WEBVTT
00:00:08.960 --> 00:01:12.159
Welcome to this episode of the NLN Nursing EDge podcast. I am Raquel Bertiz your host for today and I am joined by Dr. Kellie Bryant. She is the director of the Center for Innovation in Education Excellence and I am the senior manager. So today we have our guest Dr. Jasline Moreno. And before I give you her brief background, I would like to say that she is a very good friend of the National League for Nursing. So welcome. And she is the project director of the Maryland Clinical Simulation Resource Consortium, otherwise known as MCSRC. The goal of MCSRC, which is a consortium of prelicensure nursing programs in Maryland, is to increase the quality and quantity of simulations in prelicensure nursing education. Today we have a very interesting topic. So, welcome, Jasline.
00:01:12.159 --> 00:02:44.639
Thank you for joining us. Thank you so much, Raquel, for that warm welcome and good to see you again, Dr. Bryant Kellie. Wonderful to be here back at NLN. It's glad. We're glad to have you back. Yeah. So, let's talk about this very novel innovative idea here. And for our listeners who have not heard about OSTEs before what is OSTEs what tell us about AI? So I know the term OSTEs is not in everyone's vocabulary. So it stands for objective structured teaching encounters and it's really modeled after objective structure clinical examinations which many of us are familiar with but here rather than assessing the learner's clinical skills OSTEs really focus on educator competencies. So we have educators who have an opportunity to engage in realistic teaching encounters with standardized learners. So instead of standardized participants, we have standardized learners and they receive structured feedback. So really OSTEs provide a safe environment to practice, reflect and grow as an educator. So that's kind of what OSTEs is in a nutshell. I remember the first time I heard the term OSTEs, I thought somebody was saying OSTEs incorrectly and I was like about to correct them. Then I realized it's a totally different word. I think correct.
00:02:46.560 --> 00:06:15.199
So could you tell us a little bit like what are some of the common challenges that you see that simulation nurse simulation educators face when that can help address? What are those gaps that you find the OSTEs do a great job of kind of closing? Let me start by sharing my background and why I really grew towards this direction of OSTEs. I've been in the space of faculty development for quite some time and I do acknowledge that we have many opportunities for sim educator training formal pathways you know MCSRC has one NLN has one and Axel has one and after doing that for quite some time and really working with our educators through those programs I realized there was a gap and the gap is really evaluation and feedback which are essential for individual growth and so I started and really doing some research into OSTEs and found this to be an amazing opportunity for our educators. So going back to your question about what are some common challenges our novice simulationists might be facing. So, one of the biggest challenges I see that our educators have as they transition into a SIM educator role is really transitioning from the clinical expert from someone who has the knowledge and who's in the front of the classroom lecturing to someone who's working side by side and really becoming a facilitator of the learning experience. So, that I think is a common challenge. I know I can relate to that in my personal experience and my growth throughout my career and I see that very common where it's just you know how do you create that safe environment where your learners can engage at a higher level and really challenge their thinking instead of just imparting the knowledge that we consistently do in a traditional model. You're right and in in many instances really many of us go right into nursing education without that formal preparation. Yeah. So now that we have I mean many forms of formal preparation like what you said we have some courses here at the anal and then you do that simulation education leadership training at MCSRC. However, I think the challenge remains in terms of why even if we've had all these education opportunities, educational opportunities, we still have a lot of inconsistencies in what we would ideally expect our facilitators to do. Like I've seen this like debriefing people do all types of debriefing, right? And how do you think OSTEs would be I would say useful to kind of like navigate through this challenge? Yeah. So, I know Raquel, you and I have talked about this for quite some time and I'm sure Kellie has pondered on this as well. So what I from my experience at MCSRC is I followed a cohort of educators who came through our cell one training our foundational course and I did a small qualitative study to see you know where they were a year out how are they applying their knowledge and what I found was very interesting. There was a large cohort of educators who did not have an opportunity to really apply the knowledge that they had gained. So then what do we see? we see skill attrition, right?
