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Welcome to the 2012 Phoenix SUN!!
Exercises in Blended Learning
Regina Arnold, MS
Laerdal Medical Corp.
Disclosure Statement
Participants must attend the entire session in order to earn contact hour credit.
Verification of participation will be noted by learner initial/signature on the roster.
Planners and presenters have declared the absence or presence of any real or perceived
conflict of interest which might influence the planning of this activity.
Kelly McKeever has identified the following real or perceived conflicts of interest:
“Regina Arnold” is an employee of Laerdal.
No commercial support has influenced the planning of the educational objectives or the
content of this activity.
If there were any commercial support provided for this activity, it would be used for events
that are not related to continuing education.
There is no endorsement of any product by the provider or NCNA associated with this
It is expected that no presentation will relate to products governed by the Food and Drug
Administration. But, during the course of this activity, if there is discussion related to such
products, FDA-approved and non-approved uses will be disclosed to participants.
Learning Objectives…
• Define Blended Learning
• Value Simulation as a Critical Component of Blended
Learning for Healthcare Learners
• Recall the Components of the Circle of Learning
• Discuss how a Current Lesson Module can be Converted
to a Blended Approach
• Demonstrate operations of HeartCode BLS or ACLS
• Utilize Team Simulation for BLS or ACLS training
• Recall 10 Tips for Successful Blended Implementation
Introduce Yourselves…
• Name
• Where are you from?
• What are your interests in
blended learning?
• What are your expectations for
today’s session?
What is Blended Learning?
“The combination of different training media (ie.,
technologies, activities, and types of events) to create an
optimum training program for a specific audience. The
term “blended” means that traditional instructor-led
training is being supplemented with other electronic
formats” (Bersin, 2004).
Is Medical Simulation a Blended
Dr. David Gaba (2004) has defined simulation as a “
...technique, not a technology, to replace or amplify real
experiences with guided experiences, often immersive in
nature, that evoke or replicate substantial aspects of the real
world in a fully interactive fashion” (p. i2). He describes a
simulator as a “device” that mimics a real patient or a part of the
human body, and that is capable of interaction with the learner.
Blended Learning Curricula Are NOT Successful When
• Consist of flat e-Learning on a page (Reading Text on a
• Consist of random, unlinked activities
• Are instructor – focused
• Were built without deliberate instructional design
• Don’t focus on performance
Blended Implies Content and Concept Integration
• Curriculum Integration
• Increasing Level of Difficulty
• Feedback to Learners
• Repetitive Practice
So Why Should You Implement a Blended Solution?
Faculty/ Program
Increase Performance
Increase Test Scores
Improve Critical Thinking
Improve Patient Outcomes
Reduce Training Cost /
Time Burdens
Standardize Education
Benchmark Performance
Resource for Adjunct
Curriculum Integration
Meet Accreditation /
Oversight Educational
Student Benefits
Engage in Active Learning
Learn via Multiple Learning
Flexible Learning Times
Increase Practice /
Application Time
Improve Critical Thinking
Improve Performance
Improve Test Scores
Develop Adult Learning
Where Are We Today?
How Does Your e-Learning Match Up?
How To Design Simulation – Based Blended Learning
Begin with the End in Mind
• Learning
• Performance
• Critical Thinking Concepts
• Patient Outcomes
• Individual Performance
• Team Performance & Communication
• Environment/ Culture
• Systems Analysis
Benchmark Success – ‘What Does it Look Like?’
Develop Student-Centered, not Instructor-Centered Learning
Set the Students up for Success
Integrate and Weave Concepts through the Blend
Plan the Time to do it Right
“We can only consider what is learned, as being taught.”… Anonymous
Student – Centered Activities
Bloom’s TaxonomyHow Do We Increase
Critical Thinking????
Student – Centered Activities
Laerdal Circle of Learning
A Blended Learning
Knowledge Acquisition
The process of acquiring
or revising knowledge.
List 3 Examples of
Activities for your Blended
Skills Proficiency
The development of
psychomotor skills to master
practical procedures.
List 3 Examples of Activities
for your Blended Approach.
Computer Simulation
The use of a computer program
simulating patients to apply
concepts and integrate decisionmaking and clinical skills.
List 3 Examples of Activities for
your Blended Approach. Hint:
What other forms of computer
simulation exist?
Simulation In Teams
The use of teamwork during a
simulated patient exercise to
experience and practice a realistic
clinical situation.
List 3 Examples of Activities for
your Blended Approach.
Reinforcement - Clinical Experience
Learning through reflecting on
the treatment of real patients,
personal tuition and exchange
of knowledge with colleagues.
List 3 Examples of Activities for
your Blended Approach.
From Learning to Behavior, to Results
Measure, Analyze, Revise, Improve
From Learning to Behavior, to Results
The Kirkpatrick Model of Evaluation
Let’s See It in Action!
Case Study – From the Field
Northwestern Memorial Hospital is an 897-bed tertiary-care urban
teaching hospital. The hospital’s Medical Intensive Care Unit (MICU) is a
20-bed facility that treats approximately 1,500 patients annually.
Medical Residents insert the greatest number of central lines at the
MICU – it is believed that improper technique increases the risk of
catheter-based infections.
The Residency Director hypothesizes that training the residents on a
standardized approach to central line insertion will reduce the incidence
of CBI.
Case Study – Northwestern Hospital
4 – Results
MICU Catheter-based infections (CBIs)
cost approximately $82,000 and 14
additional hospital days.
3 – Behavior Physicians demonstrate inconsistent
approach to performing central line
insertions. Some techniques increase risk
for CBI.
Reduce occurrence of CBIs by 15%.
Reduce CBI costs by $700,000
Physicians perform central line insertions
according to validated process.
