One day, my colleague, Kelly Wise, approached me and asked, “Do you want to go on a journey with me? We need to develop a new preceptor development program.” At that point in time, we had temporarily suspended preceptor training due to turnover in the Nursing Education and Professional Development department. However, Kelly had recently received permission from our nurse administrator to reactivate, renovate, and expand our previous program. Kelly and I approached this as an opportunity to “gut” our current structure. We spent significant time reviewing the latest evidence-based literature regarding preceptor development programs, benchmarking against program curricula from other facilities, and drawing on our own experiences to create the blueprint for our upgrade. We decided to use a “simple to complex” approach, borrowing from the Dreyfus model of skill acquisition, to underpin the program’s curriculum design. Benner (2004) described the Dreyfus model as a progressive movement from novice to expert, grounded on “situated performance and experiential learning” (p. 188). The model demonstrates how learners acquire skills through instruction, practice, and reflection. We envisioned a preceptor program, grounded in an active learning environment, which would provide the initial foundation of knowledge and skills to move the preceptor from novice to competent.
We created a three-part series, which moved from foundational concepts (e.g., roles and responsibilities, socialization, and teaching/learning styles) to more complex topics (e.g., difficult conversations, conflict management, and struggling orientees) as the course progressed. We space our series’ classes several weeks apart to allow time for application and reflection. We had several distinct advantages while starting the program: (a) Kelly Wise is a subject matter expert in simulation; (b) everyone involved was willing to be innovative; and (c) another educator, Amy Lamancusa, encouraged us to incorporate learning activities and/or different teaching strategies at 20-minute intervals during the program. During our program renovation, we incorporated a variety of educational technology tools, including audience response, animated videos, gaming, and simulation. Each of these provided a distinctive contribution to our program’s effectiveness. I provide a brief overview for each technology component in the following sections.
AUDIENCE RESPONSE SYSTEMS
From the inception of the upgraded program, we incorporated audience response into multiple sections of the curriculum. An audience response system (ARS) allows for the real-time collection of anonymous, aggregated feedback, which typically results in more candid responses from participants (Mormer, 2018; Thampy & Ahmad, 2014). Importantly, anonymity creates a safe learning environment. In addition, audience response also provides an experiential learning environment, allowing participants the opportunity to make choices, provide opinions, and demonstrate content mastery (Mormer, 2018).
Our organization uses an ARS that allows participants to answer questions via keypads. An ARS may be used in a multitude of ways, and a plethora of benefits exist for the presenter. For example, I regularly use the ARS in classes to create fun icebreakers. In addition, the ARS’s polling feature allows me to gauge my learners’ knowledge and competence/confidence levels in real time. The polling feedback allows for the tailoring of the presentation if the data indicate the need to do so. For example, during learning sessions, I mentally tag items requiring additional emphasis or reinforcement. Based on the feedback, I might only briefly cover a section my learners have already mastered in order to focus our limited time on less well-understood topics. An unexpected benefit occurred during implementation; we were pleasantly surprised by feedback from learners who told us how “fancy” they felt after using the technology during class.
Conducting formative assessments is yet another important use of the ARS. Typically, I present a section of content and then provide the preceptors with an orientation-based case study. As opposed to being forced to rely on those willing to answer questions verbally in front of the whole group, I receive answers from mostly everyone when using the ARS. I follow up with additional questions to delve deeper into the information gleaned from the ARS—this process typically results in a productive class discussion. I clarify key points before advancing to the next section of content. Prior to implementing gaming into the program, we also used our ARS to conduct summative evaluations. We ask questions at the end of each class to test our preceptors’ knowledge level. Initially, we had to differentiate between the preceptors’ lack of knowledge and the potentially confusing wording of our questions. Eventually, by making the wording of the questions clearer, we could adequately evaluate the preceptors’ knowledge levels at the conclusion of the day’s session. We elevated our original knowledge/comprehension questions to questions that required application to solve given orientation scenarios. Because of the real-time data provided, we immediately knew if we had adequately covered the key concepts our preceptors needed to learn and if we needed to clarify or reinforce any important concepts. We also revisited the summative data after class to evaluate our teaching and pinpoint where adjustments needed to be made. In summary, incorporating audience response into programs, as opposed to relying purely on traditional methods, results in a more engaging and enjoyable participant experience, which leads to both increased learner participation and cognitive involvement (Grzeskowiak, Thomas, To, Phillips, & Reeve, 2015).