00:06:15.199 --> 00:06:53.360
And then they sometimes revert back to what they had been doing prior to the training. So I think that speaks to some of the inconsistencies in the debriefing practice, the prebriefing practice even after the training. So not having opportunity to practice the skill that they've been, you know, they've gained this knowledge through the training from and then really not having any feedback on where they where their strengths are, where they need to really improve upon and how to move forward. So I think OSTEs is both a way to be able to practice the skills and then also an opportunity to receive feedback and these are the two components that I think we're missing.
00:06:53.360 --> 00:08:25.279
Like we've done some amazing work in the field of simulation in growing our pedagogy and really growing educators across the country. I think just over the past 10 years it has really been a wealth of knowledge. But one piece that I think that we're really ready to emerge or really approach is evaluation and feedback. And I think that's the missing loop. I think that will help develop these competencies. And I know nursing education is competency based education, right? So I think it's very timely for educators to really experience that. And that's another advantage to going through an AI is not only do you get to practice, you get feedback and you get to experience what structured feedback in a positive environment looks like and that's a bit of role modeling that's done intentionally. So, Jasline, I think this model of OSTE is very important as needed in a simulation field. We spend so much time on doing simulation training for our educators but not enough on evaluating sim simulation educators. So my question to you is if you're at an institution where you haven't you know started using this kind of format or even evaluating your sim educators how do you create that kind of change in the culture and that safe environment so that sim educators feel comfortable and actually you know maybe one day look forward to being evaluated because you know initially when anybody hears that somebody's coming to watch them or evaluate them you're a little anxious and you know maybe for some people it may be uncomfortable.
00:08:25.279 --> 00:09:00.320
So how do you kind of create that safe space and create an environment where people, you know, will look forward to going through these OSTEs and looking at the positive side of it, you know, as far as getting feedback and helping them to improve their simulation skills. I think that's such an important component and I can speak from personal experience that that has been one of the barriers. When we piloted the OSTEs through MCSRC when the day came I got emails of people, oh, I'm not feeling good. I can't come. I can imagine. And I, you know, I got the message loud and clear.
00:09:00.320 --> 00:09:42.399
And you know, in medicine when I studied the process of OSTEs, they didn't really have psychological safety embedded. And when we really were thinking about translating this into the nursing profession, that was one of the biggest pieces that we added in. We said everything that we do in the OSTEs process has to be surrounded by psychological safety. So that is a concept that's threaded throughout the process. And I think what you're referring to is a cultural shift. You know, educators do not like to be watched. We are excellent at giving feedback and evaluating our learners, but when it comes to having that experience on our own, it's nerve-wracking, right?
00:09:42.399 --> 00:10:44.000
And it's very humbling. So I think it really requires us as a profession to be open to this experience. So we've done, you know, we've done a few pilot experiences with our educators and what we really highlight is that this is not tied to your job promotion. This is not this is really an opportunity for you to improve your skills. There's, you know, there's no one saying that you're not going to facilitate sims if you don't get a certain score. It's really for personal growth, and that's how I've championed it. We do ask for volunteers. We're not making a requirement for anyone to complete it at this time, but we're hoping that having a few folks participate, the message gets out that this is a positive experience. They're really able to grow. And one of the biggest pieces is we're just prompting them to reflect on their practice. You know, I know we've heard about the Dunning Krueger effect and we do, you know, we we've done self-reflection or self-evaluation for quite some time, but we know it's not always valid, right?
00:10:44.000 --> 00:12:33.600
So to hear from an expert and really helping you prompt your thought process on you know what are the challenges you're facing you know what steps you need to take in order to advance yourself in this area has been very eye opening and that has been one of the biggest takeaways that our participants have been sharing is that they enjoy being able to self-reflect and they never saw it from that perspective until we brought it to their light. Yeah. So these are very interesting concepts if you will to kind of like okay how do we do this right so like walk us through the typical OSTEs process so I have to say it's been a humbling experience because there are so many components and I'm looking at opportunities to simplify but pretty much what you have is you have faculty who are educators that participate as your participant, right? So they're coming into the experience and then you have standardized learners. So these can be your standardized patients that are actors that will be scripted to play the role of a learner. So for our experience, we have an actor who plays the role of a learner who's very talkative and very confident but has knowledge deficit. We have someone else who is inquisitive but very shy. We have a third person who's not engaged at all. Right? So these are roles that we've created and our actors play these roles. And then you need evaluators. So you need people who are experts in prebriefing, debriefing, the pedagogy of simulation who has a wealth of knowledge and who who's willing to serve in this role. So you and I will tell you that you need to have more than one evaluator in that space.
