Instructional Software Options and Uses In Healthcare

Instructional Software, Not to be confused with Instructional Tools

When discussing instructional software, it is important to point out the difference between instructional software used for learning and instructional tools which assist learning. Instructional software is used to deliver or support instruction, unlike software tools which enhance or support instructional activities. You can combine both types of software to form a hybrid instructional software. (Roblyer, 2016 p.75)

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Incorporating various types of software into the healthcare curriculum has it’s advantages read below to learn more.

Instructional software programs are categorized by their function; they include drill and practice software, tutorial software, simulation software and instructional game software and problem-solving software.  When integrating instructional software into the classroom, it is important to consider first what your need is, then what the relative advantage of incorporating the instructional software will be to meet desired teaching objectives. There are additional considerations but for the brevity of this discussion I will discuss them later as they apply to each particular type. 

Respiratory care students are required to memorize numerous calculations and names of anatomical structures in the body as well as be able to differentiate between slight differences in heart and lung sounds as well as be able to locate various structures inside and outside the body.   Drill and practice software provide the necessary repetitive practice to memorize this information.  Most of this memorization are in preparation for certification and licensure examinations or refreshing information for more immediate recall for utilization with more advanced concepts.

DRILL AND PRACTICE

Drill and practice software are comprised of three types.  A flash card activity, chart fill-in and branching exercise. (Roblyer, 2016 p.79)  

Study Stack allows students to create their flashcards.  Many of my students utilize this resource to memorize formulas and other content in preparation for testing. This type of software instruction is used to reinforce information that students have already been taught, not initially to learn the material. The flashcards can be shared with the Study Stack community; however I caution students when utilizing other’s flashcards.  The advantage of using this type of software package is twofold; it saves teacher time by allowing students to practice independently. The students can divide the required content and share their study stack cards, within their classroom groups saving the students time and placing the cards in an accessible format. The immediate feedback on the correctness of their answer helps them to commit the appropriate information to long-term memory. 

Wiley offers a free comprehensive library of anatomy drill and practice software that features two difficulty levels of labeling anatomical structures. There is a drag and drop and fill in the blank option depending on the desired level of difficulty. The relative advantage of this software is the varying level of difficulty that can be chosen by the student.  They can begin with the simpler task of dragging and dropping and then challenge themselves more with the fill in function. This resource is useful for students to refresh their anatomy knowledge when working on advanced pathophysiological concepts such as hemodynamic monitoring in shock for the critically ill patient. The tiered difficulty level is appropriate for students who may require more practice as well as students who feel more confident and want to refresh or analyze their foundational content knowledge. Immediate feedback helps learners commit the correct information to long-term memory.  I utilize this type of software in place of homework or additional lecture time that would be spent on reviewing material from pre-requisite courses. Such as when covering hemodynamic monitoring and fluid resuscitation management strategies of the critically ill patient, in which students must have solid foundational knowledge of cardiac and respiratory anatomy.

Kettering practice exams offer online practice for credentialing examinations through purchasing tokens. The relative advantage of this software is that it provides realistic testing scenarios for students, the questions are formed on the same matrix and style as their credentialing exams. The immediate feedback and provision of the correct answers allows instant remediation of knowledge. The practice exams save teachers from having to try and tailor their in-class examinations to the credentialing testing matrix. Aside from flashcards, Kettering also offers HomeStudy software tutorial packages, audio lectures on Critical Care, Asthma, Cardiovascular, Neonatal, Pulmonary Diagnostic, Sleep Technologies.

Easy Auscultation by MedEdu is an education website for medical professionals that provides excellent drill and practice software for heart and lung sounds. Freshman students have difficulty identifying correct heart and lung sounds, which is a skill that is acquired through repetition. The software allows them to use their stethoscope and listen to heart or lung sounds, see a waveform of the sound and also provides listening tips. Students listen to the lung sounds and then are quizzed to see if they can identify the correct heart or lung sound. The relative advantage of this type of software is that it allows repeated practice without the student having to attend additional clinical hours, a significant time and cost savings to the student and program.

