3 THEORETICAL BACKGROUND FOR SIMULATION-BASED LEARNING IN
3.2 Characteristics of Meaningful Learning in SBLEs
The concept of meaningful learning was first presented by Ausubel (1968) and later developed by many authors in various contexts (e.g., Ausubel et al., 1978;
Hakkarainen, 2007; Jonassen, 1995; Keskitalo, Pyykkö & Ruokamo, 2011; Löf-ström & Nevgi, 2007; Ruokamo & Pohjolainen, 2000). For Ausubel, Novak and Hanesian (1978), meaningful learning is a process whereby new information is assimilated to what the learner already knows; thus, this approach resembles the constructivist view of learning. In addition, according to this view, both the learn-ing materials and task must be meanlearn-ingful, and the learners must engage them-selves in the meaningful learning process (Ausubel et al., 1978). Later Jonassen (1995) developed Ausubel’s ideas in a more social constructivist direction. Ac-cording to Jonassen (1995), learning in schools and universities should emphasize active, constructive, collaborative, intentional, conversational, contextualized and reflective qualities of meaningful learning. In this study, we have developed those characteristics in a more practice-oriented direction.
The characteristics of meaningful learning used in the present study were chosen because they can be used as a practical aid for healthcare educators in planning, organizing and evaluating learning processes in an SBLE. With these theoreti-cal viewpoints in mind, the facilitator can plan, implement and evaluate the en-tire instructional process in order to enhance the quality of the students’ learning experience. These characteristics can also help us concretize more general learn-ing theories (Karagiorgi & Symeou, 2005) – in this case the socio-cultural theory of learning (Jonassen, 1995; Palincsar, 1998) – as well as bringing issues that are known to enhance learning to the fore (Dolmans, De Grave, Wolfhagen & van der Vleuten, 2005; Merrill, 2002). Through the characteristics of meaningful learning we can emphasize the importance of, for instance, activity, experiences, reflection, knowledge construction, collaboration and situativeness among the things that are im-portant for current learning theories (Dolmans et al., 2005; Laurillard, 2012).
In this study, the fourteen characteristics of meaningful learning are used to describe, foster and evaluate students’ meaningful learning in SBLEs. The special characteristics of students, the learning environment, and the course content are also considered when developing the model based on the characteristics of mean-ingful learning. In the following table (Table 1, adapted from Keskitalo, Ruokamo
& Gaba, 2014), I will present what these special characteristics are, how they can be understood and implemented in these particular learning environments, and why it is important to take them into account. Jonassen (1995) has stated that these characteristics are overlapping and interconnected, and therefore I have cho-sen to precho-sent these characteristics in pairs that are generally overlapping.
Table 1. Characteristics of meaningful learning and their practical implications.
Characteristics 1. Experiential and
2. Experimental What?
Using prior experiences as a starting point for learning(Gibbs, 1988; Kolb, 1984; Zigmont, Kappus & Sudikoff, 2011a), but also having a valuable opportunity to experiment with new tools, devices, situations, roles, theories, etc.before entering the healthcare practice (Gaba, 2004; Cleave-Hogg & Morgan, 2002).
Why?
Former experiences guide our behavior and learning (Carlson, Miller, Heth, Donahoe & Martin, 2010; Dieckmann, 2009b); therefore they should be taken into consideration. Concretely doing and experimenting, as well as making sense of these concrete experiences, is the essential aim of simulation-based learning (e.g., Alinier, 2011; Fanning & Gaba, 2007;
Keskitalo, 2011; 2012).
How?
The environment and tasks make it possible for students to engage in active examination and experimentation. The facilitator takes into account the students’ prior experiences and actively encourages them to use these experiences in learning and in responding to opportunities to acquire new ones (Zigmont et al., 2011a). Students utilize, reflect on, and accommodate prior experiences and engage in acquiring new ones.
3. Emotional What?
Simulation-based learning is designed to generate emotional experiences.