00:12:33.600 --> 00:12:42.159
I've been doing it for some time and I had built into evaluators and every time I go through an experience, you know, it's so nice to have someone there to be like, we're on the right page, right?
00:12:42.159 --> 00:14:46.559
You're thinking the same thing I'm thinking. Are we, you know, are we where are we? Is there any bias that's coming through? And having that peer check has been very valuable. So two evaluators if you can facilitate that and then you want to make sure that you have a standardized scenario you know so a scenario that's well-designed that really looks at any bias that could be present and a scenario that I use a scenario that any educator can facilitate. It's not about content expertise. It's really just about facilitating a session with your learners. And then you need a tool to evaluate your learners. So using a standardized evaluation tool we got permission from Dr. Leighton to use the FCR and that's been going very well faculty competency rubric and that has been working well for us. So those are the different components of an AI I have facilitated this in a virtual environment using Zoom. So our educators will come there we have a video that we use as the sim experience. So our educator will prebrief the learners in the Zoom platform. Then they'll watch the video. Then they'll go straight into a debrief in Zoom. And following that debrief we ask our educator and our standardized participants to go to another room and I confer with my peer evaluator and then we bring our educator back, we bring our learners back and we give feedback and then we have opportunity to collaborate, you know, hear from them and it has been very rewarding. everyone who has participated has had positive experiences and are really, you know, looking forward to how they can improve their prebriefing and debriefing skills. That's I know it's a lot. No, thank you for those steps. Yeah. Okay. So, I think I'm gonna ask the last question and this is about the future of nursing education in OSTEs.
00:14:46.559 --> 00:14:53.759
Yeah. So, I think you know OSTEs are being increasingly discussed beyond sim centers.
00:14:53.759 --> 00:15:21.120
I think we can see OSTEs having a huge impact on nursing education and really impacting healthcare practice. I can see this being a valuable experience for preceptors, nurse residency programs, clinical coaches, and even leadership development. You know, we in sim, we provide experiences for our learners to practice before they're at the bedside, right?
00:15:21.120 --> 00:17:35.759
What if we had those opportunities for roles like educators, leaders, you know, like I feel like I prep all the time when I'm teaching. I go through my lecture and I do it on my own. But what an amazing experience to get feedback from an expert because I always ask, you know, we ask our peers, hey, what do you think? Should I do it this way? Should I do it that way? But to have that formalized pathway, it can really reshape I think healthcare overall. OSTEs really have a tremendous potential as a workforce development strategy because they provide structured opportunities to develop communication, feedback, coaching, and facilitation skills that are essential across healthcare education practice settings. So, I really think there's it's limitless. I think we're on the brink of something and my in my experience it always starts with sim and then it becomes a wildfire and we reach out right so I believe OSTEs can become an important component of competency based educator development I think that's one of the biggest pieces that I'm looking at now because all of our schools are looking at competency based education and I think this is a relevant topic for them as educators because it creates intentional pathways for preparing assessing and supporting educators throughout their career That's an amazing wrap up to the future of OSTEs and I do believe that as well. We are the pioneers of innovation in in nursing education and I am saying that because I see the two of you are and we belong to the simulation world right and I do kind of like yes that's who we are. So thank you for joining us here Jasline and yeah can I just do a last minute plug if anyone's interested at their institutions and starting OSTEs and you know looking at research and maybe not finding the right tools feel free to reach out to me I'm in the process of publishing and really getting some tools out there in collaboration with the NLN but in the meantime feel free to email me and I would love to help work with your programs.
00:17:35.759 --> 00:18:16.986
We'll make sure we add your email and your contact information at the end of this podcast. Thank you for sharing and being willing to work with others on getting their OSTEs started. So, thank you for joining us for this episode of the Nursing EDge Unscripted brought to you by the National League for Nursing. Thank you to Dr. Jasline Moreno for sharing your insights with us today. So we appreciate your support and we look forward to continuing the conversation conversations of issues in nursing education in our next episode. Thank you. Thank you for having me. Thank you.
