Innovation
We have undertaken a 21-year programme of translational research to develop the safeMedicate authentic computer environment that links medication dosage calculation problem-solving (MDC-PS) features & expert real world practice to healthcare mathematics. This facilitates active context-based learning and diagnostic assessment of cognitive competence (knowing-that and knowing-why) when solving dosage calculation problems and sensitizes and encultures the student to the functional competence (know-how and skilled performance) requirements of dosage calculation problem-solving in clinical practice. This provides pre-registration healthcare students and registered healthcare practitioners with an authentic virtual environment that bridges the theory-practice gap & supports knowledge & skills development without harming patients.
What prompted innovation?
The development of the innovation was prompted by the need to address a global patient-safety problem within the domain of MDC-PS competence.
The patient-safety problem: Weeks et al (2013a) cited research reporting how medication errors account for the greatest type of healthcare error recorded worldwide: In the UK, 6,000 medication errors are reported every month and in the USA, 1.5 million people are harmed annually by medication errors. Inadequate staff competence, training & assessment has been blamed for contributing to the errors. Our own research has shown how traditional didactic methods of education and the theory-practice gap contribute to competence errors in MDC-PS.
Defining MDC-PS competence: Weeks et al (2013b) designed a MDC-PS competence model (see Figures 1a & b). Figure 1a (competence descriptors) and 1b (authentic competence requirements) illustrate how MDC-PS education must centre on the consecutive learning & development of three sub-competence domains within authentic environments. Any misconceptions and uncorrected errors in one or more domain will result in a medication error in practice.
Figure 1a & 1b (click on image to enlarge)
Traditional methods for teaching these patient-safety critical skills typically centre on the sole use of word-based problems and mathematics to transmit information on these practice-based skills to students. See Figures 2 and 3 for an example of a typical classroom-based transmission environment and a typical word based dosage calculation problem.
Figure 2 (click on image to enlarge)
Typical classroom-based transmission environment
Figure 3 (click on image to enlarge)
Typical word based dosage calculation problem
Our research indicates that for significant numbers of nursing students, exposure to these environments contributes to conceptual errors (dosage calculation problem-understanding and equation set-up errors) (Weeks et al 2013d); and that this is compounded by the presence of a theory-practice gap (Weeks et al 2013b) and significant numeracy problems existing amongst nursing programme entrants (Weeks et al 2013b; Macdonald et al 2013). Figures 4, 5 and 6 illustrate how authentic learning environments, in stark contrast to didactic transmission environments use: constructivist approaches to support context-based understanding of the derivation of numerical information embedded in clinical dosage calculation objects/artefacts (prescription charts, medication labelling and syringes etc); the detection and picking up of “mathematical dropped stitches”; and the engagement of students in actively constructing knowledge and skills via scaffolded learning and diagnostic assessment of competence in medication dosage calculation problem-solving.
Figure 4 (click on image to enlarge)
Authentic environments: support context-based understanding of the derivation of numerical information embedded in clinical dosage calculation objects/artefacts
Figure 5 (click on image to enlarge)
Authentic environments: support scaffolded mapping of numerical information onto equations for calculating medication dose numerical values
Figure 6 (click on image to enlarge)
Authentic environments: support active learning and diagnostic assessment of conceptual, calculation and technical measurement aspects of MDC-PS competence
Our research has illustrated significant improvement in MDC-PS performance when exposed to authentic learning environments (Weeks et al 2013d); and the achievement throughout a three-year curriculum, of both cognitive and functional MDC-PS competence by pre-registration nursing students when exposed to a combination of learning in safeMedicate and clinical environments (Macdonald et al 2013; Weeks et al 2013e).
What makes innovation different?
This innovation is beginning to fundamentally change the way medication calculation skills are being taught and assessed around the world. Essentially this involves capturing the drug-dosage calculation processes and expert problem-solving practices located in clinical healthcare practice and recreating them in authentic virtual computer and mobile-platform environments. This facilitates the learning, assessment and development of competence in these patient-safety critical skills under near real-world conditions.
The design, development, evaluation and distribution of the safeMedicate environments was articulated via a programme of education translational research that has effectively bridged the two gaps described in the Cooksey Report (2006). The innovative PhD research of Professor Keith Weeks was translated via the knowledge-transfer process into the safeMedicate suite of programs. Subsequently the programs were distributed through Authentic World Ltd, a spin-out company of the University of South Wales & Cardiff University and in collaboration with a series of international partners underwent rigorous international healthcare education technology assessment and evaluation.
