Innovation
The aim of the innovation was to integrate Augmented Reality (AR) with simulation, alongside other mobile learning technologies within a specific module of the Undergraduate Physiotherapy Programme at Sheffield Hallam University in an attempt to improve authenticity, patient interaction and greater transference to clinical practice.
Computer generated imagery (CGI) and patient videos were superimposed on simulated scenarios via a tablet computer held by the participants to enable students to gain a fuller understanding of the patient’s reported main problems and concerns, as well as observing the patient’s clinical presentation. This augmented reality was embedded alongside intermediate-fidelity simulation to provide students who have little prior clinical experience an authentic simulated scenario in which to immerse themselves. Feedback from staff and students indicated that this provided a much greater patient-centred focus when compared to conventional simulation methods.
In addition to the augmented reality, web-based interactive workbooks were developed with the aim of enabling students to gain a greater understanding of possible therapeutic interventions to help further develop clinical reasoning and decision making in the selection and justification of their chosen therapeutic approach. The interactive web-based work books received an overwhelmingly positive response from students as it provided far more insight into the indications and applications of a wide variety of therapeutic interventions. The interactive workbooks were devised in such a way that students were also able to observe how to introduce and explain the interventions to patients, providing further insight into professional communication.
The range of learning objects was designed to be inclusive and support learners with various learning needs and/or disabilities. A multisensory approach to the format of learning materials was taken and transcription of audio commentary was provided to ensure accessibility.
What prompted innovation?
The aim of simulation in replicating elements of real-world situations to develop learning through action and interaction is well documented (Gaba, 2004, Issenberg et al, 2005), providing an important role in the continuum of managed learning and the development of a safe, effective and more productive healthcare workforce (DH, 2011). However the degree to which participants immerse themselves in the simulated environment is likely to be influenced by authenticity and realism, particularly if those participants have limited prior real-world clinical experience on which to draw. Current intermediate-fidelity simulation facilities require the educator to actively participate in the scenario providing the necessary interaction between the student and the patient. This may act as a barrier when attempting to deliver a realistic clinical scenario. Alternative strategies for providing participants with key interactions whilst increasing the authenticity of simulation were therefore sought within the limited resources available.
In developing the web-based learning and teaching activities, staff considered the Threshold Concepts theory (Meyer and Land, 2003) and hence worked with students to identify key areas within the programme that, when not fully understood, acted as barriers in the transference of theoretical concepts to clinical practice. One key topic area identified was therapeutic interventions in the management of cardiorespiratory illness. Previously, a Word-based workbook requiring a solely student-directed approach was used to support classroom teaching. As a result of student feedback a web-based, interactive workbook containing video examples of a range of interventions with questions to develop understanding and links to wider resources was developed to provide a better balance between supported learning and autonomous learning.
What makes innovation different?
- In developing the web-based, interactive workbook academics worked in partnership with students who co-created, evaluated and further developed the resource.
- The use of AR is an excellent example of inter-professional working whereby technologies can be developed across professional groups and utilised/applied in slightly different ways supporting both profession-specific learning needs as well as wider agendas in support of greater communication, compassion and team working.
- Close collaboration with the Technology Enhanced Learning (TEL) Advisor to discuss the learning aims and objectives enabled appropriate technological resources to be identified to support the pedagogy. Acting as an enabler, the TEL advisor supported academics to develop their own digital literacy skills so that the resources can be developed, amended and updated in a sustainable manner.
Changes in practice
By using additional AR within these intermediate-fidelity simulated environments, not only has it afforded students the opportunity to interact more fully in the scenario and gain key information from their patient directly, it has also enabled the educator the ability to observe the students, rather than having to participate actively within the scenario. This has enabled the educator to identify student attitudes and behaviour towards the simulated patient which can then be explored within the facilitated debrief, incorporating issues such as communication and compassion; key elements identified within the Francis Inquiry Report (2013).
By developing the interactive workbooks, students have reported that they have repeatedly used the resource to support their learning not only within teaching sessions, but also whilst out in clinical practice. As this resource is accessible via a number of different mobile devices and platforms, it has been accessible to all students at times that are appropriate and convenient to them. This has resulted in greater engagement and utilisation of the resource.
Impact
The different resources have been embedded as part of a crossover trial comparing conventional teaching methods with ‘technology enhanced’ teaching methods. The first stage of this work will determine the impact of the resources from a variety of different perspectives:
- knowledge and understanding has been assessed through the use of MCQs
- clinical reasoning and decision making has been assessed through the module’s formal clinically-based assessment
- students’ own assessment as to their level of competence has been measured through the use of a validated self-assessment questionnaire
Additional feedback from students has been sought in the form of focus group interviews exploring the perceived value and impact of these new resources on knowledge acquisition, development of understanding/application of skills and preparedness for clinical practice.
Specific feedback about the web-based resource includes:
“I thought it was really good and really helpful, not only as a demonstration but to also consider learning from a different perspective and creating another method of learning to access.”
“The videos were long enough to contain all the relevant info and a comprehensive demo, as well as professional behaviour, without being too long-winded or becoming tedious.”
“The resource helped my style of learning more than reading a normal textbook.”
Student feedback indicates that learning was furthered by the interactive workbook being created by students for students as it enabled students to better understand the level of knowledge required for their stage of training.
Annual course review and module evaluation have both demonstrated that students value this module above all others due to its level of interaction, realism and preparation for clinical practice.
Dissemination
The work has been disseminated at various national and international meetings:
- Media Enhanced Learning Special Interest Group; 08/02/2013. M. Lindley, R.P. Gissing, E. May. R. Morton
- PELeCON 2013 – Digital Learnscapes: Meeting Future Challenges; 11/04/2013. M. Lindley, R.P. Gissing, E. May. R. Morton
- HPSN World 2013 – Building Bridges to Improve Patient Safety; 30/06/2013. M. Lindley, M. Brailsford, D. Clark, R.P. Gissing
Within the organisation the work has been disseminated at numerous Learning, Teaching and Assessment (LTA) staff support/development days.