{"version":"1.0.0","segments":[{"startTime":0.0,"endTime":29.96,"body":"[Music]"},{"startTime":36.36,"endTime":44.36,"body":"Welcome to today's episode of the NLN Nursing EDge "},{"startTime":36.36,"endTime":44.36,"body":"Unscripted. I am Raquel Bertiz, your host from the  "},{"startTime":44.36,"endTime":52.44,"body":"National League for Nursing Center for Innovation "},{"startTime":44.36,"endTime":52.44,"body":"in Education Excellence. In today's episode,  "},{"startTime":52.44,"endTime":59.44,"body":"we're diving into an essential topic in nursing "},{"startTime":52.44,"endTime":59.44,"body":"education simulation design and its role in  "},{"startTime":59.44,"endTime":67.12,"body":"fostering clinical judgment. With us today is "},{"startTime":59.44,"endTime":67.12,"body":"Dr. Beth Rogers, an expert nurse educator who  "},{"startTime":67.12,"endTime":75.24,"body":"is deeply immersed in simulation education practice "},{"startTime":67.12,"endTime":75.24,"body":"and research. Dr. Rogers is currently a professor  "},{"startTime":75.24,"endTime":82.68,"body":"at the Texas Christian University and also "},{"startTime":75.24,"endTime":82.68,"body":"the associate editor of Clinical Simulation  "},{"startTime":82.68,"endTime":89.56,"body":"in Nursing. Dr. Rogers, welcome! Thanks so much "},{"startTime":82.68,"endTime":89.56,"body":"Raquel. Thank you for having me and thanks to the  "},{"startTime":89.56,"endTime":97.68,"body":"listeners for joining in today. Okay, I'm ready "},{"startTime":89.56,"endTime":97.68,"body":"to dive into this conversation. It's amazing  "},{"startTime":97.68,"endTime":105.44,"body":"that today we have so many options in implementing "},{"startTime":97.68,"endTime":105.44,"body":"simulations, but how do we ensure that we're doing  "},{"startTime":105.44,"endTime":112.04,"body":"them effectively? So let's start with your research "},{"startTime":105.44,"endTime":112.04,"body":"findings. What did you uncover about simulation  "},{"startTime":112.04,"endTime":119.04,"body":"and clinical judgment? Well, yeah, thanks for the "},{"startTime":112.04,"endTime":119.04,"body":"opportunity to let me share my research. You know,  "},{"startTime":119.04,"endTime":125.2,"body":"some of my research has revealed that the "},{"startTime":119.04,"endTime":125.2,"body":"complexity of simulation scenarios has a  "},{"startTime":125.2,"endTime":130.6,"body":"direct impact on clinical judgment outcomes "},{"startTime":125.2,"endTime":130.6,"body":"and I think it's really kind of important  "},{"startTime":130.6,"endTime":137.48,"body":"that we let that sink in because learners really "},{"startTime":130.6,"endTime":137.48,"body":"struggle with clinical judgment when complexity  "},{"startTime":137.48,"endTime":147.88,"body":"is increased in the slightest, especially if they "},{"startTime":137.48,"endTime":147.88,"body":"haven't had time in simpler routine situations to  "},{"startTime":147.88,"endTime":155.12,"body":"develop like foundational skills. So one of the key "},{"startTime":147.88,"endTime":155.12,"body":"findings from my research is that learners would  "},{"startTime":155.12,"endTime":164.68,"body":"have really likely benefited from spending more "},{"startTime":155.12,"endTime":164.68,"body":"time in those routine, less complex simulations.  "},{"startTime":165.24,"endTime":172.68,"body":"A more gradual progression would allow them time "},{"startTime":165.24,"endTime":172.68,"body":"to master basics and build clinical judgment in a  "},{"startTime":172.68,"endTime":180.52,"body":"more manageable way. As I reflect more "},{"startTime":172.68,"endTime":180.52,"body":"and more about the research that I did, I think  "},{"startTime":180.52,"endTime":188.68,"body":"another key takeaway from my research "},{"startTime":180.52,"endTime":188.68,"body":"relates to competency and that it develops at an  "},{"startTime":188.68,"endTime":196.64,"body":"individual pace. We really have to keep that in "},{"startTime":188.68,"endTime":196.64,"body":"mind because if we push learners into high stakes  "},{"startTime":196.64,"endTime":205.96,"body":"and complex sims too soon we can actually hinder "},{"startTime":196.64,"endTime":205.96,"body":"their clinical judgment development and this is  "},{"startTime":205.96,"endTime":212.16,"body":"something that I think we observe in simulation "},{"startTime":205.96,"endTime":212.16,"body":"like on a day-to-day basis. I just  "},{"startTime":212.16,"endTime":218.12,"body":"had this conversation recently about how"},{"startTime":212.16,"endTime":218.12,"body":"we can spend an entire semester helping students  "},{"startTime":218.12,"endTime":225.52,"body":"build confidence in med administration and they "},{"startTime":218.12,"endTime":225.52,"body":"can make progress but maybe in the beginning they  "},{"startTime":225.52,"endTime":233.08,"body":"still like run out of time to give meds or give "},{"startTime":225.52,"endTime":233.08,"body":"some slightly incorrectly and they don't really  "},{"startTime":233.08,"endTime":237.84,"body":"master those medication skills and then we "},{"startTime":233.08,"endTime":237.84,"body":"put them in an urgent and high pressure  "},{"startTime":237.84,"endTime":247.48,"body":"stimulation and they skills just completely fall "},{"startTime":237.84,"endTime":247.48,"body":"apart. So if we don't let students accurately  "},{"startTime":247.48,"endTime":254.36,"body":"and consistently apply what they've learned to "},{"startTime":247.48,"endTime":254.36,"body":"those routine situations, how can we expect them to  "},{"startTime":254.36,"endTime":262.72,"body":"handle really highly complex situations?  "},{"startTime":254.36,"endTime":262.72,"body":"I do think I should tell you that the research  "},{"startTime":262.72,"endTime":269.72,"body":"that I have done is in junior students, which "},{"startTime":262.72,"endTime":269.72,"body":"is like their second semester of nursing school.  "},{"startTime":270.68,"endTime":278.44,"body":"And we need to know more about the other levels "},{"startTime":270.68,"endTime":278.44,"body":"too, but there's lots of literature showing that  "},{"startTime":278.44,"endTime":286.76,"body":"what I found is what other people find too -"},{"startTime":278.44,"endTime":286.76,"body":"that complexity matters and whenever we put  "},{"startTime":286.76,"endTime":293.4,"body":"students in really complex situations they "},{"startTime":286.76,"endTime":293.4,"body":"can't always manage them. We need to know what  "},{"startTime":293.4,"endTime":302.04,"body":"we can reasonably expect students to do to better "},{"startTime":293.4,"endTime":302.04,"body":"handle those difficult situations. Those are great  "},{"startTime":302.04,"endTime":310.44,"body":"points and they really highlight how foundational "},{"startTime":302.04,"endTime":310.44,"body":"skills need time to develop before we throw  "},{"startTime":310.44,"endTime":318.48,"body":"our learners into more complex scenarios. And "},{"startTime":310.44,"endTime":318.48,"body":"that really brings us to a bigger conversation  "},{"startTime":318.48,"endTime":328.12,"body":"in nursing education - how we think about time in "},{"startTime":318.48,"endTime":328.12,"body":"in simulation? We often put a premium or we measure  "},{"startTime":328.12,"endTime":335.88,"body":"success of our simulation programs by the amount "},{"startTime":328.12,"endTime":335.88,"body":"of time spent in simulations or clinical rotations.  "},{"startTime":335.88,"endTime":342.12,"body":"I know that's very similar to my experiences "},{"startTime":335.88,"endTime":342.12,"body":"as well that we would like to have this many  "},{"startTime":342.12,"endTime":349.72,"body":"hours in simulations and this many hours in our "},{"startTime":342.12,"endTime":349.72,"body":"traditional clinical rotations, but your research  "},{"startTime":349.72,"endTime":357.4,"body":"suggests that there's really more to it than "},{"startTime":349.72,"endTime":357.4,"body":"just hours logged in. So how do you think about  "},{"startTime":357.4,"endTime":368.24,"body":"this connection to the broader conversation about "},{"startTime":357.4,"endTime":368.24,"body":"time spent in learning experiences in simulation?  "},{"startTime":368.24,"endTime":374.72,"body":"Yeah I think that's a great question. I think "},{"startTime":368.24,"endTime":374.72,"body":"my research confirms that time alone doesn't  "},{"startTime":374.72,"endTime":381.84,"body":"guarantee learning progression. You know, at the "},{"startTime":374.72,"endTime":381.84,"body":"NLN conference there was a a big call to shift  "},{"startTime":381.84,"endTime":392.72,"body":"away from thinking about education as time served, "},{"startTime":381.84,"endTime":392.72,"body":"you know essentially like, yeah, exactly and instead  "},{"startTime":392.72,"endTime":401.48,"body":"of focusing on ensuring, we need to ensure that "},{"startTime":392.72,"endTime":401.48,"body":"there's mastery of essential skills, right, so  "},{"startTime":401.48,"endTime":407.88,"body":"you know this really resonated with me because I "},{"startTime":401.48,"endTime":407.88,"body":"think a lot of simulation programs approach them  "},{"startTime":407.88,"endTime":414.52,"body":"as a series of essential experiences and that if "},{"startTime":407.88,"endTime":414.52,"body":"you go through the, go through these experiences  "},{"startTime":414.52,"endTime":424.2,"body":"you're going to gain what we want you to gain.  "},{"startTime":414.52,"endTime":424.2,"body":"But the idea really is that, well, I guess the idea  "},{"startTime":424.2,"endTime":430.6,"body":"that we use is that the more scenarios students "},{"startTime":424.2,"endTime":430.6,"body":"are exposed to the better prepared they'll be for  "},{"startTime":430.6,"endTime":438.2,"body":"practice. But I don't know that that's necessarily "},{"startTime":430.6,"endTime":438.2,"body":"true to me. I was talking to a colleague the other  "},{"startTime":438.2,"endTime":443.76,"body":"day and he shared a great analogy. He was like, "},{"startTime":438.2,"endTime":443.76,"body":"you know, it's like we're trying to teach students  "},{"startTime":443.76,"endTime":450.04,"body":"how to cook by handing them a bunch of different "},{"startTime":443.76,"endTime":450.04,"body":"recipes without first teaching them the  "},{"startTime":450.04,"endTime":456.88,"body":"foundational skills of cooking. Chefs, to graduate "},{"startTime":450.04,"endTime":456.88,"body":"from chef school, don't have to master every single  "},{"startTime":456.88,"endTime":465.28,"body":"recipe. They master knife techniques and seasoning "},{"startTime":456.88,"endTime":465.28,"body":"and balancing flavors and then they apply that to  "},{"startTime":465.28,"endTime":474.64,"body":"their own recipe and make it their own, their "},{"startTime":465.28,"endTime":474.64,"body":"own like touch, right. But in nursing education,  "},{"startTime":474.64,"endTime":479.76,"body":"I think we should kind of do the same "},{"startTime":474.64,"endTime":479.76,"body":"thing. We should prioritize building a strong  "},{"startTime":479.76,"endTime":487.28,"body":"foundation and routine, less complex scenarios. "},{"startTime":479.76,"endTime":487.28,"body":"So we should like focus on basic assessment,  "},{"startTime":487.28,"endTime":494.0,"body":"communication, decision making skills before  putting them into complex high pressure  "},{"startTime":494.0,"endTime":501.96,"body":"scenarios because if we push learners into "},{"startTime":494.0,"endTime":501.96,"body":"complex situations too soon, it's like asking  "},{"startTime":501.96,"endTime":509.44,"body":"somebody to prepare this extremely intricate "},{"startTime":501.96,"endTime":509.44,"body":"dish before they even know how to boil water.  "},{"startTime":510.36,"endTime":518.08,"body":"Well, that's such a great analogy kind of like "},{"startTime":510.36,"endTime":518.08,"body":"I kind of get that right so learning the basics  "},{"startTime":518.08,"endTime":526.52,"body":"first so it it really illustrates how crucial "},{"startTime":518.08,"endTime":526.52,"body":"it is to give learners the time and space like,  "},{"startTime":526.52,"endTime":535.04,"body":"well, like a kitchen in all its amenities right and "},{"startTime":526.52,"endTime":535.04,"body":"in our similar circumstances it's the simulation  "},{"startTime":535.04,"endTime":541.52,"body":"lab, the clinical labs to master foundational "},{"startTime":535.04,"endTime":541.52,"body":"skills first before diving into more complex  "},{"startTime":541.52,"endTime":549.4,"body":"scenarios. And really this ties into a larger "},{"startTime":541.52,"endTime":549.4,"body":"issue when we often see nursing education how  "},{"startTime":549.4,"endTime":555.92,"body":"we think about time in simulation. So it's "},{"startTime":549.4,"endTime":555.92,"body":"not just really the number of hours, right?  "},{"startTime":555.92,"endTime":562.52,"body":"It's about how effectively that time is used "},{"startTime":555.92,"endTime":562.52,"body":"to build up skills, step by step, and this is  "},{"startTime":562.52,"endTime":569.56,"body":"where cognitive load becomes really important.  You've researched how simulation design impact  "},{"startTime":569.56,"endTime":576.8,"body":"learners' learning ability to manage the demand "},{"startTime":569.56,"endTime":576.8,"body":"placed on them. So how do you think a cognitive  "},{"startTime":576.8,"endTime":585.28,"body":"load factors into these decisions and how "},{"startTime":576.8,"endTime":585.28,"body":"does it influence how we as educators should be  "},{"startTime":585.28,"endTime":593.4,"body":"designing simulations? Oh yeah, I think cognitive "},{"startTime":585.28,"endTime":593.4,"body":"load is really crucial to clinical judgment  "},{"startTime":593.4,"endTime":601.44,"body":"development. We know from cognitive load that the "},{"startTime":593.4,"endTime":601.44,"body":"way we design sims can either help or overwhelm  "},{"startTime":601.44,"endTime":610.48,"body":"learners. You know, I've found that factors like sim "},{"startTime":601.44,"endTime":610.48,"body":"fidelity, time pressure, multitasking, and we've been  "},{"startTime":610.48,"endTime":619.08,"body":"talking about task complexity, those all increase "},{"startTime":610.48,"endTime":619.08,"body":"cognitive load. And when learners are placed in  "},{"startTime":619.08,"endTime":628.4,"body":"like a really complex scenario too soon they end "},{"startTime":619.08,"endTime":628.4,"body":"up overloaded. They have more stress, uncertainty  "},{"startTime":628.4,"endTime":635.0,"body":"they have multiple competing priorities to think "},{"startTime":628.4,"endTime":635.0,"body":"about ,and it makes it difficult for them to think  "},{"startTime":635.0,"endTime":643.56,"body":"and make good decisions and learn. But on the flip "},{"startTime":635.0,"endTime":643.56,"body":"side, when we start like with simpler situations  "},{"startTime":643.56,"endTime":650.84,"body":"that focus on the basics, learners can put their "},{"startTime":643.56,"endTime":650.84,"body":"energy, their mental energy, into mastering those  "},{"startTime":650.84,"endTime":658.8,"body":"core skills. And so it helps them build confidence "},{"startTime":650.84,"endTime":658.8,"body":"and confidence, making it easier to like handle  "},{"startTime":658.8,"endTime":667.76,"body":"more complex situations down the line. As we, or "},{"startTime":658.8,"endTime":667.76,"body":"as students gain mastery, they can tap into like  "},{"startTime":667.76,"endTime":674.68,"body":"long-term memory and not have to remember as much "},{"startTime":667.76,"endTime":674.68,"body":"because they can use what they've already learned  "},{"startTime":674.68,"endTime":682.16,"body":"to tackle the new challenges. And you know in sim, "},{"startTime":674.68,"endTime":682.16,"body":"we're finding things like pre-briefing, repeated  "},{"startTime":682.16,"endTime":689.64,"body":"practice, modeling, really help reduce cognitive "},{"startTime":682.16,"endTime":689.64,"body":"load. But these strategies are ,they all are  "},{"startTime":689.64,"endTime":697.44,"body":"kind of related to the scaffolding conversation "},{"startTime":689.64,"endTime":697.44,"body":"because they all intend to give learners support  "},{"startTime":697.44,"endTime":703.32,"body":"to reduce their cognitive load as they move "},{"startTime":697.44,"endTime":703.32,"body":"forward. It's really about finding the sweet  "},{"startTime":703.32,"endTime":709.88,"body":"spot between giving learners the right amount of "},{"startTime":703.32,"endTime":709.88,"body":"challenge so they're not overwhelmed but pushing  "},{"startTime":709.88,"endTime":716.36,"body":"them and growing to improve and that's, that's I "},{"startTime":709.88,"endTime":716.36,"body":"think our role as nursing educators and nursing  "},{"startTime":716.36,"endTime":725.96,"body":"simulationists. Yeah. Yeah, I agree with that that's "},{"startTime":716.36,"endTime":725.96,"body":"such an important point. And those strategies can  "},{"startTime":725.96,"endTime":733.08,"body":"actually apply not just in simulations but to "},{"startTime":725.96,"endTime":733.08,"body":"all other learning activities as well. But let's  "},{"startTime":733.08,"endTime":740.92,"body":"get back to what strategies can educators use "},{"startTime":733.08,"endTime":740.92,"body":"to scaffold complexity and promote growth in  "},{"startTime":740.92,"endTime":748.8,"body":"learners? That's a good question. "},{"startTime":740.92,"endTime":748.8,"body":"I think we all want to know that answer.   "},{"startTime":749.48,"endTime":758.68,"body":"I think that scaffolding complexity really starts "},{"startTime":749.48,"endTime":758.68,"body":"with meeting learners where they are and building  "},{"startTime":758.68,"endTime":767.72,"body":"from there. Right now, we assume that we "},{"startTime":758.68,"endTime":767.72,"body":"know where students stand because of previous  "},{"startTime":767.72,"endTime":775.04,"body":"coursework. So, for example, we assume "},{"startTime":767.72,"endTime":775.04,"body":"that because students have taken pharmacology that  "},{"startTime":775.04,"endTime":784.4,"body":"they know their medications. But how many times "},{"startTime":775.04,"endTime":784.4,"body":"have you thought or heard someone say, man, I know  "},{"startTime":784.4,"endTime":789.48,"body":"they were I knew students were taught this and "},{"startTime":784.4,"endTime":789.48,"body":"that class. Why can't they remember that in this  "},{"startTime":789.48,"endTime":796.56,"body":"sim? But that's kind of where we run into trouble. "},{"startTime":789.48,"endTime":796.56,"body":"Just because students were taught something or  "},{"startTime":796.56,"endTime":803.08,"body":"took a class in a previous course or introduced "},{"startTime":796.56,"endTime":803.08,"body":"something in a previous course doesn't mean that  "},{"startTime":803.08,"endTime":811.28,"body":"they've mastered it, right. So students might know "},{"startTime":803.08,"endTime":811.28,"body":"the information but not know how to apply it or  "},{"startTime":811.28,"endTime":817.76,"body":"think through a situation. So our first step "},{"startTime":811.28,"endTime":817.76,"body":"is really understanding the foundation that  "},{"startTime":817.76,"endTime":824.84,"body":"students bring to us, what skills do they already "},{"startTime":817.76,"endTime":824.84,"body":"have, how comfortable are they with like basic  "},{"startTime":824.84,"endTime":831.96,"body":"skills, and when we know where they stand, then we "},{"startTime":824.84,"endTime":831.96,"body":"can design sims that meet them where they are and  "},{"startTime":831.96,"endTime":838.36,"body":"like gradually increase their skills instead of "},{"startTime":831.96,"endTime":838.36,"body":"assuming