Benefits of and Barriers to the Educational Uses of SBLEs

Simulation-based training has proven to have many advantages (Broussard et al., 2009). It has proven to be effective in measuring participants’ knowledge, skills and behavior (Norman et al., 2012). It has also been noted to have moderate effects on patient-related outcomes (Cook et al., 2011). Students also seem to enjoy this type of training as it provides an opportunity to practice skills and knowledge needed in

the field of healthcare in an experiential and safe way (Cleave-Hogg & Morgan, 2002; Heard, Fredette, Atmadja, Weinstock & Lightdale, 2011). It has also been noted that this type of training enhances students’ confidence (Figueroa, Sepanski, Goldberg & Shah, 2013; Morgan & Cleave-Hogg, 2002; Paskins & Peile, 2010). All of these benefits are eventually expected to improve patient safety (Manser, 2009).

These advantages of simulation-based learning are usually emphasized rather than the disadvantages (Solnick & Weiss, 2007). It is an expensive and time-con-suming educational process involving modern technology, space and personnel re-sources (Zigmont et al., 2011a). Before the exercise can even begin, a great deal of time and effort is required of the facilitator to prepare the learning event (Alinier, 2011). He or she must design or select the appropriate scenario for the students, taking into account the learning objectives and integrating the appropriate medi-cal devices and other technology into the learning event, as well as recruiting role-players if needed (Alinier, 2011; Dieckmann & Rall, 2007). The facilitator must also have many competencies, including sufficient content-related and pedagogical knowledge (Keskitalo, 2011).

Thus, simulation-based training involves barriers that can prove to be a hin-drance to learning. Dieckmann et al. (2012) have found that in the beginning of a simulation-based course, an insecure and stressed facilitator, time management problems, and unclear learning goals can affect the rest of the exercise negatively (see also Zigmont et al., 2011b). In addition, lack of commitment or inactivity on the part of the participants, or an otherwise negative atmosphere, may have unfa-vorable effects on the learning experience.

In their interview study, Dieckmann et al. (2012) also found that during the simulator briefing and scenario phases, insufficient preparation by the facilitator and learners can be a hindrance to learning. In addition, the participants may also be afraid of embarrassment if they are unable to provide the correct treatment.

There can also be technical problems that interrupt or hamper the learning ex-perience. Debriefing is the final phase of simulation-based training. How it goes depends, to a great extent, on the whole simulation experience, the participants’

willingness to engage and reflect, the facilitator’s confidence and his or her ability to guide the discussion during debriefing (see also Fanning & Gaba, 2007; Ru-dolph et al., 2007).

As noted, facilitators play various roles during the simulation exercise from lec-turer to facilitator (Dieckmann & Rall, 2007). Therefore, teaching requires a great deal of sensitivity and perspicacity of the facilitator to adopt the appropriate role at the right time. Furthermore, the facilitator’s own emotions can be a hindrance to the students’ learning, since negative emotions on the part of the facilitator are usually associated with teacher-centered approaches and thus can have a negative effect on the students’ performance (Trigwell, 2012). As noted earlier, high-quality

simulation-based education requires a great deal of the facilitator and students as well, thereby setting requirements for proper instructor training. It is especially im-portant to increase the understanding of educational theories (Keskitalo, 2011; Zig-mont et al., 2011a), as well as how to use methods that allow for participation and activity, and how to facilitate debriefing (Østergaard, Østergaard & Lippert, 2007).

5 RESEARCH QUESTIONS

Based on the theoretical review presented in the preceding sections, the main goal of this research is to answer the following research question:

What kind of pedagogical model supports facilitation and students’ meaningful learning in SBLEs?

The studies included in this dissertation are strongly based on facilitators’ (n = 21) and students’ (n = 136) perspectives of the learning process in SBLEs. Sub-study I comprises interviews with eight healthcare facilitators concerning their concep-tions of teaching and learning, pedagogical models, methods and approaches, as well as educational tools used in SBLEs. The second Sub-study aims to under-stand students’ (n = 97) expectations of the learning process in SBLEs. The goal of Sub-study III is to discover the conceptions of teaching and learning of healthcare facilitators (n = 13) and students (n = 30). Sub-study IV provides the theoretical background for simulation-based learning and presents the first design for a peda-gogical model.

The aim of Study I was to explore healthcare facilitators’ conceptions of and their approaches to teaching and learning in VR and SBLEs. Sub-study I ad-dressed the following research question:

1. What kinds of concepts of teaching and learning, pedagogical models and methods, and educational tools are facilitators using in simulation-based learning environments?

After the first study, I became interested in students’ expectations of the learning process in SBLEs. It seemed important to address healthcare students’ expecta-tions in striving to design a user-friendly pedagogical model for these environ-ments. For this study the following research questions were set:

1. What kinds of expectations do students have concerning TSL (teach-ing, studying and learning) processes and facilitators in simulation-based learning environments?

2. What kinds of expectations do students have of their academic self-per-ception and the atmosphere in simulation-based learning environments?

3. Are there differences between the expectations of adults and those of young students?

Based on Sub-study I and the enthusiasm it aroused, I continued to study health-care facilitators’ and students’ conceptions of teaching and learning in Sub-study III. For this study, I set the following research question:

1. How do healthcare facilitators and students view teaching and learning?

Based on Sub-studies I, II and III, as well as the previously developed pedagogical models and learning theories, the pedagogical model was designed and evaluated in Sub-study IV. We studied five simulation-based courses in Stanford University on the basis of our previously developed model. Our purpose was to detect the charac-teristics of meaningful learning that had not been realized, as well as to deepen our understanding of the model and how it can be applied in healthcare education. For this study, the focal point was to address the following research question:

1. From facilitators’ and students’ perspectives, how do facilitating and training in SBLEs foster meaningful learning by students?

As noted, each of the four sub-studies contributes to the main research task of this study. In the following chapter, I will introduce the research methods that were used during the research process.

6 METHODS

This research includes four sub-studies (see Table 2), which have all contributed to the designing of the pedagogical model for SBLEs in healthcare education. All of the studies have been reported in peer-reviewed international scientific journals.

In this chapter, I present a more detailed description of the research design, in-cluding design-based research and case study approaches, the case studies and the subjects, the research contexts, data collection and data analysis. Overviews, evalu-ations and discussions of the studies are presented in chapters 7 and 8.

Table 2. Summary of the research design.

Aims and Research

Sub-study