Zottmann Jan M, Dieckmann Peter, Taraszow Tatjana, Rall Marcus, Fischer Frank
Klinikum der LMU München, Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany.
Herlev Hospital, Center for Human Resources Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev, Demark.
GMS J Med Educ. 2018 Aug 15;35(3):Doc35. doi: 10.3205/zma001181. eCollection 2018.
In addition to medical facts, medical students participating in simulation-based training are supposed to acquire general knowledge, e.g. heuristics to cope with critical incidents. While active participation is considered a major benefit of this kind of training, a large portion of students' time is often spent observing peers acting in the simulator. Thus, we instructionally supported learners with a collaboration script (i.e., a set of scaffolds that distribute roles and activities among learners in group learning situations) during observational phases of a simulation-based training. Our script was designed to help learners focus on heuristics and to facilitate more (inter-)active participation. We hypothesised that scripted learners would benefit from the instructional support with respect to individual and collaborative learning processes as well as individual learning outcomes. Thirty-four medical students in their 7 to 12 semester participated in this field study with control group design. The independent variable was the collaboration script (with/without). Four voluntary emergency courses with a full-scale simulator were examined. The acquisition of skills related to Crisis Resource Management (CRM) heuristics was one of the learning goals of these courses. The collaboration script induced learners to perform specific activities during and after each observational phase of the training. Further, the script sequenced the order of activities and assigned roles to the learners. Learning processes were measured on an individual level (by means of notes taken by learners during observational phases) and on a collaborative level (by means of learners' comments). Learning outcomes were measured with pre- and post-self-assessment of CRM skills and a brief video-based CRM skills test at the end of the course. The collaboration script had the expected positive effect on individual and collaborative learning processes, leading to an increased focus on heuristic strategies and increased collaborative activity of scripted learners. There was no evidence that the experimental conditions differed regarding the objective measure of individual learning outcomes. However, self-assessment data revealed that students in the control condition perceived a higher improvement of CRM skills throughout the course. We suggest that our script might have helped learners adjust an illusion of their own competency - such an illusion may have appeared in the control group as a result of processing fluency. Findings suggest that simulation-based training in medical education can be enhanced with additional instructional support in the form of collaboration scripts designed to turn observational course phases into more active and better focused learning experiences.
除了医学知识外，参与基于模拟训练的医学生还应获取一般知识，例如应对危急情况的启发法。虽然积极参与被认为是此类训练的主要益处，但学生的大部分时间却常常花在观察同伴在模拟器中的表现上。因此，在基于模拟训练的观察阶段，我们使用协作脚本（即一组在小组学习情境中在学习者之间分配角色和活动的支架）为学习者提供教学支持。我们的脚本旨在帮助学习者专注于启发法，并促进更多（相互）积极参与。我们假设，使用脚本的学习者在个体和协作学习过程以及个体学习成果方面将受益于这种教学支持。34名处于7至12学期的医学生参与了这项采用对照组设计的实地研究。自变量是协作脚本（有/无）。研究了四门使用全尺寸模拟器的自愿急救课程。掌握与危机资源管理（CRM）启发法相关的技能是这些课程的学习目标之一。协作脚本促使学习者在训练的每个观察阶段期间及之后执行特定活动。此外，脚本对活动顺序进行了编排，并为学习者分配了角色。学习过程在个体层面（通过学习者在观察阶段所做的笔记）和协作层面（通过学习者的评论）进行衡量。学习成果通过对CRM技能的自我评估前测和后测以及课程结束时基于视频的简短CRM技能测试来衡量。协作脚本对个体和协作学习过程产生了预期的积极影响，使使用脚本的学习者更加专注于启发式策略，并增加了协作活动。没有证据表明在个体学习成果的客观衡量方面实验条件存在差异。然而，自我评估数据显示，对照组的学生在整个课程中感觉CRM技能有更高的提升。我们认为，我们的脚本可能帮助学习者调整了对自身能力的错觉——由于处理流畅性，这种错觉可能在对照组中出现。研究结果表明，医学教育中的基于模拟的训练可以通过以协作脚本形式提供的额外教学支持得到加强，协作脚本旨在将观察课程阶段转变为更积极且更专注的学习体验。