where they're at and jumping ahead too  "},{"startTime":838.36,"endTime":845.76,"body":"quickly. So after we know where they are, "},{"startTime":838.36,"endTime":845.76,"body":"I think the next step is ensuring students have  "},{"startTime":845.76,"endTime":855.64,"body":"enough time to master simpler, routine, more like "},{"startTime":845.76,"endTime":855.64,"body":"skills before we move them on into more complex  "},{"startTime":855.64,"endTime":863.6,"body":"situations, because that'll give them "},{"startTime":855.64,"endTime":863.6,"body":"a stronger foundation and confidence to tackle  "},{"startTime":863.6,"endTime":869.16,"body":"that same situation later on in a more complex "},{"startTime":863.6,"endTime":869.16,"body":"situation. I mean it's kind of like  "},{"startTime":869.16,"endTime":874.96,"body":"building a house - you don't build the second floor "},{"startTime":869.16,"endTime":874.96,"body":"until you have a solid foundation otherwise it's  "},{"startTime":874.96,"endTime":884.16,"body":"going to crumble. And we can look to "},{"startTime":874.96,"endTime":884.16,"body":"other professions for for guidance here on  "},{"startTime":884.16,"endTime":893.44,"body":"this scaffolding topic. Like take engineering for "},{"startTime":884.16,"endTime":893.44,"body":"example. Engineers don't start by having students  "},{"startTime":893.44,"endTime":899.4,"body":"design a skyscraper. That is not their "},{"startTime":893.44,"endTime":899.4,"body":"expectation of students whenever they graduate.  "},{"startTime":899.4,"endTime":906.12,"body":"They first focus on the fundamentals of "},{"startTime":899.4,"endTime":906.12,"body":"understanding physics and the materials they're  "},{"startTime":906.12,"endTime":915.92,"body":"working with and how structures fit together and "},{"startTime":906.12,"endTime":915.92,"body":"the kind of key concepts of what is needed to make  "},{"startTime":915.92,"endTime":923.12,"body":"a building work. It's not about rushing "},{"startTime":915.92,"endTime":923.12,"body":"to the final product of designing the most  "},{"startTime":923.12,"endTime":932.16,"body":"complicated task. It's about grasping the why and "},{"startTime":923.12,"endTime":932.16,"body":"understanding the thinking and how behind a design  "},{"startTime":932.16,"endTime":939.12,"body":"so that whenever they get to a complex project "},{"startTime":932.16,"endTime":939.12,"body":"they can use what they know and apply it to that  "},{"startTime":939.12,"endTime":946.24,"body":"complex situation. And that's really what we should "},{"startTime":939.12,"endTime":946.24,"body":"do in nursing. We need students to master core  "},{"startTime":946.24,"endTime":956.36,"body":"skills before they face those more intricate "},{"startTime":946.24,"endTime":956.36,"body":"sims. So to me, I think a great  "},{"startTime":956.36,"endTime":966.0,"body":"way to scaffold effectively is to first break down "},{"startTime":956.36,"endTime":966.0,"body":"like sims into smaller manageable pieces and focus  "},{"startTime":966.0,"endTime":975.16,"body":"on the skills like one at a time. For example, "},{"startTime":966.0,"endTime":975.16,"body":"maybe early on you can focus on basic clinical  "},{"startTime":975.16,"endTime":982.8,"body":"judgment skills like assessment or prioritization "},{"startTime":975.16,"endTime":982.8,"body":"and like a low stakes routine scenario. But then  "},{"startTime":982.8,"endTime":990.0,"body":"once they master that you can add in complexity "},{"startTime":982.8,"endTime":990.0,"body":"with maybe time pressure or taking care of two  "},{"startTime":990.0,"endTime":997.76,"body":"patients instead of one. But it doesn't take a "},{"startTime":990.0,"endTime":997.76,"body":"lot of complexity to overwhelm students and I  "},{"startTime":997.76,"endTime":1005.76,"body":"know you were at the conference at the NLN Summit "},{"startTime":997.76,"endTime":1005.76,"body":"in the fall and you got to hear Dr. Jared Kutzin  "},{"startTime":1005.76,"endTime":1012.4,"body":"give us a really good example of scaffolding and "},{"startTime":1005.76,"endTime":1012.4,"body":"I really think that was a really great example. In  "},{"startTime":1012.4,"endTime":1017.64,"body":"case you weren't there, he told us that"},{"startTime":1012.4,"endTime":1017.64,"body":"in his sim program he starts with a knowledge  "},{"startTime":1017.64,"endTime":1024.92,"body":"assessment to check can see where students are. "},{"startTime":1017.64,"endTime":1024.92,"body":"Do they understand the material? And then they  "},{"startTime":1024.92,"endTime":1032.48,"body":"have to actually pass it to move on, unlike "},{"startTime":1024.92,"endTime":1032.48,"body":"nursing school. A 'C' on an exam gets you to  "},{"startTime":1032.48,"endTime":1041.68,"body":"move forward, but they have to pass that knowledge "},{"startTime":1032.48,"endTime":1041.68,"body":"test. So after that he'll introduce  "},{"startTime":1042.28,"endTime":1049.6,"body":"a skill related to the knowledge and then "},{"startTime":1042.28,"endTime":1049.6,"body":"maybe build complexity with applying it to the  "},{"startTime":1049.6,"endTime":1060.28,"body":"real world situation or a virtual sim, but he "},{"startTime":1049.6,"endTime":1060.28,"body":"scaffolds within a skill, within a concept. And the  "},{"startTime":1060.28,"endTime":1069.44,"body":"key concept is it's a step-by-step approach that "},{"startTime":1060.28,"endTime":1069.44,"body":"really helps learners build skills at a manageable  "},{"startTime":1069.44,"endTime":1077.32,"body":"pace and master a part of the skill, add more "},{"startTime":1069.44,"endTime":1077.32,"body":"complexity. And you know, there's a lot of ways  "},{"startTime":1077.32,"endTime":1085.68,"body":"to achieve that example of scaffolding, but at the "},{"startTime":1077.32,"endTime":1085.68,"body":"end of the day, scaffolding is about understanding  "},{"startTime":1085.68,"endTime":1093.24,"body":"the building blocks of learning and really giving "},{"startTime":1085.68,"endTime":1093.24,"body":"learners the experience at the right time so that  "},{"startTime":1093.24,"endTime":1101.68,"body":"they can grow and be ready for more challenging "},{"startTime":1093.24,"endTime":1101.68,"body":"situations. And that illustrates starting with  "},{"startTime":1101.68,"endTime":1108.8,"body":"a solid foundation right and then building "},{"startTime":1101.68,"endTime":1108.8,"body":"from there rather than jumping straight into  "},{"startTime":1108.8,"endTime":1118.8,"body":"to complex situations in simulations, which, by the "},{"startTime":1108.8,"endTime":1118.8,"body":"way, we love to do as nurse educators sometimes.  "},{"startTime":1118.8,"endTime":1129.84,"body":"Also I think highlights the need for intentional "},{"startTime":1118.8,"endTime":1129.84,"body":"planning and designing of simulations to kind of  "},{"startTime":1129.84,"endTime":1141.0,"body":"like really illustrate that scaffolding concept "},{"startTime":1129.84,"endTime":1141.0,"body":"and also the time element to have our students  "},{"startTime":1141.0,"endTime":1148.68,"body":"master all those necessary building blocks or "},{"startTime":1141.0,"endTime":1148.68,"body":"or competencies as we said. And of course, another  "},{"startTime":1148.68,"endTime":1156.4,"body":"important element there is really constant checks "},{"startTime":1148.68,"endTime":1156.4,"body":"of where they are, meaning assessments, right? And  "},{"startTime":1156.92,"endTime":1163.28,"body":"therefore there's really a lot of discussions in "},{"startTime":1156.92,"endTime":1163.28,"body":"nursing education right now about transitioning  "},{"startTime":1163.28,"endTime":1169.0,"body":"to competency based education. Given your "},{"startTime":1163.28,"endTime":1169.0,"body":"research on the importance of foundational  "},{"startTime":1169.0,"endTime":1177.52,"body":"skills and gradual progression, how do you think "},{"startTime":1169.0,"endTime":1177.52,"body":"your findings align with or contribute to this  "},{"startTime":1177.52,"endTime":1185.64,"body":"ongoing conversation of concept based education "},{"startTime":1177.52,"endTime":1185.64,"body":"in nursing? Yeah, I think that's a really important  "},{"startTime":1185.64,"endTime":1193.4,"body":"question because with the push towards competency "},{"startTime":1185.64,"endTime":1193.4,"body":"based education, you know there's a lot of focus  "},{"startTime":1193.4,"endTime":1200.4,"body":"on designing the assessment and the evaluation "},{"startTime":1193.4,"endTime":1200.4,"body":"to in to make sure that learners are meeting our  "},{"startTime":1200.4,"endTime":1208.52,"body":"program outcomes. And as nurses I think "},{"startTime":1200.4,"endTime":1208.52,"body":"our main focus is on what can  "},{"startTime":1208.52,"endTime":1216.64,"body":"we do, how can we do it well, how can we get this "},{"startTime":1208.52,"endTime":1216.64,"body":"problem attacked, right? But sometimes in our rush  "},{"startTime":1216.64,"endTime":1222.76,"body":"to get those evaluations in place, we might lose "},{"startTime":1216.64,"endTime":1222.76,"body":"sight a little bit of something that's kind of  "},{"startTime":1222.76,"endTime":1232.32,"body":"critical - the learners themselves. We need "},{"startTime":1222.76,"endTime":1232.32,"body":"to think deeply about what they find challenging,  "},{"startTime":1232.32,"endTime":1241.4,"body":"what foundational skills do they need to master, "},{"startTime":1232.32,"endTime":1241.4,"body":"and how can we guide them in learning how to think,  "},{"startTime":1241.4,"endTime":1250.72,"body":"not just do. And in nursing education there's "},{"startTime":1241.4,"endTime":1250.72,"body":"a, there's a push to prepare students for managing  "},{"startTime":1250.72,"endTime":1256.92,"body":"highly complex patients before they graduate "},{"startTime":1250.72,"endTime":1256.92,"body":"because patients are getting sicker in hospitals.  "},{"startTime":1256.92,"endTime":1264.32,"body":"And I can definitely understand "},{"startTime":1256.92,"endTime":1264.32,"body":"that point, but I don't know that  "},{"startTime":1264.32,"endTime":1272.92,"body":"it's realistic to expect students to handle every "},{"startTime":1264.32,"endTime":1272.92,"body":"possible scenario. What's more important is that we  "},{"startTime":1272.92,"endTime":1285.0,"body":"provide them those foundational skills that they "},{"startTime":1272.92,"endTime":1285.0,"body":"have hopefully mastered that can still "},{"startTime":1285.0,"endTime":1291.12,"body":"develop as they're practicing and a lot of those "},{"startTime":1285.0,"endTime":1291.12,"body":"skills, both physical skills and cognitive  "},{"startTime":1291.12,"endTime":1299.48,"body":"skills, but if we focus on the core skills that "},{"startTime":1291.12,"endTime":1299.48,"body":"then we can help students build confidence and  "},{"startTime":1299.48,"endTime":1307.36,"body":"competence to, okay, I may not understand everything "},{"startTime":1299.48,"endTime":1307.36,"body":"about this complex patient but I know how to do an  "},{"startTime":1307.36,"endTime":1314.52,"body":"assessment, I know how to ask questions, I know "},{"startTime":1307.36,"endTime":1314.52,"body":"how to think through is medication appropriate  "},{"startTime":1314.52,"endTime":1323.96,"body":"or not, rather than just kind of pushing them into "},{"startTime":1314.52,"endTime":1323.96,"body":"the deep end without having the essential thought  "},{"startTime":1323.96,"endTime":1331.12,"body":"processes and skills to care for that complex "},{"startTime":1323.96,"endTime":1331.12,"body":"patient. So if we think about it  "},{"startTime":1331.12,"endTime":1340.08,"body":"in a care type situation, if we think about like a "},{"startTime":1331.12,"endTime":1340.08,"body":"newly graduated nurse, would we expect them to take  "},{"startTime":1340.08,"endTime":1345.8,"body":"over care for a post-op patient with we'll like "},{"startTime":1340.08,"endTime":1345.8,"body":"design the most complicated patient ever. We'll  "},{"startTime":1345.8,"endTime":1355.6,"body":"say they have a balloon pump and multiple drips "},{"startTime":1345.8,"endTime":1355.6,"body":"and instability they are going up  "},{"startTime":1355.6,"endTime":1364.64,"body":"and down in their stability and maybe sound, yeah, "},{"startTime":1355.6,"endTime":1364.64,"body":"we'll throw in they're pregnant and preeclamptic  "},{"startTime":1364.64,"endTime":1371.48,"body":"too. That is not a realistic patient. What we"},{"startTime":1364.64,"endTime":1371.48,"body":"should really focus on is whether they've  "},{"startTime":1371.48,"endTime":1378.52,"body":"mastered foundational skills to build toward "},{"startTime":1371.48,"endTime":1378.52,"body":"that level of care. So can they take  "},{"startTime":1378.52,"endTime":1384.96,"body":"take a thorough report, can they identify the "},{"startTime":1378.52,"endTime":1384.96,"body":"most important cues and plan their assessment  "},{"startTime":1384.96,"endTime":1392.48,"body":"accordingly, or do they understand why "},{"startTime":1384.96,"endTime":1392.48,"body":"they're performing specific interventions and  "},{"startTime":1392.48,"endTime":1401.32,"body":"what priorities they want to make. To me, mastering "},{"startTime":1392.48,"endTime":1401.32,"body":"those foundational skills is key to learning how  "},{"startTime":1401.32,"endTime":1410.32,"body":"to deal with a complex patient. Once we ensure "},{"startTime":1401.32,"endTime":1410.32,"body":"that learners are secure those basics,  "},{"startTime":1410.32,"endTime":1422.24,"body":"then they can apply skills and in a more logical "},{"startTime":1410.32,"endTime":1422.24,"body":"type way to complex situations. So I just think  "},{"startTime":1422.24,"endTime":1431.6,"body":"we might need to shift our concept of what we are "},{"startTime":1422.24,"endTime":1431.6,"body":"working towards learners achieving. It's not really  "},{"startTime":1431.6,"endTime":1438.44,"body":"about preparing them for the end evaluation. It's "},{"startTime":1431.6,"endTime":1438.44,"body":"about teaching them the thought processes and clinical  "},{"startTime":1438.96,"endTime":1448.36,"body":"reasoning that will get them there. So it's just "},{"startTime":1438.96,"endTime":1448.36,"body":"rethinking how we define complexity because I  "},{"startTime":1448.36,"endTime":1454.72,"body":"think we think of complexity in terms of like "},{"startTime":1448.36,"endTime":1454.72,"body":"a scenario topic, but like even if we just take  "},{"startTime":1454.72,"endTime":1462.08,"body":"medication for example. There are levels of "},{"startTime":1454.72,"endTime":1462.08,"body":"complexity within medication. So"},{"startTime":1462.08,"endTime":1468.36,"body":"complexity in medication could just be given a "},{"startTime":1462.08,"endTime":1468.36,"body":"routine medicine versus a non-routine medicine,  "},{"startTime":1469.12,"endTime":1474.92,"body":"different routes, whether it's appropriate for "},{"startTime":1469.12,"endTime":1474.92,"body":"the patient's condition or not. We  "},{"startTime":1474.92,"endTime":1483.44,"body":"can scaffold complexity within those basic "},{"startTime":1474.92,"endTime":1483.44,"body":"foundational skills with all of it, really,  "},{"startTime":1483.44,"endTime":1489.0,"body":"like no matter whether it's an assessment or "},{"startTime":1483.44,"endTime":1489.0,"body":"order management, any of those things. We can  "},{"startTime":1489.0,"endTime":1497.52,"body":"view complexity within the foundational skill. "},{"startTime":1489.0,"endTime":1497.52,"body":"We don't have to make complexity mean they're  "},{"startTime":1497.52,"endTime":1507.32,"body":"taking care of super complex patients in an "},{"startTime":1497.52,"endTime":1507.32,"body":"inappropriate situation. So I really think we  "},{"startTime":1507.32,"endTime":1516.28,"body":"can just restructure our thinking related to "},{"startTime":1507.32,"endTime":1516.28,"body":"simulation experiences. It's not about passing  "},{"startTime":1516.28,"endTime":1524.2,"body":"assessments or exposure to as many scenarios "},{"startTime":1516.28,"endTime":1524.2,"body":"as possible. It's about creating opportunities  "},{"startTime":1524.2,"endTime":1533.24,"body":"to practice, develop thinking, ensure mastery of "},{"startTime":1524.2,"endTime":1533.24,"body":"foundational skills, and understanding the why.  "},{"startTime":1533.24,"endTime":1539.04,"body":"And that's how we set students up for for "},{"startTime":1533.24,"endTime":1539.04,"body":"success, not just in sims, but in the real world  "},{"startTime":1539.04,"endTime":1548.8,"body":"too. Right, right. And hopefully as a profession "},{"startTime":1539.04,"endTime":1548.8,"body":"or as a nursing education community we can  "},{"startTime":1548.8,"endTime":1558.44,"body":"eventually kind of get united as to the end in "},{"startTime":1548.8,"endTime":1558.44,"body":"point of what we want our students to achieve  "},{"startTime":1558.44,"endTime":1567.36,"body":"eventually. And I think we're getting there. and "},{"startTime":1558.44,"endTime":1567.36,"body":"I know that we can talk about this dear topic or  "},{"startTime":1567.36,"endTime":1577.52,"body":"topic dear to our our heart on and on and on, but "},{"startTime":1567.36,"endTime":1577.52,"body":"for now I would like you to I guess both of us, I  "},{"startTime":1577.52,"endTime":1583.52,"body":"would like us to really kind of like take a pause, "},{"startTime":1577.52,"endTime":1583.52,"body":"reflect some more, and really just push forward  "},{"startTime":1583.52,"endTime":1590.36,"body":"with things that we need to kind of like implement "},{"startTime":1583.52,"endTime":1590.36,"body":"in our daily practice as nurse educators. And thank  "},{"startTime":1590.36,"endTime":1599.52,"body":"you so much for sharing your insights. This has "},{"startTime":1590.36,"endTime":1599.52,"body":"been a thought-provoking conversation about the  "},{"startTime":1599.52,"endTime":1606.24,"body":"importance of intentional simulation design and "},{"startTime":1599.52,"endTime":1606.24,"body":"building foundational skills before tackling a  "},{"startTime":1606.24,"endTime":1612.36,"body":"complex sim. Yeah, thank you so much for inviting "},{"startTime":1606.24,"endTime":1612.36,"body":"me and thank you to the listeners for tuning in  "},{"startTime":1612.36,"endTime":1618.68,"body":"to today's conversation. You know, I know shifting "},{"startTime":1612.36,"endTime":1618.68,"body":"our thinking is never easy but I'm always proud to  "},{"startTime":1618.68,"endTime":1625.24,"body":"be a part of a dedicated group of nurse educators "},{"startTime":1618.68,"endTime":1625.24,"body":"who are just as committed to continuous growth and  "},{"startTime":1625.24,"endTime":1633.32,"body":"success as we all want to be. So always remember, "},{"startTime":1625.24,"endTime":1633.32,"body":"you know, it doesn't take too much complexity  "},{"startTime":1633.32,"endTime":1642.92,"body":"to overwhelm learners. I appreciate this "},{"startTime":1633.32,"endTime":1642.92,"body":"opportunity to be on this podcast. Yes, so I hope  "},{"startTime":1642.92,"endTime":1649.92,"body":"that as nurse educators we continue to reflect on "},{"startTime":1642.92,"endTime":1649.92,"body":"how we are designing our simulation experiences  "},{"startTime":1649.92,"endTime":1655.68,"body":"and all other learning experiences in our "},{"startTime":1649.92,"endTime":1655.68,"body":"curriculum and how we frame them in educational  "},{"startTime":1655.68,"endTime":1678.12,"body":"theories, standards of practice and evidence. "},{"startTime":1655.68,"endTime":1678.12,"body":"So bye for now and until our next episode."},{"startTime":1678.12,"endTime":1678.685,"body":"[Music]"}]}