TUTORIAL

The tutorial software combines complete instruction with drill and practice and can be used as a standalone instructional method. The relative advantage is students are allowed to progress to more difficult concepts at their pace. Advanced students can complete the content without losing interest and becoming bored. Careful selection of tutorial software is essential to ensure that the desired objectives will be covered. Teachers should also evaluate the method of instruction. Optimally the instructional software should allow students to control the pace, pause and repeat content if needed. Immediate feedback for the drill and practice component is essential to reinforce memorization of correct information. Tutorials may be either Linear or Branching. Linear tutorials provide the same information despite student performance. Branching tutorials direct learners on alternate paths depending on their performance. (Roblyer, 2016 p.83-86)

Kettering HomeStudy software tutorial packages in critical care, asthma, cardiovascular, neonatal, pulmonary diagnostic and sleep technologies that provide standardized curriculum according to accreditation standards in advanced concepts in respiratory care. The relative advantage of using tutorial software is to instruct students on curriculum content and allow students to progress through these more difficult content areas at their pace.  Additionally, not all program educators have the same knowledge in all subjects.  This software program has the advantage of providing additional references to other resources, such as course textbooks for respiratory care and journal references that they have access to through the college’s online library or in print. Presently the two primary educators have strong backgrounds in neonatal care, sleep medicine, and pulmonary diagnostics, but have limited experience with adult critical care, asthma, and cardiovascular care. Providing tutorials in these subject areas would allow for appropriate instruction without having the college incur additional expenses for annual guest lecturers’ or employment of additional adjunct faculty to teach these topics. The tutorial software would also allow advanced students to learn information that may not otherwise be offered by the program because of time constraints and lack of resources of equipment and supplies.  Not all respiratory programs have to provide extensive curriculum in sleep diagnostics.

Study.com provides an audio-visual (8 min) pause play transcript and associated quizzes of all courses from elementary, middle, high college graduate and post-graduate and professional development.  The relative advantage is that students have self-paced instruction.  This resource offers general information so utilizing it for review of core concepts would be most appropriate.

The healthcare industry relies on instructional tools to introduce, train, evaluate and maintain proficiency for optimal patient care.  Healthcare clinicians must be competent decision makers, skilled in procedures and therapies in a rapidly progressing stressful environment.  Providers require rigorous training and critical evaluation of skills to ensure patient safety.  Skills must be practiced to be mastered and maintained.  Clinicians must troubleshoot equipment and differentially diagnose life-threatening conditions for optimal patient care.  For high acuity, low-frequency skills competence often needs to be obtained through other means than direct patient contact.  Either because the scenario poses too much risk to the patient or the opportunity does not present itself frequently enough for clinicians to maintain proficiency.  Simulation and game-based software are software are viable alternatives for training and maintaining proficiency in these conditions.  (Damassa, 2010 p. 2-6)

SIMULATION

Because of the diversity of knowledge necessary for competence and the limited clinical hours, respiratory students may not encounter all types of patients and situations during their clinical experience.  To supplement clinical skills and provide repetition and practice simulation is a useful adjunctive tool to reinforce, practice and remediate deficiencies in performance. (Motola, 2013 p. e1525) Simulations provide procedural and situational training, essential educational strategies in healthcare education.

Kettering provides practice for respiratory clinical simulations examinations.  The clinical simulation software utilizes a branching concept, depending on the answers the student provides the software directs them to different pathways.  In the situation of clinical simulation, the patient is either treated and recovers or may die.  There are also remediation points within the scenarios for students to review their current choices and make decisions to correct their course of diagnosis, evaluation, and treatment.  The relative advantage of this tutorial software is that it replicates the actual simulation testing examination enhancing student proficiency in decision making while acclimating them to the high stakes testing style.

Edwards Critical Care Toolkit incorporates a software-based fluid response simulator that I have used as part of my hemodynamics curriculum.  The simulator allows students to make decisions based on presented hemodynamic data displayed on the simulated hemodynamic monitor.  They are given patient scenarios, the simulator can run automatically, forcing students to make decisions, or it can be static allowing them to manipulate variables independently to see the effects of the hemodynamic variables.  There are also modules on other high risk or low incident scenarios.  They have simulations for critical care, stroke, heart failure, EBOLA, and VAP.  The relative advantage is to provide students access to situations that they would not otherwise be exposed to or have limited exposure to, such as low incidence and high-risk situations. The software allows for safe exploration of “what if’ scenarios without harming patients.  

