Penni Watts, PhD, RN, CHSE
CHSE-A ONLINE PORTFOLIO
REFLECTIVE STATEMENTS
Professional Values and Capabilities
I have been involved in simulation for 8 years. My services are sought on and off campus in the area of mentoring and consulting on various aspects of simulation implementation. I am committed to excellence in simulation and to ensuring the curriculum objectives are met while continually advocating for high ethical and professional behaviors in those involved in simulation. My responsibilities include the development, leadership, and advocacy for the campus wide interprofessional simulation curriculum with undergraduate health students. This has been challenging and has involved careful conversations between the professions in understanding simulation best practice. The road has been rocky and I have had many failures along the way. There was resistance and my "let's make this happen now" mantra failed. I was devastated. However, I took a step back and reflected on the issues. I myself had to return to the true goal and issues at hand and formulate a revised approach. I strive for professional behavior and mutual respect with others; yet, I was not fully developed in my own understanding of interprofessionality. What I lacked was what I was teaching everyday: to be curious and understand the frame of others. I had to humble myself as a 25-year nurse veteran and seek to understand others. This took much self-reflection and listening to others. I am committed to improving the inter-professional simulation program and continue improving myself so I can role model those behaviors.
I have much more to learn about each profession and how to engage and improve teamwork. I have also personally grown through this process and have re-framed my work as a professional. Continually working on my own self-awareness, and what I truly value is a work in progress. Working with the simulation team is something I enjoy and respect as we are striving to role model the behaviors we are teaching our learners. I work well with groups and often migrate to the leadership role where my personality and team leading skills prove successful. Having self-awareness and self-monitoring skills are challenging and require intentional strides to step back and ensure I check myself consistently.
After first hand witnessing true acts of disrespect for other professions during simulation, this became a priority for the faculty involved in simulation. It was even more devastating that nursing faculty were the ones demonstrating this behavior. When I began facilitating interprofessional simulation, we had not prepared for the complexity that exists between professions. There had been no preparation on our part of the “co-debriefing” aspect of debriefing of interprofessional groups. These events led to a course on Modeling Interprofessional Behavior. Through developing this course, I had to study each professions standards and seek to understand their frames. This course focused on the concept of having high regard for each other as health professional in all contexts and role modeling for our learners. While the course was successful in helping others, the success for me was learning who I really was as a professional nurse and simulationist.
Scholarship and Spirit of Inquiry
I am very passionate about nursing education and improving clinical practice. I have always been a “life-long learner” and seek to learn and improve myself. As my career focus has become simulation, I am committed to implementing simulation in the most appropriate and effective manner for improving clinical care. I am constantly in the literature reviewing new articles for any information that may help me become a better educator. An essential component of my professional growth is seeking feedback from the senior associate dean and the assistant dean in my school of nursing. Their guidance and mentorship has been a tremendous influence on my approach to situations, handling conversations, and in facilitating other faculty’s development. Working closely with other simulation experts, I invite feedback regarding not only role as a professor and educator but also as a leader within our institution regarding simulation. Being a member of INACSL and SSIH, I remain connected to the simulation community and to constant interactions with other simulation experts across the country. I often spend time reading and collaborating with my simulation peers regarding new ideas and evidence from the simulation community. As a recent PhD graduate, my research focus was on evaluation in simulation. There is still much to learn in the simulation arena. Part of my annual evaluation as an instructor, and now assistant professor in nursing, I was doing an excellent job of implementing simulation, but had not taken it to the next level of scholarship and grant funding. I have worked on several small projects but had not fully understood the impact of my own program of research. While I have been successful at implementing simulation in our simulation lab, I am now developing an infrastructure for conducting more inquiry and discovery on simulation practice.
While I am most often the educator, I want to always learn and seek to improve myself as a simulation expert. By searching the literature, listservs, and networking, I consistently work to improve myself and my work as a simulation expert. After attending the Center for Medical Simulation Advanced Instructor Course, I realized my limitations as a debriefer. I was challenged with really thinking deeply and critically about each simulation. This was a challenge for me, especially to admit that I struggled with analyzing difficult debriefings and simulations. I then immersed myself in strengthening my skills in dealing with these situations and worked with the most expert debriefer in our institution. Critiquing new evidence and methods in simulation is a perpetual practice that helps mold and shape the implementation of our current and future simulation experiences. Noticing whether the new information is applicable, appropriate, and relevant, helps guide the development of future simulation experiences. As I continue to grow as a leader in simulation, I am constantly learning to view every situation, experience, and simulation from another perspective. I must always be engaged and energetic in all situations while striving to improve the development of simulation methodologies.
