Section 4: Simulation
243
244
Chapter 16
Stimulating Critical Thinking Through Simulation Amanda Louw, Christopher Dawson, Amanda Andrews and Bernie St. Aubyn
Introduction to Critical Thinking and Simulation As well as passing on factual knowledge, higher education needs to prepare students to fulfil all sorts of active professional roles. In addition to a thoroughly developed repertoire of specific skills, such real-life roles frequently demand further abilities – to engage effectively alongside others in existing practices whilst thinking critically about them, to make quick decisions under pressure, and to build collective learning from shared experiences. These higher-order cognitive abilities cannot be effectively developed in lectures and tutorials, but require hands-on experience. The increasing use of simulations has resulted partly from the arrival of new technologies that make these strategies more practical to use in professional training contexts. The need for their much wider application is made evident by a range of general social and theoretical changes that have taken place over the last century and that are now placing ever more urgent pressures on the whole field of higher education worldwide. The impact of these changes on teaching practices can be brought out by considering the various literatures drawn together by Schatzki (2012:13–14) as “practice theory”. Philosophers influenced by Heidegger or Wittgenstein, sociologists and anthropologists such as Bourdieu and Giddens, as well as other writers in fields such as psychology all emphasise three common themes regarding human practices that Schatzki (2012) identifies: • Practices are social in the sense that they involve many individuals behaving in an organised manner together; • Individual actions, and even our very thoughts, are coloured by and depend on the practices we participate in; 245
Chapter 16
• We are so thoroughly immersed in our practices that it makes no sense to think of individuals as separate subjects trying to understand an objective world. While these ideas are far from new, their direct application to classroom practice in higher education has yet to be completely followed through. We cannot think of ourselves as trying to educate each student in isolation, and, from the student’s point of view, the input from any one teacher means little until it is brought into a collaborative practical context. The need to address the embedding of learning in a practical context has long been recognised (Bonwell & Eison, 1991; Gallo, 1994), and simulations are one tool that has been used to try to get students actively engaged together in their learning. Hopwood et al. (2016) aim to provide what they call a “socio-material” theoretical underpinning specifically for this use of simulation in adult education. They identify the importance of setting up physical circumstances that allow for multiple interpretations, where learning arises from what emerges as a result of many people participating together. This kind of learning cannot take place in lectures, tutorials, traditional fully guided group projects, essays, or online quizzes. It requires the challenge of genuine decisions, with consequences, that the participants must make together, and the freedom to explore unanticipated approaches and negotiate collective responsibility. In this kind of simulated situation, there is a need for critical thinking to emerge. When there is no one right answer and a pressing problem must be faced in a group, everyone’s ideas tend to be welcomed and critically discussed. From Brookfield’s (2012) extensive study of critical thinking in adult students, he was able to identify five frequently repeated themes: • “critical thinking is a social learning process”; • “it is important for teachers to model the process for students”; • “critical thinking is best understood when grounded in very specific events or experiences”; • critical thinking is triggered by “having to deal with an unexpected event”; • “learning critical thinking needs to be incrementally sequenced”. 246
Stimulating Critical Thinking Through Simulation
The chapters in this section of the anthology explore a whole spectrum of ways in which students can be confronted with the kinds of unexpected events from which critical thinking can emerge and how the learning processes involved can be modelled and structured. Given the importance of critical thinking in education, educators should be developing teaching methods that foster this ability. A nurse’s approach to critical thinking is believed to affect the accuracy of the nursing assessment with a direct link to patient care and outcomes (Paans et al., 2012). It is believed that using simulation can simultaneously provide the students with an opportunity for training and promote their critical thinking skills. Simulation has been part of nursing education practice and has appeared in the past 40 years (Nehring & Lashley, 2009). It aims to replace and amplify real experiences with guided ones, which are often immersive in nature. These experiences evoke or replicate substantial aspects of the real word in a fully interactive fashion. The underpinning literature values the benefits of this technique, which include enhanced problem solving and decision-making skills, enhanced interpersonal and communication skills (with a positive effect on team working), and enhanced technical and functional expertise (Moyer, 2016). Simulation-based learning can be the way to develop health professionals’ knowledge, skills, and attitudes whilst protecting patients from unnecessary risk (Lateef, 2010). It is not surprising, given the nature of the nursing role, that this teaching technique is well documented as a successful method of nurse education (Adib-Hajbaghery & Sharifi, 2016). In Chapter 17, Andrews and St. Aubyn demonstrate this in relation to the skill of record-keeping in nursing. Record-keeping is an essential aspect of nursing practice; however, it is not always afforded the time and inclusion in essential nursing care that it requires. They illustrate how, by using a low-fidelity (low-cost, minimal resources) simulation strategy, the importance of accurate record-keeping can be instilled in the clinical practice and in the attitudes of nursing students. An example of a high-fidelity simulation strategy is offered by Louw in Chapter 18 on inter-professional simulation training, involving the medical imaging, emergency medical care, nursing, and medical professions. With the use of sophisticated artificial patient simulators in a highly authentic setting, and supported by knowledge and skills embedded in 247
