Clinical judgment is critical to the development of professional knowledge, as it supports the reasoning necessary for nursing practice. However, the literature indicates that a significant number of novice practitioners in health care do not meet entry-topractice expectations for clinical judgment and have difficulty transferring knowledge and theory into practice, regardless of educational preparation and credentials. In the Ontario health-care environment, Internationally Educated Nurses (IENs) are considered novice practitioners. This study explores IENs' experience and understanding of clinical judgment when engaged in a simulated clinical environment and in stimulated recall and reflective practice. The research employs qualitative descriptive openended exploratory and interpretive methods, informed by constructivism and transformative-learning theories. The participants (four IENs, aged 27-37, who were attending a university academic bridging program) participated in three interactive simulated clinical activities using high-fidelity SimMan TM manikins; each simulated activity was followed by a stimulated recall session and a focus group. The simulated activities were videotaped and stimulated recall and focus groups were audiotaped. Tanner's Model of Clinical Judgment was used to guide this process. Thematic analysis uncovered six themes pertaining to IEN's experience and understanding of clinical judgment: the shift from expert to novice, the need to rethink cultural competence and culturally competent care, the acknowledgement that culture and diversity are integral to understanding clinical judgment, the role of communication as a means to understanding clinical judgment, the recognition of unlearning as a way to understanding clinical judgment, and the phenomenon of unknowing as a dimension of understanding clinical judgment.
The current coronavirus disease (COVID-19) pandemic has shifted traditional educational approaches in health professions education (HPE) from in-person to remote learning. Although pedagogical strategies have been developed and implemented rapidly to support cognitive and affective domains of learning in HPE, less progress has occurred in psychomotor skills acquisition. Psychomotor skills, referred to as technical skills training, are underpinned by educational theories and conceptual frameworks. Considering the widening gap in learning domains, this editorial provides an overview and recommendations for developing and implementing remote training supported by educational theories, such as deliberate practice, and conceptual frameworks in technical skills acquisition in HPE. We begin by discussing the unique curricular needs for remote psychomotor skills in medical teaching-learning contexts and subsequently present a theory-driven and evidence-based model for remote psychomotor skills acquisition.
The flipped-classroom format offers students opportunities for engagement and ownership of learning by enabling them to make sense of their views and perspectives and connect their personal and professional experiences. Student engagement and the infusion of active learning are core concepts of the educational process; given the present generation of students' exhibited preference for digital literacy, experiential learning, interactivity, and immediacy, technology is increasingly being integrated into higher education milieus to enhance student involvement and knowledge attainment. Combined with the changing curriculum needs in nursing education today, a core course in the undergraduate program of an Ontario university was recently redesigned through implementation of a flipped-classroom format; experiential teaching/learning approaches were integrated to provide a greater opportunity for application of clinical judgment. The flipped-classroom format included prerecorded lecture modules, online forums and quizzes, unfolding-case studies, a classroom student-response system, and lab activities. Outcomes and recommendations are provided on the basis of this implementation.
The COVID-19 pandemic has dramatically changed how education is delivered worldwide. The resultant rise of e-learning, whereby teaching is undertaken remotely and on digital platforms, has extensively impacted universities and other higher education organizations around the world. One approach to support this change in education delivery is the use of virtual simulation approaches. Our team at SimXSpace has piloted a virtual workshop using Zoom, an online video-conferencing platform, and virtual simulated persons (SPs) to support communication and interpersonal skills among learners. The main objective of the pilot virtual workshop was to develop and implement the SP methodology remotely via the Zoom platform (Zoom Video Communications, San Jose, California) and to evaluate its effectiveness as an immersive environment for simulation. The virtual workshop involved four instructors who intend to implement virtual SPs within their courses, two workshop facilitators, and two SPs. The workshop was conducted synchronously using Zoom features. The workshop followed a predefined structure and was completed as planned. Outcomes suggest that remote simulation delivery using virtual SPs and delivered online via Zoom is feasible and provides an effective environment in which to conduct SP methodology to teach communication and interpersonal skills. The findings suggest that remote simulation and virtual SPs can support experiential education and provide an effective and engaging learning environment. The virtual workshop was successful and laid a foundation for future online training programs for the use of SP methodology. Moreover, it formed an effective outline for subsequent iterations of this virtual training workshop and prompted discussion of plans for future workshops with various programs across a pan-university context.
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