Designing and Developing Learning Activities
An essential aspect of my role in my institution is designing simulation activities for many professions and faculty on our campus. Facilitating needs assessments for these groups can be challenging. I work with faculty to help them reframe and identify the real deficits and areas needing work in their learners. Channeling these desired needs into appropriate learning objectives can be challenging as faculty expect to achieve too much in their simulation. When I began working in simulation, I thought I was effective in implementing simulations. However, I allowed faculty to create experiences with too many objectives and unrealistic expectations. I learned valuable lessons in working with faculty and developed strategies to support faculty in developing simulations. I began using the Jeffries Simulation Framework and the Standards of Best Practice as the guiding principles for our simulation events. In addition, I use Kolb’s experiential learning theory when developing simulation experiences.
I am challenged with many novice faculty and educators who believe that simulation is just using a mannequin to teach with. Educating and involving them in the process is essential to gain understanding and buy-in into simulation methodology. Matching modalities with the learning objectives is imperative in simulation and often I am challenged with helping faculty develop their simulation. Faculty sometime desire to use a certain modality because of their own personal preference and I must coach them to develop an understanding of the importance of matching appropriate modalities. I have grown from my many mistakes by having a “mismatch” of modality and objectives in a simulation. Now, I spend more time preparing and performing run-throughs with the faculty to ensure I am on target with the accurate formula for simulation experiences.
While most of my work is devoted to developing faculty in simulation, I am on a mission to develop the best formula for training faculty in simulation. Through this entire process, I have learned about myself and my own personal desire to investigate for more evidence based methods to teach and train students and faculty. Understanding the learner has also become key for developing simulation experiences. The more simulations I am involved in, the more I learn about the diversity of the learners and the best strategies for facilitating their learning. At the beginning of my simulation career, I thought I knew what students needed. As I have matured as a simulation facilitator, it has become evident that the learners actually tell us what they need through simulation. Developing simulations has made me keenly aware of the diverse learning styles and needs of students and faculty during training. While I have had advanced training in simulation, I still seek feedback from other expert simulation professionals with challenging projects. Working with professionals from across the country on a variety of projects, I have learned more about my own personal style, strengths, and weaknesses and the best approaches for teaching others. It has been invaluable working with other simulationists as we support each other and provide constructive feedback on our performance.
Implementing and Evaluating Simulation-based Educational Activities
Implementing a simulation event is the most rewarding of all activities related to simulation for me. I believe it requires keen observation and surveillance skills to ensure the activity is appropriate for the learners and how to improve for the next session. Being successful in implementing a simulation means having an awareness of the activity, goals, objectives, and ultimate outcomes of the learners. Having a clear understanding of the level of learner and the expectations of their performance creates opportunities for adaptations and adjustments to the activity as needed. Creating and maintaining a safe learning environment and including adequate preparatory information prior to the simulation promotes a supportive and engaging learning environment.
Through evaluations and anecdotal conversations with learners I have adapted and adjusted the pre-briefing and orientation to simulation to ensure the learners have opportunities for self-reflection and self-discovery. I have learned that how the facilitator engages the learners from beginning of the Prebriefing until end of the debriefing. The facilitator’s attitude and enthusiasm sets the stage for the most optimal learning. Prebriefing is an art and requires constant customization based upon each simulation, evaluations, learner response, and overall atmosphere of the simulation event. I discovered this when I began working with novice simulation educators and noticed the difference in the some participant’s responses could be correlated to the facilitator’s demeanor. I spend much of my time in simulation working on developing better pre-briefs, simulations, and debriefing sessions. My colleagues and I are proponents of “debriefing the debriefer” using our current debriefing structure for learners. While I do much facilitation and debriefing of simulation, I still obtain feedback informally and formally through the DASH and having my debriefing sessions “debriefed”. Allowing learners to reflect on their learning and by making them feel safe to discuss mistakes is not easy and requires constant assurance in every simulation experience. I pride myself on ensuring the learners are comfortable in the simulation and that they feel safe speaking up and trying new skills and techniques.
After each simulation, the simulation evaluations and anecdotal notes are analyzed A formal debrief and review of every simulation event is planned for consistent quality improvement. I review each evaluation form for any statements or comments by learners that may improve the next simulation. Content experts or faculty members observing the simulation compare student’s performances to expected clinical behaviors and note any deficits and strengths. I am interested in not only modifying the course and curriculum as needed, but also on my performance in the implementation of the simulation and how I can do better related to course setup, logistics, style of facilitation, and learner success. I modify my practice based upon feedback on all aspects of simulation implementation. After formulating a comprehensive improvement plan for each simulation, I work with faculty and learners to continue creating better simulation experiences. I have learned that simulation implementation is not a static process and requires constant revisions and attention to the learner outcomes.