Have you ever designed an amazing role-playing exercise only to hear crickets when you ask for volunteers to participate during the class? If so, try using animated videos! Before discovering this platform, I often struggled to solicit volunteers for role-playing activities, especially in smaller cohorts where the volunteer pool was reduced. When evaluating the opportunities to modify class exercises that required volunteers, we decided to keep the simulations in the final class but modify the role-playing exercises in the series’ first two classes. To achieve this, scenarios were created using an animation studio program, which provided a fun and innovative method to tell a story. Animated videos, which are ideal for addressing communication skills and professional behaviors, can be used to demonstrate difficult conversations between the preceptor and orientee (Mormer, 2018). This platform allowed me to depict real-life struggles between orientees and preceptors. I also integrated scenes depicting other healthcare team members’ interactions. One unfolding story details an orientee’s struggle to progress through orientation. A few scenes highlighted the expectations he faced in his new role as well as the criticism he faced due to his lack of familiarity with the complex diagnoses of his patients in his new work setting. Other scenes reinforced how the preceptor’s empathic responses significantly improved the orientee’s morale.
In short, using animated videos eliminates the need for volunteers, instead allowing everyone in class to participate through an indirect but still relatable lens (Mormer, 2018). Of note, we debrief the videos just as we would the role-play and simulation scenarios. However, participants actually feel more comfortable sharing their reactions given the “actors” are not their peers in the classroom.
Other advantages exist when using animated videos. Being able to show several animated character’s perspectives with scene transitions lends to the scenario’s richness and complexity. Another advantage is the freedom to author the screenplay exactly as needed with both appropriate and inappropriate responses (Mormer, 2018). It is worth noting, however, that there is still value to using volunteer participants in role-playing exercises as it allows them to practice thinking on their feet in real time. Therefore, we chose to keep a few role-playing exercises in our preceptor development program.
Gamification, the use of gaming or game elements to engage learners (Ferguson, Davidson, Scott, Jackson, & Hickman, 2015), represents an innovative approach that has advanced from board games to digital and serious games, which immerse learners into online virtual environments (Wang, DeMaria, Goldberg, & Katz, 2016). Gaming as an instructional strategy creates a flexible, active learning environment; increases engagement; and targets higher order thinking (Hahn & Bartel, 2014). Brigham (2015) identified that gaming taps into innate human competitiveness and desire to improve. More importantly, the camaraderie that builds within teams and banter that occurs between teams, as a result of gaming during classes, increase their motivation to excel (Brigham, 2015). In addition, gaming provides an experiential learning experience for participants, which provides moments of reflection to heighten critical thinking skills (Beek, Boone, & Hubbard, 2014). Multiple platforms exist for creating digital games—some free, some at a cost.
Gaming has recently become an invaluable addition to our preceptor development program. In fact, each of the preceptor classes in our initial training program uses gaming in some capacity. For example, we use gaming for summative evaluation at the conclusion of each class. Gaming allows preceptors to answer questions that test their knowledge levels in a less threatening environment. To make the games more fun, we divide the preceptors into teams and provide them with a creative team name and mascot; the competition that results is fierce!
For our instructors, some additional benefits of gaming include the fact that it provides them with the ability to quickly gauge the participants’ comprehension of presented concepts. Also, participants learn in real time whether or not they selected the correct answer. This allows instructors to discuss and remediate those concepts that participants have not yet mastered while they are fresh in their minds—traditional testing methods do not allow for this real-time interaction. Instructors run and analyze detailed reports after class and drill down to specific data, such as the percentage of wrong answers selected for a question or the specific answers chosen by specific learners. As with audience response, this allows instructors to determine where their teaching needs to be adjusted to improve the next iteration of class.