Emotional responses should be taken into account during the debriefing phase (Keskitalo, Ruokamo & Väisänen, 2010; Zigmont, Kappus & Sudikoff, 2011b).
Why?
Emotions are always intertwined with learning (Engeström, 1982;
Immordino-Yang & Faeth, 2010; Schuzt & DeCuir, 2002), especially in simulation-based learning. Emotions affect motivation, but they also have an impact on how students act in the learning environment and what they remember later on (Damasio, 2001; DeMaria et al., 2010; Trigwell, 2012).
Therefore, we should take them into account.
How?
The environment, scenarios and materials are constructed to generate emotions (DeMaria et al., 2010). The facilitator prepares the students for the forthcoming learning event during the introduction and simulator and scenario briefing phases, as well as taking emotional responses into account, e.g., during the debriefing (Dieckmann & Yliniemi, 2012).
Students are willing to engage and reflect on their feelings and consider the influence of their feelings on their motivation, activity, work, etc.
(Dieckmann et al., 2007; Keskitalo et al., 2010).
4. Socio-constructive and
5. Collaborative What?
Students evaluate and accommodate new ideas on the basis of their previous knowledge during the joint learning process (Dolmans et al., 2005; Jonassen, 1995; Keskitalo, 2012; Löfström & Nevgi, 2007; Dieckmann et al., 2007).
Why?
In most cases, simulation-based learning is designed to be a collaborative undertaking. The aim is for students to participate in the enquiry process and gradually accumulate knowledge about the patient’s condition from their previous knowledge, their peers, the patient’s file and the medical investigations, as well as other sources, in order to deliver the correct treatment (Alinier, 2011).
How?
The environment, tasks and materials support students’ knowledge construction and collaboration. The environment can include tools with which knowledge can be retrieved and stored for later use. The facilitator develops tasks that are based on the students’ prior knowledge, conceptions and beliefs and that require collaborative activity (e.g., Fanning & Gaba, 2007). He/she also directs the collaborative activities and knowledge construction. The students participate in the interaction, bringing their knowledge, understanding and skills to the joint activity and discussion. They apply and practice knowledge and skills using different senses, learning strategies, roles, etc. (Merriënboer & Sweller, 2010; Tynjälä, 1999).
6. Active and
7. Responsible What?
The students’ role is active, and the students are responsible for their own learning. The facilitator guides rather than lectures (Fanning & Gaba, 2007;
Issenberg, McGaghie, Petrusa, Gordon & Scalese, 2005; Jonassen, 1995;
2002; Keskitalo, 2011).
Why?
SBLEs are designed to be replicates of real working life (Alinier, 2011;
Issenberg et al., 2005), where treating the patient is the most essential thing to do. The purpose of SBLEs is for students to learn to manage the necessary skills and knowledge in order to work as skillful healthcare professionals. Therefore, we should encourage students to work as they would do in real life.
How?
The environment supports student activity. In addition, the assignments and the learning materials support students’ active information retrieval, evaluation and construction. The facilitator plans meaningful learning activities and encourages the students to apply their knowledge and practice skills during the learning process (Alinier, 2011). The students are active and responsible in the practicing, retrieval, evaluation and application of knowledge as well as in discussion and reflection (Issenberg et al., 2005).
8. Reflective and
9. Critical What?
Critical reflection on one’s own learning, learning strategies, knowledge, skills, attitudes, and the learning environment (Fanning & Gaba, 2007;
Hakkarainen, 2007; Issenberg et al., 2005; Jonassen, 1995; Rudolph, Simon, Rivard, Dufresne & Raemer, 2007).
Why?
Critical reflection on the learning process is often considered to be the most critical phase of simulation-based learning as it enhances the students’ learning (Alinier, 2011; Cook et al., 2011; Dreifuerst, 2012;
Issenberg et al., 2005).
How?