2 – Learning No standardized approach. Desired results Score at least 95% on knowledge
warrant standardized approach.
1 – Reaction Nursing staff report frustration with
inconsistent physician approach
assessment and perfect score on at least 2
standardized central line insertion
 95% of course participants would
recommend course to a colleague
Nursing staff report higher satisfaction
Level 4: Results
Today’s Case: Problem Statement
St. Elsewhere Hospital is an 650-bed community hospital with an
Emergency Department as well as primary stroke and heart attack
services. The hospital’s Medical Surgical Unit (Med-Surg) units are large
and are staffed by more than 350 registered nurses. Two nursing schools
in the area have a total of 40 students on the unit every day with clinical
The hospital is renewing its Chest Pain Certification this year, and has
been evaluating cardiac data on all units. The average resuscitation rate
from V-Fib arrests in the hospital is 55%, above the national average.
However, on the med-surg units, it is only 30%. The response time of the
Emergency team is 5 minutes to the unit. Surveys have identified that the
nurses deliver disorganized, ineffective care in the initial minutes of these
The Chief Medical Officer tasks you with designing education to improve
this problem, deliver training to the nurses, and requires all students who
will be on the units to complete the training as well.
Today’s Case – What Does Success Look Like?
4 – Results
Med Surg Resuscitation Rate from Vfib is
only 30%.
Improve Resuscitation Rates to 50% or
3 – Behavior
Rapid Reponse Teams are called, but arrive
to find disorganized care to the patient, often
with no, or incorrect treatment being
provided to the patient.
Nurses and other floor staff will provide
standardized, continuous, and consistent care
to patients who are found unresponsive with
no pulse.
2 – Learning
No standardized approach. Desired results
warrant standardized approach.
1 – Reaction
Nursing staff report frustration with
equipment and not enough practice time
with megacode situations on the unit. Basic
equipment in the patient room is often
Score at least 95% on knowledge
assessment, achieve skill proficiency, and
perform to 95% on two cardiac arrest
scenarios outlined by the American Heart
Association and the hospital resuscitation
 95% of course participants would
recommend course to a colleague
Nursing staff report higher satisfaction
Equipment is standardized and
maintained by ancillary staff
Design for Success
10.5 Tips for Success
1. Begin with backwards design
2. Determine what goes where
3. Build learning communities into the design
4. Set clear expectations & detailed student directions
5. Orient learners to the course / blended learning process
6. Communicate in multiple modes – learning preferences
7. Use a variety of voices / media types
8. Elicit frequent feedback
9. Present a friendly tone
10.Keep organization simple & consistent
10.5 Educators: Revisit, Review, & Revise
- Adapted from K. Teeley, RN: Simmons College
Let’s Design the Blend!
Begin with the End in Mind !!!
(Nursing Education: First 5 Minutes Treatment for Cardiac Arrest)
•Group 1: What Cognitive Topics/ Objectives Need to be Achieved? How
can we use data to convince people this is important training and that
behavior needs to change?
•Group 2: What Skills do the Nurses need to have Competency in? How
would you design the skills competencies?
•Group 3: What Types of Computer Simulation or other Application –
Level activities exist that you will use to reinforce concepts and integrate
skills into practice?
•Group 4: Design 2 Simulations to utilize during Team Training.
•Group 5: What topics would you cover in Debriefing and why? Would
they differ for student nurses and practicing RNs? Why or why not?
•Group 6: How can you continually support Behavior Change after the
•Group 7: How would you evaluate if any systems/ environmental factors
need to be changed to support the new performance standards? How
would you design a program so people maintain their practice skills?
Course Plan & Execution – Rotate Through Skills Stations
Course: First 5 Minutes for Med-Surg Nursing
•Cognitive Activities: Pre-test, Survivor Video Testimonial, Hospital and Unit
Statistics, First 5 Minutes Webinar, Video and Performance Checklist Download,
Policy/Procedure Download, Post-test
•Skills Assessment: Code Cart (Backboard & Defib Pad review), BVM ventilation
of patient, Oxygen devices & flowrates, Calling for help, Patient assessment,
Quality of Compressions (Voice-Activated Manikins and Skill Reporter)
•Students Only: Case Discussion during Class: Michael Swan
•Computer Simulation: Heartcode BLS or ACLS with Skills Competency on voiceactivated manikins for Certification
•Simulation in Teams: Complete two successful simulations as team leader. 1
patient in bed, 1 patient in bathroom
•Debriefing: Major points: Calling for Help Process, Initiating Supine on Flat
Surface or Backboard, Performing High-Quality Chest Compressions
•Reflection (Students): Homework assignment Reinforcement/ Patient Care
(Staff): On-unit reminders, supervisor support, charge nurse bedside debrief at
actual events
•MOC Program set up every quarter for everyone to refresh. Education
reproduced for new hires. Monthly mock codes done on the floor with mobile
simulation. Equipment and policy changes to improve resources for staff
Thank You!!
Bersin, J. (2004). The Blended Learning Book. Pfeiffer: San Francisco.
Cohen, ER, Feinglass, J., Basuk, JH, Barnard, C, O’Donnell, A, McGaghie, WC,
& Wayne, DB. (2010). Cost savings from reduced catheter-related bloodstream
infection after simulation-based education for residents in a medical intensive
care unit. Simulation in Healthcare, 5(2), 98-102.
Gaba, DM. (2004). The future vision of simulation in health care. Quality and
Safety in Health Care, 13 (Suppl 1), 2-10.
Issenberg, SB, McGaghie, WC, Petrusa, ER, Lee Gordon, D, Scalese, RJ.
(2005). Features and uses of high-fidelity medical simulations that lead to
effective learning: a BEME systematic review. Medical Teacher, 27(1), 10-28.
University of Central Florida. (2012). The Blended Learning toolkit, available:
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