Changes in practice
In partnership with NHS Education for Scotland and a specialist healthcare numeracy reference group we undertook a three-year programme of evaluation research and presented our work to the UK professional regulator, the Nursing and Midwifery Council (NMC) (Sabin et al 2013). Subsequently this informed the content of the Essential Skills Cluster for Medicines Management (NMC 2010) for undergraduate pre-registration nurse training in the UK and from 2012 involves the UK wide use of the principles underpinning our MDC-PS rubric and competence model.
Impact
Internationally, in partnership with CAE Healthcare, a leader in healthcare simulation education, we are making a significant impact upon the way in which medication dosage calculation skills are being taught and integrated into healthcare professional curricula across four continents.
We currently have approximately 95,500 registered safeMedicate users in the UK with 60% of universities offering nursing programmes and an increasing number of NHS organisations using the safeMedicate programs. Internationally we have over 25,000 registered users within 67 universities and hospital systems across six countries (UK, USA, Canada, Australia, Qatar, Poland).
Student evaluations of their learning and the efficacy of their learning environments are a critical component of education management. We have presented a grounded theory of how and why authentic learning and assessment environments support the development of medication dosage calculation problem-solving knowledge and skills (Weeks et al 2013e). Our premise on Veni, Vidi, Duci (I came, I saw, I calculated), draws on the student journey through their world of learning these patient-safety-critical skills and emphasises the importance of “seeing” authentic features of MDC-PS in supporting and sustaining competence development.
Dissemination
The outcomes of the translational research underpinning the innovation have been reported within over 50 international publications and conference presentations.
In 2013 Professor Keith Weeks and two international research teams published an eight-paper “Safety in Numbers” series setting out our 21-year programme of education translational research.
- Weeks, K.W., Sabin, M., Pontin, D. & Woolley, N. (2013a). Safety in numbers: An introduction to the Nurse Education in Practice series. Nurse Education in Practice, Volume 13, Issue 2, March 2013, Pages e4-e10.
- Young, S., Weeks, K.W. & Hutton, B.M. (2013). Safety in Numbers 1: Essential numerical and scientific principles underpinning medication dose calculation. Nurse Education in Practice, Volume 13, Issue 2, March 2013, Pages e11-e22.
- Weeks, K.W., Hutton, B.M., Coben, D., Clochesy, J.M. & Pontin, D. (2013b). Safety in Numbers 2: Competency modelling and diagnostic error assessment in medication dosage calculation problem-solving. Nurse Education in Practice, Volume 13, Issue 2, March 2013, Pages e23-e32.
- Weeks, K.W., Hutton, B.M., Young, S., Coben, D., Clochesy, J.M. & Pontin, D. (2013c). Safety in Numbers 3: Authenticity, Building knowledge & skills and Competency development & assessment: the ABC of safe medication dosage calculation problem-solving pedagogy. Nurse Education in Practice, Volume 13, Issue 2, March 2013, Pages e33-e42.
- Weeks, K.W., Clochesy, J.M. & Hutton, B.M (2013d). Safety in Numbers 4: The relationship between exposure to authentic and didactic environments and nursing students’ learning of medication dosage calculation problem solving knowledge and skills. Nurse Education in Practice, Volume 13, Issue 2, March 2013, Pages e43-e54.
- Sabin, M., Weeks, K.W., Rowe, D., Hutton, B.M., Coben, D., Hall, C. & Woolley, N. (2013). Safety in Numbers 5: Evaluation of computer-based authentic assessment and high fidelity simulated OSCE environments as a framework for articulating a point of registration medication dosage calculation benchmark. Nurse Education in Practice, Volume 13, Issue 2, March 2013, Pages e55-e65.
- Macdonald, K., Weeks, K.W. & Moseley, L. (2013) Safety in Numbers 6: Tracking pre-registration nursing students’ cognitive and functional competence development in medication dosage calculation problem-solving: the role of authentic learning and diagnostic assessment environments. Nurse Education in Practice, Volume 13, Issue 2, March 2013, Pages e66-e77.
- Weeks, K.W., Higginson, R., Clochesy, J.M. & Coben, D. (2013e) Safety in Numbers 7: veni, vidi, duci: a grounded theory evaluation of nursing students’ medication dosage calculation problem-solving schemata construction. Nurse Education in Practice, Volume 13, Issue 2, March 2013, Pages e78-e87.
The special edition series of papers is currently available as a collective at: http://www.nurseeducationinpractice.com/content/safety