The environment includes things that support the students’ reflection (e.g., a video camera, TV, peaceful and pleasant room, safe atmosphere, competent instructor, etc.). In addition assignments (e.g., a learning diary) can support the students’ reflection. The facilitator supports the students’
reflection by asking questions, specifying, elaborating, guiding, etc. (e.g., Rudolph et al., 2007). The students reflect on their own learning processes and the decision making that was involved in these processes (Dreifuerst, 2012; Rudolph et al., 2007). Students receive and give feedback (Jonassen, 1995).
10. Competence-based and
11. Contextual What?
Learning is contextual; thus learning objectives are simulated through real-life cases and examples that have their origin in working real-life (Alinier, 2011;
Dolmans et al., 2005; Hakkarainen, 2007; Jonassen 1995; Keskitalo, 2011;
2012; Löfström & Nevgi, 2007; Ruokamo & Pohjolainen, 2000).
Why?
Information is best learned when it is taught and practiced in a context that resembles real life (Bransford, Brown & Cocking, 1999). The aim of simulation-based learning is to educate skillful and adult professionals who have the ability to demonstrate the actions and skills needed in real working life (Anema, 2010).
How?
The environment includes authentic tools and devices which are embedded in real-life cases (Alinier, 2011). Content is simulated through real-life cases and presented in a variety of ways and from different perspectives (Dolmans et al., 2005). In addition, the learning objectives are based on the competence that is required in real working life (Harden, Crosby, Davis & Friedman, 1999). The facilitator plans appropriate and sufficiently authentic scenarios for the students’ learning and formulates the learning objectives together with the students, if possible. This engages them better in learning and makes them conscious of the competence they will need to have in the future (Schuzt & DeCuir, 2002; Gibbons, Bailey, Comeau, Schmuck, Seymour & Wallace, 1980).The students try to find out solutions and different perspectives on the issues and compare the learning situation to the real world (Schuzt & DeCuir, 2002; Tynjälä, 1999).
12. Goal-oriented and
13. Self-directed What?
Setting general learning objectives as well as one’s own learning goals and following up on those goals during the learning process (Brockett
& Hiemstra, 1991; Dolmans et al., 2005; Jonassen, 1995; Keskitalo, 2012;
Keskitalo et al., 2010; 2014; O’Shea, 2003; Schuzt & DeCuir, 2002).
Why?
Goals direct our thoughts, behavior and strategies, and without clear goals it is difficult to find ways to solve problems (Dieckmann, 2009b;
Schuzt & DeCuir, 2002). Simulation-based learning is also about educating adult learners who are self-directed and intrinsically motivated by nature (Fanning & Gaba, 2007).
How?
The environment, assignments and materials support the planning, follow-up and evaluation of students’ own learning. In SBLEs, video recordings, discussions, learning diaries, observational ratings, tests, etc. can be used to evaluate learning. The facilitator supports, guides and maintains the students’ learning processes. The facilitator models, encourages and gives timely support. The students set their own learning goals and actively try to fulfill them.
14. Individual What?
Taking into account individual differences; providing individual guidance and feedback(Hakkarainen, 2007; Keskitalo et al., 2010; 2014; McGaghie, Issenberg, Petrusa & Scalese, 2010; Ruokamo & Pohjolainen, 2000).
Why?
Learning is different for each individual (De Corte, 1995), and students also perceive the learning environment differently. Therefore, individual differences should be considered whenever possible (Alinier, 2011;
Zigmont et al., 2011a).
How?
The environment, assignments and materials support different learning styles. The environment can be changed to meet various needs. The facilitator familiarizes him/herself with the students and gives individual feedback and support. The students can train using the strategies that are best suited for them and receive individual feedback from and about their own learning.
The characteristics of meaningful learning can be used to create a good basis for learning. Since they take the approaches of various learning theories into ac-count, they can help to create learning experiences that are more holistic and meaningful. Jonassen (1995) has also stated that learning can also be meaningful even if not all of the characteristics of meaningful learning are present all the time. However, the right combination of these characteristics generally results in more meaningful learning than would result from the presence of only one of the characteristics by itself.
3.3 Previously Developed Pedagogical Models for