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The Application of Observational Practice and Educational Networking in Simulation-Based and Distributed Medical Education Contexts

Welsher, Arthur, MSc; Rojas, David, MSc, PhD(c); Khan, Zain, MSc; VanderBeek, Laura, MD; Kapralos, Bill, PhD; Grierson, Lawrence, E.M., PhD

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: February 2018 - Volume 13 - Issue 1 - p 3–10
doi: 10.1097/SIH.0000000000000268
Empirical Investigations

Introduction Research has revealed that individuals can improve technical skill performance by viewing demonstrations modeled by either expert or novice performers. These findings support the development of video-based observational practice communities that augment simulation-based skill education and connect geographically distributed learners. This study explores the experimental replicability of the observational learning effect when demonstrations are sampled from a community of distributed learners and serves as a context for understanding learner experiences within this type of training protocol.

Methods Participants from 3 distributed medical campuses engaged in a simulation-based learning study of the elliptical excision in which they completed a video-recorded performance before being assigned to 1 of 3 groups for a 2-week observational practice intervention. One group observed expert demonstrations, another observed novice demonstrations, and the third observed a combination of both. Participants returned for posttesting immediately and 1 month after the intervention. Participants also engaged in interviews regarding their perceptions of the usability and relevance of video-based observational practice to clinical education.

Results Checklist (P < 0.0001) and global rating (P < 0.0001) measures indicate that participants, regardless of group assignment, improved after the intervention and after a 1-month retention period. Analyses revealed no significant differences between groups. Qualitative analyses indicate that participants perceived the observational practice platform to be usable, relevant, and potentially improved with enhanced feedback delivery.

Conclusions Video-based observational practice involving expert and/or novice demonstrations enhances simulation-based skill learning in a group of geographically distributed trainees. These findings support the use of Internet-mediated observational learning communities in distributed and simulation-based medical education contexts.

From the Department of Kinesiology (A.W., L.E.M.G.), McMaster University, Hamilton; Department of Medicine (D.R.), University of Toronto, Toronto; Faculty of Business and Information Technology (Z.K., B.K.), Ontario University Institute of Technology, Oshawa; Departments of Surgery (L.V.), Family Medicine (L.E.M.G.), Community and Rural Education Program (Mac-CARE) (L.E.M.G.), Program for Educational Research and Development (L.E.M.G.), and Michael G. DeGroote School of Medicine (L.E.M.G., A.W., L.V), McMaster University, Hamilton, Ontario, Canada.

Reprints: Lawrence Grierson, PhD, Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main St W, Hamilton, Ontario L8P 1H6, Canada (e-mail:

A.W. led the experimental portion of the study as part of his graduate thesis work, including data collection and analysis, and was the lead author of the manuscript. D.R. led the evaluation portion of the study. D.R., Z.K., and B.K. developed and managed the OPEN system for the experiment. L.V. organized and managed the rating of video demonstrations. This work occurred in the medical education research laboratory led by L.E.M.G., who supervised all aspects of the project. All authors contributed to the critical revision of the paper, approved the final manuscript for publication, and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

This work was generously supported via research funding awarded to L.E.M.G. via the Ontario Simulation Network (Sim-ONE).

The authors declare no conflict of interest.

This study was approved by the Hamilton Health Sciences' Integrated Research Ethics Board (Hamilton, Canada).

Attribution to: Department of Family Medicine and Program for Educational Research and Development, Faculty of Health Sciences, McMaster University.

© 2018 Society for Simulation in Healthcare