00:00:08.960 --> 00:01:12.159
Welcome to this episode of the NLN Nursing EDge podcast. I am Raquel Bertiz your host for today and I am joined by Dr. Kellie Bryant. She is the director of the Center for Innovation in Education Excellence and I am the senior manager. So today we have our guest Dr. Jasline Moreno. And before I give you her brief background, I would like to say that she is a very good friend of the National League for Nursing. So welcome. And she is the project director of the Maryland Clinical Simulation Resource Consortium, otherwise known as MCSRC. The goal of MCSRC, which is a consortium of prelicensure nursing programs in Maryland, is to increase the quality and quantity of simulations in prelicensure nursing education. Today we have a very interesting topic. So, welcome, Jasline.
00:01:12.159 --> 00:02:44.639
Thank you for joining us. Thank you so much, Raquel, for that warm welcome and good to see you again, Dr. Bryant Kellie. Wonderful to be here back at NLN. It's glad. We're glad to have you back. Yeah. So, let's talk about this very novel innovative idea here. And for our listeners who have not heard about OSTEs before what is OSTEs what tell us about AI? So I know the term OSTEs is not in everyone's vocabulary. So it stands for objective structured teaching encounters and it's really modeled after objective structure clinical examinations which many of us are familiar with but here rather than assessing the learner's clinical skills OSTEs really focus on educator competencies. So we have educators who have an opportunity to engage in realistic teaching encounters with standardized learners. So instead of standardized participants, we have standardized learners and they receive structured feedback. So really OSTEs provide a safe environment to practice, reflect and grow as an educator. So that's kind of what OSTEs is in a nutshell. I remember the first time I heard the term OSTEs, I thought somebody was saying OSTEs incorrectly and I was like about to correct them. Then I realized it's a totally different word. I think correct.
00:02:46.560 --> 00:06:15.199
So could you tell us a little bit like what are some of the common challenges that you see that simulation nurse simulation educators face when that can help address? What are those gaps that you find the OSTEs do a great job of kind of closing? Let me start by sharing my background and why I really grew towards this direction of OSTEs. I've been in the space of faculty development for quite some time and I do acknowledge that we have many opportunities for sim educator training formal pathways you know MCSRC has one NLN has one and Axel has one and after doing that for quite some time and really working with our educators through those programs I realized there was a gap and the gap is really evaluation and feedback which are essential for individual growth and so I started and really doing some research into OSTEs and found this to be an amazing opportunity for our educators. So going back to your question about what are some common challenges our novice simulationists might be facing. So, one of the biggest challenges I see that our educators have as they transition into a SIM educator role is really transitioning from the clinical expert from someone who has the knowledge and who's in the front of the classroom lecturing to someone who's working side by side and really becoming a facilitator of the learning experience. So, that I think is a common challenge. I know I can relate to that in my personal experience and my growth throughout my career and I see that very common where it's just you know how do you create that safe environment where your learners can engage at a higher level and really challenge their thinking instead of just imparting the knowledge that we consistently do in a traditional model. You're right and in in many instances really many of us go right into nursing education without that formal preparation. Yeah. So now that we have I mean many forms of formal preparation like what you said we have some courses here at the anal and then you do that simulation education leadership training at MCSRC. However, I think the challenge remains in terms of why even if we've had all these education opportunities, educational opportunities, we still have a lot of inconsistencies in what we would ideally expect our facilitators to do. Like I've seen this like debriefing people do all types of debriefing, right? And how do you think OSTEs would be I would say useful to kind of like navigate through this challenge? Yeah. So, I know Raquel, you and I have talked about this for quite some time and I'm sure Kellie has pondered on this as well. So what I from my experience at MCSRC is I followed a cohort of educators who came through our cell one training our foundational course and I did a small qualitative study to see you know where they were a year out how are they applying their knowledge and what I found was very interesting. There was a large cohort of educators who did not have an opportunity to really apply the knowledge that they had gained. So then what do we see? we see skill attrition, right?
