What do I take home after the simulation? The importance of emergent learning outcomes in clinical simulation

BACKGROUND

Clinical simulation learning includes a debriefing after the simulated experience. Debriefing consists of several stages. In this work we focus on the last stage (summary or transfer phase), in which the participants present the most relevant of what they learned during the session.

OBJECTIVES

To analyze the perception of 4th year Nursing Degree students on the most significant aspects they learned during the simulation sessions.

METHOD

A qualitative, cross-sectional and descriptive study was conducted, with students in their last year of the Nursing Degree at the Catholic University of Murcia. The opinions of 67 students from 5 groups, on the debriefing phase, were analyzed, by comparing them with the objectives that were initially proposed during the design of the scenarios used in the simulations.

RESULTS

A total of 78 clinical scenarios were analyzed, with 292 pre-established learning objectives, on a total sample of 67 students. The participants provided a total of 464 learning outcomes that were significant for them, of which 101 coincided with those that were initially planned (21.8%), while the rest, 363 (78.2%), were considered emergent (not planned a priori). For the most part, the learning outcomes described by the students were technical knowledge and/or skills (70.5%), as compared to non-technical knowledge and/or skills (29.5%).

CONCLUSION

For the most part, the learning outcomes considered by the students to be significant did not correspond with the objectives set a priori in the design of the scenarios. Most were emergent elements, especially those that referred to the technical knowledge and skills. The emergent knowledge must be considered crucial by the educators for the teaching and training of students.

Differential derived stimulus relations across probe-trial versus adduction testing are not a function of comparison-stimulus presentation

The present research assessed whether unreliable derivation of three-node equivalence relations in adduction testing is due to the absence of comparison-stimulus presentation. College students first learned arbitrary-matching-to-sample discriminations (AB, BC, CD, and DE) with Arabic numbers (A), nonsense syllables (B, C, D), and nonrepresentational forms (E) as stimuli. Participants then were exposed to either probe-trial testing or adduction testing. In probe-trial testing, each trial involved one of the four E stimuli (e.g., E1) as a sample and each of the four A stimuli (A1, A2, A3, A4) as comparisons. Successful performance involved participants selecting the corresponding A stimulus in the absence of differential consequences (e.g., A1 in the presence of E1). In adduction testing, each trial involved an arithmetic equation such that successful performance involved combining derived EA relations with simple math skills. Critically, unlike in typical adduction testing, participants were presented with four response options to select from (i.e., comparison stimuli). In probe-trial testing, each participant derived the EA relations, whereas no participant performed successfully in adduction testing. The present findings suggest that the unreliable derivation of three-node equivalence relations in adduction testing is not due to the typical absence of comparison stimuli. The present research challenges experimental psychologists to clarify the role of testing context in identifying the necessary and sufficient conditions that control emergent learning.

Efficiency Is Everything: Promoting Efficient Practice by Harnessing Derived Stimulus Relations

A pivotal skill of practice involves engineering emergent learning. Toward this end, graduate training in applied behavior analysis must emphasize concepts of and research on stimulus relations in order for practitioners to develop these skills.