ORIGINAL ARTICLE
International Collaborative Faculty Development Program on Simulation-Based Healthcare Education: A Report on Its Successes and Challenges Hyun Soo Chung1, S. Barry Issenberg2, Paul Phrampus3, Geoff Miller4, Sang Mo Je,5 Tae Ho Lim5 and Young Min Kim6 1
2
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea, Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, 3Peter M. Winter Institute for Simulation Education and Research, University of Pittsburgh, Pittsburgh, 4Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, USA, 5Department of Emergency Medicine, Hanyang University College of Medicine, and 6Department of Emergency Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
Purpose: Countries that are less experienced with simulation-based healthcare education (SBHE) often import Western programs to initiate their efforts to deliver effective simulation training. Acknowledging cultural differences, we sought to determine whether faculty development program on SBHE in the United States could be transported successfully to train faculty members in Korea. Methods: An international, collaborative, multi-professional program from a pre-existing Western model was adapted. The process focused on prioritization of curricular elements based on local needs, translation of course materials, and delivery of the program in small group facilitation exercises. Three types of evaluation data were collected: participants’ simulation experience; participants’ ratings of the course; and participant’s self-assessment of the impact of the course on their knowledge, skills, and attitudes (KSA) toward simulation teaching Results: Thirty faculty teachers participated in the course. Eighty percent of the participants answered that they spent less than 25% of their time as simulation instructors. Time spent on planning, scenario development, delivering training, research, and administrative work ranged from 10% to 30%. Twenty-eight of 30 participants agreed or strongly agreed that the course was excellent and relevant to their needs. The participants’ assessment of the impact of the course on their KSA toward simulation teaching improved significantly. Conclusion: Although there were many challenges to overcome, a systematic approach in the adaptation of a Western simulation faculty development course model was successfully implemented in Korea, and the program improves self-confidence and learning in participants. Key Words: Culture, Evaluation, Faculty development, Simulation-based healthcare education
increased [1]. Simulation allows all levels and disciplines
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of healthcare providers to acquire and practice clinical skills to safely perform critical procedures [2,3]. Simula-
Over the past two decades, the use of simulation to
tion allows for training in crisis resource management
improve the quality and safety of patient care has rapidly
and team training in complex clinical environments [4].
Received: June 6, 2012 • Revised: August 15, 2012 • Accepted: August 18, 2012 Corresponding Author: Hyun Soo Chung Department of Emergency Medicine, Yonsei University College of Medicine, 211 Eonjuro, Gangnamgu, Seoul, Korea 135-720 Tel: +82.2-2019-3030 Fax: +82.2-2019-4820 email:
[email protected]
Korean J Med Educ 2012 Dec; 24(4): 319-327. http://dx.doi.org/10.3946/kjme.2012.24.4.319 pISSN: 2005-727X eISSN: 2005-7288 Ⓒ The Korean Society of Medical Education. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hyun Soo Chung, et al : Simulation Faculty Development Program
In addition, various types of simulation activities can be used in medical education for their application to basic
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science [5]. Several factors have led to the growth and utilization of simulation-based healthcare education (SBHE) in
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Korea. Curricula were changed to aim for a more
The authors adapted a multi-professional simulation
immersive and experiential learning and clinical skills
instructor program with the aim of maximizing
evaluations were integrated as part of the national
simulation-based instruction skill acquisition through a
licensing examination. As a result, medical schools
collaborative effort between Michael S. Gordon Center
accreditation included evaluation of a dedicated clinical
for Research in Medical Education (GCRME) at the
skills lab.
University of Miami (www.gcrme.miami.edu), Peter M.
The dissemination of innovation and change in medical
Winter Institute for Simulation, Education and Research
education including SBHE has been influenced by a
(WISER) at the University of Pittsburgh (www.wiser.pitt.
Western bias. Many theoretical and conceptual frame-
edu), and the Korean Society for Simulation in Health-
works, rules and principles, and system development are
care (KoSSH, www.kossh.or.kr). The program was based
rooted from the Western culture [6]. Recently, many
on previously developed course from the two United
institutions and organizations in the Western world have
States centers, GCRME and WISER. The course is a 3-day
begun to offer formal training for the simulation-based
program designed to introduce the fundamental skills and
healthcare educators [7]. However, these faculty de-
abilities for delivering SBHE through a variety of
velopment programs are less prevalent in Korea.
techniques and technologies. The course is designed with
Therefore, countries that are less experienced with SBHE
‘interactive lecture-small group activities-debriefing’
often import Western programs in order to initiate their
format so that reflection and learning with respect to the
efforts for delivering effective simulation training.
learning objectives can take place. The course has been
The goal of this study is to evaluate the impact of an
run in other English speaking Asian countries, such as
international collaborative faculty development program
Hong Kong and Singapore. But this was the first time the
in SBHE by assessing the reaction and learning im-
course was offered in a non-English speaking Asian
provement of participants. We will also describe our
country. A prioritization of the revised curriculum to
experiences and some of the challenges faced in adapting
serve the local needs of Korea was completed to shorten
a cross-cultural faculty development program.
the program. Course materials and handouts were all
Contents of this manuscript were published in a Letter
translated to Korean to provide more comfort and ease
format in the journal Medical Teacher [8]. The manu-
for the participants. Translations were done and
script was also presented as an abstract at the 12th
cross-checked by two members from KoSSH who have
Annual International Meeting on Simulation in Health-
previously attended the United States course. The training
care [9]. The course descriptions are presented again in
was performed by three instructors from GCRME and
this manuscript.