INSTRUCTIONAL GAMES

Instructional games add rules to drills or simulations.  There is an element of competition.  The relative advantage is to provide enhanced motivation to drill and practice or simulation techniques with the addition of competition. (Roblyer, 2016 p. 92) Educational games improve health care professional practice and quality of patient care. (Akl, 2013)

Virtual reality plays a critical role in providing students the ability to get involved in an interdisciplinary process that imitates real world scenarios such as with Linden Lab’s Web-based virtual reality hospital in 2nd Life that has over 600,000 users (Dammasa, 2010 p. 4). Students learn about their role as part of an interdisciplinary team in the healthcare system.  They may learn decision-making sequences, procedural skills or just manipulate variables to observe the outcome. The relative advantage of utilizing simulation for high-risk, low-frequency skills is that student practice can be done in a safe environment without any harm to patients.  The environment can be tailored create “what if situations” that may not be desirable or may not occur in their clinical situations.  Although I have not had personal experience with this particular software, London’s Imperial College is successfully using it to their curriculum access a link to more information here.

V Sim created by Laerdal allows diagnosis of respiratory disease in a 3D game based simulation. The simulator is particularly useful for students because it provides a realistic scenario with clinical decision points in real-time without confounding environmental factors. Simulation software is helpful for clinicians to learn, practice and refine skills before entering a clinical situation where they may be asked questions by parents, nurses or physicians. It can better prepare them for unexpected scenarios, improving their critical thinking and troubleshooting performance for situations that may present themselves.  The relative advantage of high stakes competition drives student’s motivation to use the game based software. I find that the students are more engaged than with traditional instructional software, and it can be used to present scenarios that may not naturally occur during their clinical course.

The problem-based software allows students to utilize their critical thinking and analytical skills.  V Sim and other high fidelity medical simulation software such as the Respiratory Simulation Toolkit created by Oakes’ Health Educator Publications incorporates simulation software that drives decision-based care based on displayed physiological data, electronic medical record information. The scenario is driven by a comprehensive algorithm that color codes decisions into green, yellow and red categories based on the quality of the decision. Students are engaged in a realistic scenario, given information to analyze and interpret and make clinical decisions based on the information presented. Debriefing and post-debriefing are necessary steps to integrate when using this type of software. Students sometimes get so excited in the simulation experience that they need time to decompress before reviewing and reflecting on their performance. We record the scenarios and discuss them in the classroom section of the lab. The simulation kit provides NBRC (National Certification) style questions to pose to students during this phase. The relative advantage of using problem-based software is that students have the opportunity to refine decision-making skills in a safer, more controlled environment. Many of the simulation and game-based software applications used in healthcare incorporate problem-based algorithms.

In conclusion, instructional software has been shown to be beneficial for memorization, learning, practicing and generating higher order thinking and problem-solving skills.  Efficient utilization of instructional software depends on the desired objectives, many instructional software applications are used in conjunction with other teaching methods and strategies.  Simulation and game-based software combine drill and practice and instructional software methods to create realistic interactive learning environments.  These types of instruction are useful when other methods of teaching are not practical or feasible. In the case of healthcare education and training, considerations for frequency and patient safety play a significant role in determining the utilization of instructional software to meet learning objectives.

View an example of integrating instructional software into a lesson plan here.

References

Akl, E. A., Kairouz, V. F., Sackett, K. M., Erdley, W. S., Mustafa, R. A., Fiander, M., … & Schünemann, H. (2013). Educational games for health professionals. Cochrane Database Syst Rev, 3(3).

Damassa, D. A., & Sitko, T. D. (2010). Simulation technologies in higher education: Uses, trends, and implications. ECAR Research Bulletin, 3, 2010. DOI: 10.3109/0142159X.2013.818632

Motola, I., Devine, L. A., Chung, H. S., Sullivan, J. E., & Issenberg, S. B. (January 01, 2013). Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Medical Teacher, 35, 10, 1511-30. DOI:10.3109/0142159X.2013.818632

Roblyer, M. (2016). Integrating educational technology into teaching (7th ed.). Massachusetts: Pearson.