Center for Immersive and Simulation-based Learning

ISL At Stanford

Types of Learning

Immersive and Simulation-based techniques can be a highly effective approach to many different kinds and content learning, which can be categorized as: Knowledge, Tasks and Skills, Decision-making, and Teamwork.

Knowledge consists of facts, concepts, and the relationships between them. This knowledge can be the fundamental description of human biology and physiology (such as anatomy or molecular genetics) or it can be the applied description of the human body in health and disease (such as pathology and pathophysiology). Knowledge also includes the conceptual and practical basis of therapy (such as pharmacology, surgery, or radiation oncology), as well as the evidence-based protocols that guide optimum therapy. Immersive learning provides the means to make knowledge “come alive”, facilitating comprehension and interest.

Tasks and Skills encompass the practical and physical parts of health care. Unlike many professions, the care of real people doesn’t just require words spoken or written or drawings, numbers, and spreadsheets. It actually requires clinicians to lay hands on patients and perform important procedures. Knowing how to do these procedures involves aspects of psychomotor skill that cannot be acquired merely with the knowledge of what needs to be done. Simulation via part-task trainers and other systems can allow the hands-on skills to be learned and honed systematically and without discomfort or risk to patients. The skills are quite diverse and run the gambit from aspects of physical examination, to blood drawing, to invasive procedures (such as spinal tap or chest drainage) to complex surgical procedures (such as laparoscopic surgery or cardiac surgery) and catheter-based interventions (such as “cath-lab” procedures treating aortic aneurysm or carotid artery blockage).

Decision-making is a key component of all health care activities. Diagnosis requires decisions as to what might be wrong. Treating patients requires many decisions, both in real-time (seconds – hours) or playing out over a longer period of time. Simulations can provide structured and supervised practice in either kind of decision-making, and is uniquely able to probe and challenge decision-making in very time-critical hazardous settings like operating rooms, intensive care units, or emergency departments.

Teamwork brings together all the component knowledge, decision-making, and skills of individuals to work collectively on the patient. Teamwork is itself a set of knowledge, attitudes, and practical skills that must be learned and practiced. Immersive and simulation sessions allow personnel to practice the skills in a structured environment and even to experience what it is like to have be in the role of someone else in the patient care team (such as a physician being the “nurse” in a simulation or vice versa). Such role-reversals can’t be fostered in real patient care situations but can easily be created using simulation. Whether the teams interact in person or via computer-generated virtual worlds, getting team members to work and practice interacting together will be a keystone of improving teamwork and the quality and safety of patient care.

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