Sub-study I: Exploring Facilitators’ Conceptions and Their Approaches

Keskitalo, T. (2011). Teachers’ conceptions and their approaches to teaching in virtual reality and simulation-based learning environments. Teachers and Teaching:

Theory and Practice, 17(1), 131–147.

The starting point for designing the pedagogical model for SBLEs in healthcare was research that aims to understand how the facilitators (n = 8) who have been teaching in ENVI, or have been considerably involved in its development, perceive teaching and learning in an environment like ENVI. The specific aim was to find out on what grounds facilitators based their teaching and what educational tools and pedagogical models and methods they use in their teaching. With that in mind, the purpose was to start building a pedagogical model for these novel learn-ing environments. When startlearn-ing this research, I noticed there was only sparse information available about healthcare facilitators’ conceptions of teaching and learning in SBLEs, compared to the research that was available on higher edu-cation teachers’ and grade school teachers’ conceptions of teaching and learning (e.g., Bruce & Gerber, 1995; Kember & Kwan, 2000; Postareff & Lindblom-Ylän-ne, 2008; Postareff, Lindblom-Ylänne & Nevgi, 2007; Trigwell & Prosser, 1996), which have been studied quite extensively since Roger Säljö (1979) published his first categorization of conceptions of learning. The lack of and consequent need for this kind of research was clear to me and triggered my enthusiasm to study this topic further in Sub-study III (Keskitalo et al., 2011; Keskitalo, Ruokamo, Väisänen & Gaba, 2013).

Analysis of thematic interviews with facilitators revealed that teaching was viewed mostly as a means to facilitate students’ learning. However, the

facilita-tors viewed themselves also as experts of the content knowledge, which they felt was important to disseminate to the students. Furthermore, they often mentioned problems in integrating theoretical and practical knowledge, which facilitators tried to solve by using real-world examples. In this study, the conceptions of ing were more varied among the participants. According to the facilitators, learn-ing occurs through students’ acquisition of knowledge, dolearn-ing, and explorlearn-ing and constructing the knowledge and skills that they will need in their future careers.

Moreover, the participants viewed learning as an individual process.

These conceptions became evident in teachers’ approaches to teaching as well as their utilization of problem-based learning (PBL), which was the most frequently cited pedagogical approach. Simulation-based courses were structured to include an introduction, simulator briefing, scenarios and debriefing phases (Dieckmann, 2009b; Joyce et al., 2002). However, there were also some facilitators who did not mention any of the pedagogical models or methods, but rather based their teach-ing on the student group or the teachteach-ing objectives. In order to emphasize stu-dents’ individuality, the facilitators utilized a variety of pedagogical methods in their teaching. These ranged from lessons to group work and role-play.

In addition to using ENVI in their teaching, facilitators used traditional ed-ucational tools such as written material, PowerPoint slides and network-based learning environments (Optima, LearnLinc, Moodle). In this study, the facilitators really valued ENVI, frequently mentioning that it has brought authenticity to their teaching. In practice, this means that students can put theory into practice in a safe, realistic environment and see how it works without being afraid of making mistakes. Despite the many benefits ENVI has brought, there were also challenges confronted by the facilitators. First of all, facilitators should overcome their own fears related to teaching in the environment; consequently, open-mindedness and desire to develop were mentioned as important characteristics of facilitators. Facil-itators stated that while teaching, they should be familiar with the subject matter and medical technology. Pedagogical knowledge was also considered as important as it helps to actualize the instructional process smoothly. Furthermore, the fa-cilitators stated that fewer students in the class during simulation-based training would be more beneficial for teaching and learning.

One overriding strength of this study was that it provided insights into a rather unexplored topic. In this study, I interviewed eight facilitators, which is a rather small number of participants. However, that was the number of ENVI facilitators available at the time, although simulation-based education tends to be usually rath-er small-scale (Helle & Säljö, 2012). The point of the thematic intrath-erviews was to find out what a particular facilitator knew and thought about this topic (Cohen et al., 2011). In addition, I selected this method because I did not want to restrict the discussion too much. With a thematic interview I was able to modify questions,

ex-plain what I meant, change the wording or ask a new question if the answer of the participant prompted some new ideas or questions (Cohen et al., 2011).

The method of self-reporting is commonly used in educational studies and es-pecially in studies that have tried to detect conceptions of teaching and learn-ing (cf. Kember, 1997). However, this method may not always be the best choice.

First of all, the interview questions may be interpreted differently and the partici-pants may have provided answers to a different question than the one being asked.

Moreover, the analysis is based on the wording of interviewees’ responses, which they may not notice themselves since interviews are usually considered as a two-person conversation (Cohen et al., 2011). To counterbalance the danger of mis-interpretation, I enhanced the trustworthiness of the study by letting participants comment on my interpretations (Graneheim & Lundman, 2004). However, I did not receive any comments that were crucial for my data analysis.

To summarize, this study indicates that healthcare facilitators consider them-selves as facilitators of students’ learning, whereas learning was seen as a more var-ied process. Facilitators had many strategies to execute teaching in ENVI, which featured a student-centered approach to teaching and learning. Participants also highly appreciated the SBLEs. At the same time, simulated environments place demands on facilitators. They have to have strong expertise in the subject matter and in the use of the technology of the environment. Pedagogical knowledge was also considered to be important. The research convinced me that facilitators could benefit from a pedagogical model designed for SBLEs that could guide healthcare educators in designing their teaching, and this could be particularly useful for those facilitators who do not use any pedagogical aids. As these innovative learning envi-ronments are rarely designed with learning theories in mind, they do not necessarily ensure efficient learning (cf. Helle & Säljö, 2012; Hämäläinen & Häkkinen, 2010).

This study started my learning process and was a first step in the development of the pedagogical model for SBLEs in healthcare education. It provided valuable information about facilitators’ conceptions of teaching and learning, and their ap-proaches to teaching as well as knowledge about the pedagogical use of ENVI. In addition, the study provided insights into what kind of support facilitators need for their teaching and, for example, what such a learning environment demands of the facilitators and how facilitators should develop their own expertise. Currently, we do not fully know how learning occurs in this type of environment, nor how to optimize that learning (e.g., Cook et al., 2011; Helle & Säljö, 2012). Thus, this study has contributed to the current discussion about the pedagogical use of simu-lations and has provided guidelines concerning the directions in which we need to take the theory and pedagogical model. For the development of the pedagogical model, this study clearly emphasized the teachers’ roles as facilitators of students learning, which in turn necessitates students’ own activity. Furthermore, this study

brought to the forefront certain features of meaningful learning (e.g., active, indi-vidual, contextual, socio-constructive) as well as the simulation-based learning mod-els (Dieckmann, 2009b; Joyce et al., 2002). As a great motivator and starting point for the development and research process, Sub-study I aroused my curiosity about students’ expectations, which I took into account in the next study (Sub-study II).

7.2 Sub-study II: Students’ Expectations