We aim to inform educators on the use of digital storytelling and simulation as complementary teaching methods to enhance and assess student learning in a flipped classroom. These combined educational methods have deepened our students’ learning by incorporating human connections and emotions into their didactic experience.
This presentation aims to inform educators on the use of digital storytelling (DS) and simulation (SIM) as complementary teaching methods to enhance and assess student learning in a flipped classroom. We will share how the use of these educational methods have deepened our students’ learning by incorporating human connections and emotions into their didactic experience. This method was utilized in an allied health care class but could be easily translated into other areas of study.
Digital Storytelling is an innovative tool for providing context to complex topics, which allows students to develop a deeper understanding of the material by linking human emotions to cognitive processes. New technologies and multimedia tools improve the ease of use and implementation into healthcare education. According to Robin (2006), DS is primarily used to provide personal narratives, examine historical contexts, or deliver stories that inform or instruct. Through application in a classroom, DS can enhance student’s problem-solving capabilities, listening and communication skills, and therapeutic use of self (Robin, 2006). Beyond the benefits of storytelling for affective outcomes, student-driven DS increases students’ understanding of abstract material, promotes technological competencies, and develops the skills of teaching and learning required for patient education. From an instructional perspective, DS can be used to motivate students to engage in complex content (Lal, Donnelly, & Shin, 2015). Narratives provide a framework for students to conceptualize their future in clinical practice. The flexible nature of DS as a teaching and learning practice is optimal for healthcare education, which requires both a breadth and depth of understanding in multiple practice areas.
Simulation is utilized in healthcare education to help students develop a variety of skills including problem-solving, critical thinking, technical skills, communication, and clinical reasoning skills (Uys & Treadwell, 2014). The use of simulation-based learning with healthcare professionals permits students to engage in hands-on experiential learning without presenting a risk to the client (Maran & Galvin, 2003). Eliminating the risk allows the learner to feel more comfortable and confident when participating in the SIM experience. Students can be provided with various simulation experiences designed around a common theme, to foster a range of technical and soft skills, enabling the learner to discover a holistic approach to healthcare delivery.
Simulation can be presented in different forms including; written cases, videos, standardized patients, and virtual clients (Maran & Galvin, 2003). Standardized patients are actors or actual patients who are trained to present in a consistent manner which targets specific technical or soft skills. This approach can be useful when assessing competencies which require both procedural and non-procedural learning (Maran & Galvin, 2003). Standardized family members can also be incorporated into the scenario to help the student improve professional communication. The use of a standardized patient and potentially a simulated family member provides the opportunity for educators to integrate cultural and psychological factors. It can also be used to foster interdisciplinary collaboration and communication through specific simulation prompts.
Simulation-based learning often generates an emotional experience that can be addressed during the debriefing period. Emotions surrounding simulation are generally positive regarding the learning experience. Students sometimes feel nervous or anxious during the SIM. Having the opportunity to process those emotions during the debriefing period and consider how to handle them in future encounters, may help students to deal with the complex emotions experienced by healthcare professionals more effectively in clinical practice (Keskitalo and Ruokamo, 2017).
Students show increased comprehension of course material and improved performance on summative assessments in flipped courses (Fautch, 2014). This method allows students to take more responsibility for their learning and relate the concepts to their experiences which is essential in andragogy (Cercone, 2008). This approach permits educators to make much better use of face to face time, focusing on the application of the content that is covered online and translating that knowledge into practical skills.
Our model includes utilizing a digital story at the beginning of a unit of content to help the learner better understand not only the condition or deficit that they are studying but the underlying human affected by the condition. This initial digital story is intended to help the learner apply a context to the content they are studying. This introductory digital story is used to aid the learner in understanding how the client’s roles, rituals, routines, and psyche are affected by their condition. The DS is told by a client or caregiver of someone with the condition or deficit.
Equipped with a context and a deeper understanding of the effects of the condition or deficit on the human person, the learner experiences their didactic content for the course online, in a flipped format. Best practices for engagement are utilized in an interactive style that challenges the student to discover appropriate evaluation and treatment techniques as they relate to the given condition or deficit. The learner then has an opportunity to apply their knowledge and utilize problem-based strategies to interact with the content.
After the student has an understanding of the didactic content, and an investment in the client through the DS, they come to campus for a face to face lab. During the lab time, the students apply their didactic knowledge and learn additional psychomotor skills required for healthcare intervention. They learn and practice evaluation and treatment skills associated with the condition(s) or deficit(s) relevant to current coursework. These skills are taught and practiced with the understanding that the learner will participate in some sort of practical exam in the future where they will demonstrate these techniques.
Next, students incorporate; the didactic content, psychomotor skills from the lab, and information from the digital story into a high-fidelity simulation experience. In this experience, the student is immersed in a clinical encounter where they interact with a client and potentially a family member or someone from another discipline. This SIM allows the student to experience very similar emotions to those with which they will be confronted as healthcare professionals. During the debriefing period, educators help the learners (participants and observers) explore the emotional, psychological, cognitive, and physical demands of the high-fidelity simulation and their translation to clinical practice. Depending on the condition being studied, the objectives focus on technical skills, communication with the client and/or caregiver, cultural sensitivity, interdisciplinary collaboration, or professional advocacy among other potential objectives.
Finally, a DS is created by the learner as an authentic assessment exemplifying student learning for the unit. The content of this DS is contingent on the objectives of the simulation. For example, if the SIM objectives involve technical skills, the student is required to produce a DS focusing on client or caregiver education. The learner explains their findings to the client and makes recommendations for the next steps in therapy. The student then describes how to incorporate the training provided into the client’s daily life. If the objective is related to interprofessional education, the learner reflects on what he/she did well and what could be done better next time. The student elaborates on the importance of and challenges with interprofessional communication in a clinical setting.
As healthcare professionals, we strive to meet global societal needs through holistic, client-centered care. The use of DS and SIM can be applied to achieve these goals. In a classroom, cultural perspectives and diverse societal needs are challenging for students to conceptualize due to their limited exposure to other populations and settings. DS and SIM can help students explore the cultural and psychosocial aspects of client and caregiver experiences, which may not be available in the controlled confines of a classroom (Lal, et al., 2015). Additionally, the debriefing portion of the SIM facilitates the processing of the learner’s emotions as an emerging healthcare professional in a safe environment.
This model was implemented with students in an allied health care program in a comprehensive format. It could easily be used in any area of study that requires 21st century cognitive communication skills, psychomotor mastery, cultural sensitivity, or a variety of other skills. The use of combined DS and SIM could be scaled down by utilizing the combination in an assignment or a portion of the content of any given unit of study. It could be scaled up by developing an entire course around this model. The potential for utilizing DS and SIM as an adjunct to flipped and hybrid classes is only limited by the educator's imagination.
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Keskitalo, T., & Ruokamo, H. (2017). Students' Emotions in Simulation-Based Medical Education. Journal Of Interactive Learning Research, 28(2), 149-159.
Lal, S., Donnelly, C., Shin, J. (2015). Digital storytelling: An innovative tool for practice, education, and research. Occupational Therapy in Health Care, 29(1), 54-62, doi: 10.3109/07380577.2014.958888.
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