Retooling Health Assessment: It Takes More Than a Hammer

1. Retooling Health Assessment: It Takes More Than a Hammer Cheryl Wilson MSN, ARNP, ANP-BC

2. Objectives • Understand the gap between knowledge and skill • Identify strategies to bridge knowledge and skill from Advance Health Assessment across to clinical courses • Understand the continuum of simulated learning and how to apply in blended courses

3. Who Am I? • Advanced Registered Nurse Practitioner-Adult Health Board Certified • Instructor Graduate and Undergraduate programs • Disclosure-provide non-compensated consultation as a SME to Shadow Health

5. What were the challenges? • Hybrid course only met 3 times a semester • No simulation integrated into Health Assessment course • Identified a gap between knowledge and skills • Application of skills in the clinical setting

6. Faculty challenges • Use of simulation • Faculty background and training • Preparation for lab • Ratio of faculty to students • Consistency of lab experiences

7. Modalities of Learning • Task Trainers • Digital Clinical Experience (DCE) • Problem Based Learning (PBL) • Clinical Reasoning exercises • Case Studies • Electronic Health Records (EHR) • Observed Structured Clinical Exam (OSCE) • Standardized Patients (SP’s)

8. Digital Clinical Experiences • Students interview the patient for a full health history • Go through full physical exam of each system • Documentation of findings

9. Digital Clinical Experience • Standardized experience • Communication skills • Physical exam skills • Clinical judgment

10. Problem Based Learning • Case presentation in small groups • Provide partial information in history • Students ask additional History questions • Discuss physical exam they would perform • 4-5 differential diagnosis • Match up signs and symptoms from case

11. Observed Structured Clinical Exam • Utilization of standardized patients • Full health history • Focused physical exam • Differential diagnosis • Final course competency-putting all the pieces together

12. Continuum of Simulated Learning • Why Simulation? • Provide opportunities to enhance critical thinking and clinical judgment • Ability to evaluate students effectively • Provide scenarios to enhance learning • Clinical situations possibly encountered in practice and how to work through clinical problems.

13. Continuum

14. Faculty involvement • Role of course coordinator • Integration of simulation • Digital clinical examination • Facilitation of clinical reasoning • Consistency of skills taught across all sections

15. Pedagogical Background • Development of expertise • Clinical competence • Benner (1984) From Novice to Expert

16. Benner, P. (1984)

17. Training • Provide faculty training in integration of the digital clinical experience • How to review results • Synthesize results • Troubleshoot student problems with software application • Weekly schedule of all lab activities • Assigned to each faculty • Resource to prepare for upcoming lab sessions

18. Documentation • Integrated documentation of patient findings within the DCE • Model notes provided in grading rubric • Documentation in EHR of Problem Based Learning group work

19. Strategies • Provide consistent training of all faculty in lab • Integration of simulation throughout the course • Inter-rater reliability of grading and evaluation

20. Conclusion • Re-tooling of the course to integrate simulation and strengthen diagnostic reasoning/clinical judgment skills. • Utilization of multiple modalities of learning • Training of faculty for reliability in evaluation and consistency of delivery • Continuous evaluation of course to improve student learning outcomes

21. References