WISER, and two instructors from KoSSH who have previously attended the original United States course, and also completed 1 to 2 years as research scholar
320
Korean J Med Educ 2012 Dec; 24(4): 319-327.
Hyun Soo Chung, et al : Simulation Faculty Development Program
fellowships at GCRME or WISER.
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and open-ended responses. Modified retrospective preand post-course ratings of changes in KSA related to the learning objectives were used, where the participants
The evaluation was grounded on Kirkpatrick's four
answered to both pre- and post-questionnaires simul-
levels model [10]: Reaction (Level 1: measurement of
taneously on-site after the course. Participants were
satisfaction), Learning (Level 2: measurement of learn-
asked to rate their learning on a 5-point score (1=
ing), Behavior (Level 3: measurement of behavior
strongly disagree to 5=strongly agree) for both the pre-
change), and Results (Level 4: measurement of results).
and post-course stages. The questionnaire consisted of
This study focused on evaluating Level 1 and Level 2 of
31-items related to the KSA of a simulation instructor.
the Kirkpatrick’s model.
The questions were developed based on the learning
We collected three types of evaluation data:
objectives developed by the course faculties. Addi-
1) We developed a survey on the participants’ pre-
tionally, questions regarding confidence in the six
course baseline status of simulation experience in-
teaching roles of healthcare educators by Harden &
cluding barriers faced in their work place. It consisted of
Crosby [12], were also assessed using the modified
4 different sections: general information, operation of
retrospective pre- and post-course ratings. All the
simulation center, perceived barriers, and simulation-
questionnaires were developed based on Kirkpatrick’s
based learning as a specialty. A total of 48 items were to
guide for effective training program [10]. A total of 4
be completed by participants online before attending the
individuals with expertise in SBHE evaluated the
course. Questionnaires included multiple choice, open-
questionnaires for content validity.
ended questions, or statements on a 5-point score (1=
Quantitative data were analyzed using SPSS (SPSS Inc.,
strongly disagree to 5=strongly agree). A questionnaire
Chicago, USA) and p-values of ≤0.05 were considered
to measure barriers to implementation was developed
statistically significant. Pre- and post-course comparisons
based on the Consolidated Framework for Implementa-
were calculated by Wilcoxon signed rank test.
tion Research [11].
The study was exempted from the local Institutional
2) Participant’s ratings of the course were obtained using
Review Board. Participation was voluntary and informed
a post-course questionnaire. It consisted of 31-items on
consent was obtained from each participant who returned
reaction to learning objectives responding on a 5-point
a complete questionnaire. Respondent anonymity was
score (1=strongly disagree to 5=strongly agree), and 14-item
maintained throughout the data collection and analysis.
questionnaires regarding the reaction for the overall course responding on a 4-point score (1= strongly disagree to 4=strongly agree). Open-ended questions were asked about
3&46-54
the top three activities that were most satisfactory and least satisfactory for the participants.
Thirty participants completed the course. Twenty-five
3) Participant assessment of the effects of the course
participants responded to the online pre-course survey for
on their knowledge, skills, and attitudes (KSA) toward
the demographic backgrounds (Table 1). The majority of
simulation teaching were obtained with a post-course
the participants’ experience as a simulation instructor was
questionnaire. The items included quantitative ratings
less than 3 years. Educators from various disciplines
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Hyun Soo Chung, et al : Simulation Faculty Development Program
participated in the course: 13 faculties from medical school,
their institution. The roles were instructors (72%), scenario
6 from nursing school, 2 from paramedic school, 2 from
developer (56%), course developer (44%), evaluator (36%),
clinical nursing, 1 coordinator, and 1 administrator. The
director (28%), researcher (16%), and coordinator (12%).
participants had multi-roles as a simulation educator at
Eighty percent of the participants answered that they spend less than 25% of their time as simulation instructors, but
Table 1. Demographics of Participants (n=25) Demographic No. (%) Gender Male 9 (36) Female 16 (64) Age 30~39 13 (52) 40~49 10 (40) ≥50 2 (8) Professions Physician 13 (52) Paramedics 10 (40) Nurses 2 (8) Simulation instructor experience