00:06:15.199 --> 00:06:53.360
And then they sometimes revert back to what they had been doing prior to the training. So I think that speaks to some of the inconsistencies in the debriefing practice, the prebriefing practice even after the training. So not having opportunity to practice the skill that they've been, you know, they've gained this knowledge through the training from and then really not having any feedback on where they where their strengths are, where they need to really improve upon and how to move forward. So I think OSTEs is both a way to be able to practice the skills and then also an opportunity to receive feedback and these are the two components that I think we're missing.
00:06:53.360 --> 00:08:25.279
Like we've done some amazing work in the field of simulation in growing our pedagogy and really growing educators across the country. I think just over the past 10 years it has really been a wealth of knowledge. But one piece that I think that we're really ready to emerge or really approach is evaluation and feedback. And I think that's the missing loop. I think that will help develop these competencies. And I know nursing education is competency based education, right? So I think it's very timely for educators to really experience that. And that's another advantage to going through an AI is not only do you get to practice, you get feedback and you get to experience what structured feedback in a positive environment looks like and that's a bit of role modeling that's done intentionally. So, Jasline, I think this model of OSTE is very important as needed in a simulation field. We spend so much time on doing simulation training for our educators but not enough on evaluating sim simulation educators. So my question to you is if you're at an institution where you haven't you know started using this kind of format or even evaluating your sim educators how do you create that kind of change in the culture and that safe environment so that sim educators feel comfortable and actually you know maybe one day look forward to being evaluated because you know initially when anybody hears that somebody's coming to watch them or evaluate them you're a little anxious and you know maybe for some people it may be uncomfortable.
00:08:25.279 --> 00:09:00.320
So how do you kind of create that safe space and create an environment where people, you know, will look forward to going through these OSTEs and looking at the positive side of it, you know, as far as getting feedback and helping them to improve their simulation skills. I think that's such an important component and I can speak from personal experience that that has been one of the barriers. When we piloted the OSTEs through MCSRC when the day came I got emails of people, oh, I'm not feeling good. I can't come. I can imagine. And I, you know, I got the message loud and clear.
00:09:00.320 --> 00:09:42.399
And you know, in medicine when I studied the process of OSTEs, they didn't really have psychological safety embedded. And when we really were thinking about translating this into the nursing profession, that was one of the biggest pieces that we added in. We said everything that we do in the OSTEs process has to be surrounded by psychological safety. So that is a concept that's threaded throughout the process. And I think what you're referring to is a cultural shift. You know, educators do not like to be watched. We are excellent at giving feedback and evaluating our learners, but when it comes to having that experience on our own, it's nerve-wracking, right?
00:09:42.399 --> 00:10:44.000
And it's very humbling. So I think it really requires us as a profession to be open to this experience. So we've done, you know, we've done a few pilot experiences with our educators and what we really highlight is that this is not tied to your job promotion. This is not this is really an opportunity for you to improve your skills. There's, you know, there's no one saying that you're not going to facilitate sims if you don't get a certain score. It's really for personal growth, and that's how I've championed it. We do ask for volunteers. We're not making a requirement for anyone to complete it at this time, but we're hoping that having a few folks participate, the message gets out that this is a positive experience. They're really able to grow. And one of the biggest pieces is we're just prompting them to reflect on their practice. You know, I know we've heard about the Dunning Krueger effect and we do, you know, we we've done self-reflection or self-evaluation for quite some time, but we know it's not always valid, right?
00:10:44.000 --> 00:12:33.600
So to hear from an expert and really helping you prompt your thought process on you know what are the challenges you're facing you know what steps you need to take in order to advance yourself in this area has been very eye opening and that has been one of the biggest takeaways that our participants have been sharing is that they enjoy being able to self-reflect and they never saw it from that perspective until we brought it to their light. Yeah. So these are very interesting concepts if you will to kind of like okay how do we do this right so like walk us through the typical OSTEs process so I have to say it's been a humbling experience because there are so many components and I'm looking at opportunities to simplify but pretty much what you have is you have faculty who are educators that participate as your participant, right? So they're coming into the experience and then you have standardized learners. So these can be your standardized patients that are actors that will be scripted to play the role of a learner. So for our experience, we have an actor who plays the role of a learner who's very talkative and very confident but has knowledge deficit. We have someone else who is inquisitive but very shy. We have a third person who's not engaged at all. Right? So these are roles that we've created and our actors play these roles. And then you need evaluators. So you need people who are experts in prebriefing, debriefing, the pedagogy of simulation who has a wealth of knowledge and who who's willing to serve in this role. So you and I will tell you that you need to have more than one evaluator in that space.