Chapter 16
the long-term memory of medical imaging students, she illustrates how, without the explicit involvement of the facilitator, students come to insights such as the importance of the specific roles of healthcare team members, and the need for prioritisation and multi-level communication. Although simulation techniques have been most often described in the healthcare education literature, Lateef (2010) describes simulation as a technique for practice and learning that can be applied to many different disciplines, and, in higher education, simulations are being used in various educational courses to reach a variety of learning outcomes. In addition to the applications already highlighted, Dawson describes in Chapter 19 the use of a political hierarchical structure to stimulate creative thinking and the use of the English language among students from diverse language backgrounds. The political and business interactions simulated in that course were not even directly relevant to the material being taught but were chosen purely because they allowed students to engage in the kinds of interaction that would stimulate their full creative involvement in the process of developing the language skills they required. Together, these three chapters illustrate the role of simulation training in terms of its capabilities to incorporate real-world situations and familiar concepts in unfamiliar or stress-laden contexts to enhance students’ critical thinking proficiencies in a variety of educational settings. We demonstrate that simulation training is not, as might be inferred from the available literature, applicable only to health sciences education, but that it is also a valuable teaching strategy in language education. Furthermore, simulation strategies can be tailored to pursue specific learning outcomes that target higher cognitive skills such as critical thinking, teamwork, and multi-level communication. Simulations in education are not necessarily resource bound and can be conducted either in highfidelity settings, which are highly effective but restrictive in terms of the resources needed, or in low-fidelity settings, which are less costly and therefore more easily achievable but can be somewhat less authentic. The achievement of learning outcomes is, however, similar in both high- and low-fidelity settings (Hoadley, 2009). This section of three chapters aims to demonstrate the use of simulation practices to stimulate critical thinking that is both effective and transferable to the wider educational landscape. The authors in this section come from a range of professional backgrounds but have in common their 248
Stimulating Critical Thinking Through Simulation
use of simulation practices to improve their students’ learning experiences and develop their critical thinking and other higher-order cognitive skills as they become proficient in their chosen fields. In all three cases, students were presented with a challenging situation: the pressure of justifying oneself in a courtroom, the need to prioritise patient care, and the task of creating an original project with minimal guidance. The learning outcomes targeted in each of the three cases forced the students to work together collaboratively and creatively and to apply previously acquired knowledge and skills in a novel setting. This resulted in vivid social learning experiences that produced new knowledge through the full engagement of all the students.
About the Authors Dr Amanda Louw is an educator in the Department of Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg, South Africa. She can be contacted at this e-mail: amandal@ uj.ac.za Dr Chris Dawson is a lecturer in English language at Lugano University (Università della Svizzera italiana) and adjunct professor of philosophy at Franklin University, Switzerland. He can be contacted at this e-mail:
[email protected] Amanda Andrews is a senior teaching fellow at the School of Professional Practice at Birmingham City University and is a qualified registered nurse. She can be contacted at this e-mail:
[email protected] Bernie St. Aubyn is a senior lecturer in nursing at Birmingham City University and has also worked as a registered nurse, registered midwife, and a registered health visitor. She can be contacted at this e-mail: bernie.
[email protected]
249
Chapter 16
Bibliography Adib-Hajbaghery, M. & N. Sharifi (2016). Effect of simulation training on the development of nurses and nursing students’ critical thinking: A systematic literature review. Nurse Education Today, Vol. 50, pp. 17–24. Bonwell, C. C. & J. A. Eison (1991). Active Learning: Creating excitement in the classroom. Washington DC: Association for the Study of Higher Education ERIC Clearinghouse on Higher Education. Brookfield, S. D. (2012). Teaching for Critical Thinking: Tools and techniques to help students question their assumptions. San Francisco: Jossey-Bass. Gallo, D. (1994). Educating for Empathy, Reason and Imagination. In K. S. Walters (Ed.) Re-Thinking Reason: New perspectives in critical thinking. Albany: State University of New York Press. Hoadley, T. A. (2009). Learning advanced cardiac life support: a comparison study of the effects of low- and high-fidelity simulation. Nursing Education Perspectives, Vol. 30, pp. 91–95. Hopwood, N.; D. Rooney; D. Boud & M. Kelly (2016). Simulation in Higher Education: A sociomaterial view. Educational Philosophy and Theory, Vol. 48, No. 2, pp. 165–178. Lateef, F. (2010). Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma, and Shock, Vol. 3, No. 4, pp. 348–352. Moyer, S. M. (2016). Large group simulation: Using combined teaching strategies to connect classroom and clinical learning. Teaching and Learning in Nursing, Vol. 11, No. 2, pp. 67–73. Nehring, W. M. & F. R. Lashley (2009). Nursing simulation: A review of the last 40 years. Simulation & Gaming, Vol. 40, No. 4, pp. 528–552. Paans, W.; W. Sermeus; R. M. B. Nieweg; W. P. Krijnen & C. P. van der Schans (2012). Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study. BMC Nursing, Vol. 11, Article 11. Schatzki, T. R. (2012). A Primer on Practices. In J. Higgs; R. Barnett; S. Billett; M. Hutchings & F. Trede (Eds.), Practice-based education: perspectives and strategies, Rotterdam: Sense, pp. 13–26. Sinclair, B & K. Ferguson (2009). Integrating simulated teaching/learning strategies in undergraduate nursing education. International Journal of Nursing Education Scholarship, Vol. 6, pp 1–11.
250
