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Assessing clinical decision making skills using an interactive online tool. Verina Waights & Ali Wyllie Faculty of Health and Social Care COLMSCT CETL Fellows

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Assessing clinical decision making skills using an interactive online tool l.jpg

Assessing clinical decision making skills using an interactive online tool.

Verina Waights & Ali Wyllie Faculty of Health and Social Care COLMSCT CETL Fellows

OU Conference ‘Making Connections’ (30th April 2008) Quality eLearning strand


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Outline

  • Context of Project

  • Overview principles of quality eLearning experience

  • Outline characteristics of CDM tool

  • Demo CDM

  • Findings to date

  • Looking to the future


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Background

  • Nurses make clinical decisions in response to changes in each patient's condition, which may occur within very small time-frames

  • The ability to make clinical judgements depends on both a sound theoretical background and good decision-making skills

  • Clinical decisions are strongly influenced by the context in which they are made (Bucknall 2000)

  • As the complexity of decision tasks increases, so context-specific knowledge determines the effectiveness of decision-making (Botti & Reeve 2003)


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Aims

  • to develop a web-based tool to provide decision-making opportunities, building on Laurillard (2002): who suggests that:

  • ‘Traditional modes of assessment of knowledge are seen as inadequate because they fail to assess students‘ capability in the authentic activities of their discipline’.

  • to assess nursing students’ decision-making skills in a context-driven virtual environment.


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What makes quality eLearning

  • Boud and Prosser’s (2002) principles for designing a high quality learning environment suggests learning activities should:

  • support learner engagement - build on prior knowledge

  • acknowledge the learning context – integral with study

  • seek to challenge learners – active participation

  • provide practice – through individual and/or group activities


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Principles of good feedback practice

  • Nicol and Milligan (2007:72) seven principles of good feedback practice. Principle 6: Good feedback practice ‘provides opportunities to close the gap between current and desired performance’.

  • Boud’s (2000:158) arguments about closing the gap can be viewed in 2 ways:

  • It is about supporting students in the act of production of a piece of work

  • It is about providing opportunities to repeat the ‘task –performance – feedback cycle’.


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Pedagogical approach

  • Based on principles of case-based learning design and experiential learning (Kolb 1984).

  • Students’ options are scaffolded

  • Learning is student - led and asynchronous

  • Feedback is contexual, individualised to student’s learning journey and timely

  • Intention is to assist students to practice in risk-free environment until ready to practice in work setting.


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Research methods

  • Students’ perceptions of their decision-making skills and efficacy of tool will be evaluated through:

  • Individual completion of an online questionnaire to enable quantitative and qualitative evaluation

  • Qualitative output from video observation and ‘Think aloud’ techniques with students’ interacting in the IET Userlab


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Case study: patient with a leg ulcer

  • Realistic: case prepared in collaboration with a practice nurse to mimic reality

  • Relevant: Wound healing and clinical decision-making are integral components of Nursing Programme of study

  • Ethical: consent obtained from the patient and anonymity assured

  • Context: Miss Alice Phelps, an independent 80 year old lady with an ulcer on her left lower leg.


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Case study – patient with leg ulcer


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Narrative

  • The story evolves over a series of consultations depending on the treatment the patient receives.

  • At each stage students consult resources to find out about their patient’s condition then determine the best treatment from 3 available options. Their decisions result in the patient progressing through successive consultations until an end point is reached.

  • They are encouraged to have a second attempt at the maze if their first attempt is unsuccessful.

  • Images of the consultations and patient’s final outcome create a visual narrative within the maze


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Practice Resources

  • The students have a range of media resources to consult:

    • Audios of consultations between the nurse and patient

    • Photos of leg ulcers

    • Instruction sheets on possible treatments

    • Patient charts and records

    • Patient records

    • Laboratory reports

    • Links to the BNF (British National Formulary)


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Reflective Log

  • The Reflective Log captures each decision point and the student’s reasons for their choice.

  • At the end of each attempt the student can review their pathway and reflect on their decisions and reasoning.

  • The final attempt additionally provides author feedback on decision-making at each stage.


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Example Reflective log


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Scoring

  • Scoring at each decision point depends on the type of decision as outlined below and whether it is the first or second attempt:

  • For example:

  • 1st attempt: a 5 b 3 c 0 2nd attempt: a 3 b 2 c 0

  • The final score is an average of the two attempts at the maze.


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Findings to date - score

  • 7 students completed tool/8 students partly completed tool


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Findings to date - questionnaire


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Summary to date

  • Students felt using tool:-

  • Increased their confidence in decision-making and caring for leg ulcers – support learner engagement

  • would assist in their practice – acknowledge the learning context

  • Positive, motivating experience – challenge learners

  • Developed their knowledge and skills - provide practice


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Looking toward the future

  • The approach piloted in this project can be applied in part or whole in other courses, programmes or disciplines.

  • The tool can be combined with other VLE tools, such as online discussion forums and voting tools, to create flexible and collaborative learning and assessment sequences.

  • The Reflective Log can become part of a TMA.

  • Our findings are being used to inform future assessment strategies within HSC. We are particularly interested in: Contextualised CMA questions; Narratives; Embedded multiple media; Case-based CMAs; Decision-Making; Confidence-indicator tool.


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