“This is important,” adds Moulton, “because students can look at clinical data — for instance, an elevated blood pressure (BP) reading — and put parameters around it. That is acontextual information. Even when BP is elevated, the context can be added with vSim. Now you've got this abnormal BP [and] it has meaning. It's tied to a patient — their age, their medical history, enabling the learner to weigh, in context, when considering this piece of clinical data.”
“What are the connections between situational awareness and clinical reasoning?” Bonsall asks. Defining situational awareness as “perception, comprehension, and anticipation or response,” Moulton says this “mirrors very closely with what clinical reasoning is,” which requires “getting data, assigning meaning to data, and then responding or anticipating a next response. The work in situational awareness that's been done in many other industries can help us respond to certain situations and broaden awareness, gaining more information to make decisions.”
“An example is a pilot's education,” Moulton adds. “They may do a flight simulation, think about what data is coming in, assign meaning to it, and respond in the simulator,” essentially practicing in a safe space. Adds Forneris, “It also creates an opportunity for them to ask questions and double-check the information with somebody else, to get out of that snap decision, being reactionary and taking action right away.”
Recognizing when to ask questions can make learners more cognizant of their situational awareness, stresses Moulton, helping to remove the fear of acting alone. “We can help our learners ask themselves, 'Am I seeing the whole picture? What am I missing?'" If we can help learners develop that inner monologue, they'll be able to pull in a colleague if something is not right and they need help getting down to what's really going on. This helps to avoid tunnel vision,” Moulton adds, because “we lose sight of the bigger picture.”
“Can vSim better prepare learners for Next-Gen NCLEX?” Bonsall probes. “Use of vSim does provide context,” Forneris explains, along with an opportunity for the learner to keep rehearsing, building on the “micro-skills of clinical reasoning,” which include the ability to make a clinical judgment.
“Rehearsing that pattern is something we often, in education, fail to do,” Forneris adds. “We think that if students do this experience once, they've learned it. It is really something you have to practice. vSIM allows that opportunity to go back in and redo it.”
Adds Moulton, “On the exam, we want to evaluate and measure a situation, a story.” This includes “a little vignette, a patient with a history and data, and we ask the learner to respond. Now they're responding to this data in context. Our teaching methods need to match how we're evaluating. We need to teach with analysis and decision-making happening. Simulation and other modalities can help create that practice and rehearsal.”