I recently attempted to incorporate gaming into the preceptor program by using it as my main teaching strategy for a few topics. First, I identified the topics in the program that did not easily lend themselves to accompanying learning activities. Then, instead of lecturing on those topics using repetitive PowerPoint slides with bulleted lists, I created an interactive game to stimulate an active learning environment. I created a game to teach each topic in its entirety. One question, for example, asks “Your orientee just arrived on the unit for her first day. One hundred preceptors were surveyed. Name the top five things you should cover with your orientee on the first day.” The preceptors compete against one another while learning key information in a fun and interactive way. More importantly, gaming allowed for the ability to teach concepts and provide real-time feedback based on their answers—going beyond what traditional teaching methods allow.
According to our evaluation results, 80% of learners strongly agreed and 20% agreed that the use of gaming increased their engagement and contributed to a positive learning experience (which they hoped would be repeated in the future). More broadly, studies have shown gaming increases engagement and improves short-term knowledge retention (Brull, Finlayson, Kostelec, MacDonald, & Krenzischeck, 2017). In short, gaming is a fun, easy-to-use platform that is sure to spice up your preceptor development program.
The final class of the preceptor series involves a heavy focus on simulation. Kelly expertly guided us through the process by creating scenarios to elevate the “soft skills” of our preceptors. These skills included active listening, asking the right questions, empathic communication, and conflict management. We start with a relatively simple scenario in which a preceptor interacts with an orientee, who after several attempts is unable to perform a skill. In the next scenario, the preceptor needs to improve the confidence of an underconfident orientee in order for the orientee to progress. The final scenario deals with an overconfident orientee who is difficult to work with because she displays a “know-it-all” attitude and an unwillingness to abide by the facility’s policies and procedures. In addition, a few amazing standardized patients were enlisted to play the orientee role in each scenario. They were coached on how to respond based on the actions of the preceptor volunteer in the scenario. These simulations provide opportunities to evaluate how preceptors think and act in a variety of situations. We broadcast each simulation to the other preceptors in the class so that they can learn by observing.
Notably, we discovered that the preceptors learn the most in the debriefing sessions following the scenario. We follow a facilitator-guided three-phase debriefing structure that includes a reaction, analysis, and summary phase, as outlined by Sawyer, Eppich, Brett-Fleegler, Grant, and Cheng (2016). During the debriefing sessions, we start by allowing the group to hear feedback from the perspective of the preceptor volunteer who had directly engaged in the scenario. Next, we expand the discussion to include the audience. We discuss what happened during the simulation and clarify why the preceptor chose those specific actions. Reflection proves to be a powerful learning tool for the preceptors. We close by focusing on different strategies that the preceptor might have considered while engaging with the orientee, ensuring that we provide positive feedback, and reinforcing the strategies used during the most challenging interactions.
Murray and Buckley (2017) recently published a study that used a similar approach to difficult conversations for nurse practitioner preceptors. They found that the use of simulation increased the perceived self-efficacy of communication skills. The preceptors appreciated the safe environment provided by simulation, and the simulations boosted their confidence (Murray & Buckley, 2017). Our class evaluations echo these sentiments, as the responses identified the simulations as among the most effective learning strategies, with consistent requests to include the practice in future training.
Structuring a preceptor development program around active learning strategies enhances participant engagement and satisfaction. Selecting from techniques such as simulation, audience response, gaming, and animated videos provides the preceptor program designer with an expanded set of options from which to build more engaging learning exercises. These education technologies, when effectively used, offer unique advantages, which significantly enhance the overall learning experience. We believe our program’s evaluation scores are a reliable indicator of the “wow factor” experienced by our preceptor cohorts and strongly encourage others to join us in using these great learning technologies!
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