don't have to have faculty trained in using mannequins. 00:25:56.670 --> 00:26:00.710 position:50% align:middle And the scenarios are already developed, the libraries are there. 00:26:00.710 --> 00:26:08.500 position:50% align:middle The downside of that is that you can't tailor those as nicely to nursing as you wanted. 00:26:08.500 --> 00:26:11.090 position:50% align:middle They tend to be a little bit more medical-driven. 00:26:11.090 --> 00:26:13.050 position:50% align:middle Right now we're moving away from that. 00:26:13.050 --> 00:26:19.860 position:50% align:middle A lot of these big companies have started hiring NPs to be scenario writers. 00:26:19.860 --> 00:26:24.650 position:50% align:middle So, there were a couple things that we would find that, hey, we would say nursing would never do that, 00:26:24.650 --> 00:26:25.740 position:50% align:middle or nursing would do that. 00:26:25.740 --> 00:26:27.180 position:50% align:middle That would be a test that we would order. 00:26:27.180 --> 00:26:30.970 position:50% align:middle That's part of, you know, the package that we would do to rule out and 00:26:30.970 --> 00:26:32.320 position:50% align:middle rule in diagnoses. 00:26:32.320 --> 00:26:37.030 position:50% align:middle So, you have to have really strong clinicians. 00:26:37.030 --> 00:26:46.900 position:50% align:middle So, you know, one of my co-PIs is a DNP, who is also an FNP, because me as a PhD, CNS, 00:26:46.900 --> 00:26:47.970 position:50% align:middle I didn't have the skillset. 00:26:47.970 --> 00:26:53.460 position:50% align:middle So, it was kind of a beautiful harmony to work with my DNP colleague who did have that skillset. 00:26:53.460 --> 00:26:59.970 position:50% align:middle So, I think it is all those things and more to just make sure that people are using 00:26:59.970 --> 00:27:02.790 position:50% align:middle it correctly, particularly debriefing. 00:27:02.790 --> 00:27:09.960 position:50% align:middle It is not an extenuation of the clinical day, you know, it has its own reason to be and to do, 00:27:09.960 --> 00:27:10.990 position:50% align:middle and that is not it. 00:27:10.990 --> 00:27:19.014 position:50% align:middle And so, you have to be really careful to follow best practices when you're using this. 00:27:19.014 --> 00:27:27.990 position:50% align:middle - I guess the follow-up to that question is, for the control arm, 00:27:27.990 --> 00:27:33.040 position:50% align:middle so the students who were in their traditional clinical settings, were there trainings for those preceptors or 00:27:33.040 --> 00:27:36.790 position:50% align:middle clinical instructors similar to the way there were for the [crosstalk]? 00:27:36.790 --> 00:27:38.950 position:50% align:middle - They didn't do anything different. 00:27:38.950 --> 00:27:42.240 position:50% align:middle They just did traditional precepted clinical. 00:27:42.240 --> 00:27:47.950 position:50% align:middle And I didn't present it as part of today, but we did both pre and post, a real, 00:27:47.950 --> 00:27:51.270 position:50% align:middle in-depth look at what they were doing in their clinical practices. 00:27:51.270 --> 00:27:54.710 position:50% align:middle So, we knew what was happening in sim because, you know, we arranged that, 00:27:54.710 --> 00:27:57.910 position:50% align:middle but we also asked them what they were doing in their clinicals. 00:27:57.910 --> 00:28:03.430 position:50% align:middle So, you know, were they spending those five weeks with peds or, you know, what they were doing? 00:28:03.430 --> 00:28:05.220 position:50% align:middle So, we were able to capture that. 00:28:05.220 --> 00:28:08.000 position:50% align:middle That can be next year's presentation. 00:28:08.000 --> 00:28:12.110 position:50% align:middle But yes, that was usual standard practice. 00:28:12.110 --> 00:28:20.510 position:50% align:middle We didn't in any way intervene with that. 00:28:20.510 --> 00:28:21.380 position:50% align:middle Okay. 00:28:21.380 --> 00:28:23.003 position:50% align:middle Thank you so much.