00:12:33.600 --> 00:12:42.159
I've been doing it for some time and I had built into evaluators and every time I go through an experience, you know, it's so nice to have someone there to be like, we're on the right page, right?
00:12:42.159 --> 00:14:46.559
You're thinking the same thing I'm thinking. Are we, you know, are we where are we? Is there any bias that's coming through? And having that peer check has been very valuable. So two evaluators if you can facilitate that and then you want to make sure that you have a standardized scenario you know so a scenario that's well-designed that really looks at any bias that could be present and a scenario that I use a scenario that any educator can facilitate. It's not about content expertise. It's really just about facilitating a session with your learners. And then you need a tool to evaluate your learners. So using a standardized evaluation tool we got permission from Dr. Leighton to use the FCR and that's been going very well faculty competency rubric and that has been working well for us. So those are the different components of an AI I have facilitated this in a virtual environment using Zoom. So our educators will come there we have a video that we use as the sim experience. So our educator will prebrief the learners in the Zoom platform. Then they'll watch the video. Then they'll go straight into a debrief in Zoom. And following that debrief we ask our educator and our standardized participants to go to another room and I confer with my peer evaluator and then we bring our educator back, we bring our learners back and we give feedback and then we have opportunity to collaborate, you know, hear from them and it has been very rewarding. everyone who has participated has had positive experiences and are really, you know, looking forward to how they can improve their prebriefing and debriefing skills. That's I know it's a lot. No, thank you for those steps. Yeah. Okay. So, I think I'm gonna ask the last question and this is about the future of nursing education in OSTEs.
00:14:46.559 --> 00:14:53.759
Yeah. So, I think you know OSTEs are being increasingly discussed beyond sim centers.
00:14:53.759 --> 00:15:21.120
I think we can see OSTEs having a huge impact on nursing education and really impacting healthcare practice. I can see this being a valuable experience for preceptors, nurse residency programs, clinical coaches, and even leadership development. You know, we in sim, we provide experiences for our learners to practice before they're at the bedside, right?
00:15:21.120 --> 00:17:35.759
What if we had those opportunities for roles like educators, leaders, you know, like I feel like I prep all the time when I'm teaching. I go through my lecture and I do it on my own. But what an amazing experience to get feedback from an expert because I always ask, you know, we ask our peers, hey, what do you think? Should I do it this way? Should I do it that way? But to have that formalized pathway, it can really reshape I think healthcare overall. OSTEs really have a tremendous potential as a workforce development strategy because they provide structured opportunities to develop communication, feedback, coaching, and facilitation skills that are essential across healthcare education practice settings. So, I really think there's it's limitless. I think we're on the brink of something and my in my experience it always starts with sim and then it becomes a wildfire and we reach out right so I believe OSTEs can become an important component of competency based educator development I think that's one of the biggest pieces that I'm looking at now because all of our schools are looking at competency based education and I think this is a relevant topic for them as educators because it creates intentional pathways for preparing assessing and supporting educators throughout their career That's an amazing wrap up to the future of OSTEs and I do believe that as well. We are the pioneers of innovation in in nursing education and I am saying that because I see the two of you are and we belong to the simulation world right and I do kind of like yes that's who we are. So thank you for joining us here Jasline and yeah can I just do a last minute plug if anyone's interested at their institutions and starting OSTEs and you know looking at research and maybe not finding the right tools feel free to reach out to me I'm in the process of publishing and really getting some tools out there in collaboration with the NLN but in the meantime feel free to email me and I would love to help work with your programs.
00:17:35.759 --> 00:18:16.986
We'll make sure we add your email and your contact information at the end of this podcast. Thank you for sharing and being willing to work with others on getting their OSTEs started. So, thank you for joining us for this episode of the Nursing EDge Unscripted brought to you by the National League for Nursing. Thank you to Dr. Jasline Moreno for sharing your insights with us today. So we appreciate your support and we look forward to continuing the conversation conversations of issues in nursing education in our next episode. Thank you. Thank you for having me. Thank you.
