A Framework for the Development of an ECG Simulator
for Health Professionals
Tracy Paul Barill
Director
and Trainer, Nursecom Educational Technologies
(604) 988-5890
www.nursecom.com
November 2000
©2000 Nursecom Educational
Technologies
Introduction
“Make
a better mousetrap, and the world will beat a path to your door.”
Ralph Waldo Emerson
Within the
education sector, private and corporate training accounts for $75 billion
annually and growing. Packer (2000) provides one explanation for this booming
training industry: “Changes in technology, plus increased competition, fuel the
demand for more education. Knowing how to learn and adapt has
become an invaluable skill” (p. 41).
Many small training companies are entering this competitive training environment. Competitive qualities such as imagination, speed, and a closer relationship with the learner strengthen the positions of smaller training companies. The Internet is the great equalizer, providing an open distribution channel for both the small and the mighty. The competitive edge is clearly with those who offer products and services that are a best fit with the needs of the online learner.
The characteristics of the online learner may be evolving with the needs of the workplace. Workers are now destined to experience several distinctly unique jobs through their lives. This trend, together with a decade of downsizing, has prompted workers to increasingly focus on “employability rather than employment security” (Short & Opengart, 2000, p. 60). Within this atmosphere, a new type of learner is emerging, a free agent learner (FAL), defined as a learner who is “engaged in self-directed learning that is career specific and develops competencies that can promote employability and career success” (Packer, p. 41). The FAL wants easily accessible, fun, time-sensitive and challenging learning opportunities (Martineau & Cartwright, 2000; Tapscott, 1998). Successful deployment of online training activities to the FAL may also ensure a sellable product for corporate customers.
Designing
effective, efficient and engaging online training is the promised land of any
instructional designer (Milano & Ullius, 1998). In a competitive market,
these features are vital yet perhaps not enough. Attention to the deployment of
training and the factors pertinent to the adoption of each learning technology
should also shape learning programs (Driscoll, 1999; Nielsen, 2000; Rogers,
1995; Schrum & Berenfield, 1997; Surrey, 1999). With insight into the characteristics of the
free agent learner, training should be designed with a clear sense of the
learner’s desire for rich, contextually appropriate and time sensitive
experiences (Csikszentmihalyi, 1990; Kearsley, 2000; Surry, 1999).
Nursecom is
a small training company that has entered the online training market. Committed
to satisfy the learning needs of health care professionals, Nursecom has
provided programs in advanced cardiac arrest management, dysrhythmia
interpretation (The Six Second ECG), cardiac physiology and emergency
care. As a principal of this company and its primary trainer for the past few
years, I am recently involved in the instructional design, development and
deployment of an online training program in basic electrocardiogram (ECG)
interpretation.
This paper
presents the iterative process of instructional design and development of the online Six Second ECG Simulator to its present point of completion.
Particular focus is placed on the literature and strategies used to develop a
learning product for the free agent learner that is effective, efficient,
engaging, and utilized. As soon became
evident with the instructional design of this online training tool, the
repurposing of course content – the attempt to build a better mousetrap - was
not sufficient to realize success.
Instructional
Design and Development of the ECG Simulator
Background
The Six
Second ECG is an accredited basic dysrhythmia interpretation
course held in a variety of settings from Port Albernie,
Nursecom conducted a needs
assessment, a performance analysis and a context/learner analysis of health
professionals in critical care settings. The continued need for effective
training in ECG interpretation is apparent. ECG training content should challenge
the learner to correctly diagnose dysrhythmias and to understand the clinical
significance of each cardiac rhythm.
The context/learner analysis
revealed several important characteristics of potential learners and their
environment. In keeping with the description of a free agent leaner, the
learner is exceptionally time conscious. Being an adult learner, the learner
may be drawn towards learning that is more experiential, that protects rather
than threatens their self-esteem, and that problem solves perceived real-world
situations. The adult learner is often an independent learner, bringing past
experience continually into the realm of learning (Driscoll, 1998).
The knowledge and skill of
dysrhythmia interpretation demands both a conceptual and a procedural type of
learning. ECG analysis is systematic. Making sense of the ECG rhythm requires a
solid conceptual base.
Earlier efforts developing online
ECG programs were disappointing. The mantra
”effective, efficient, engaging and utilized” was not realized through the
strategies implemented. Heuristic and user evaluations confirmed that these ECG
programs did not motivate the learner to complete modules. After placing the
online initiative on hold for a few months, researching further literature
sources and exploring successful online training initiatives, a new perspective
began to form.
These ECG training prototypes failed
and would continue to fail despite revisions to their interface. They were not
engaging; nor were they readily utilized. The classroom course was re-purposed into
an online program without sufficient attention to the unique characteristics of
the online learner. In addition, the full potential of online technologies was
not harnessed. Work towards the implementation of the next prototype began
based on: 1) successful deployment strategies of other companies; 2) attention
to time constraints of the learner; and 3) the combined influence of
The Design, Development and Deployment of An ECG Simulator
Overview
The first series of online training prototypes did not meet expectations. While much of the literature in educational technology pointed to the benefits of online education and outlined a prescriptive account of necessary online learning components, my experience with was less than encouraging. Bolstering content with online technologies such as computer-mediated communication does not in itself qualify as an engaging experience within the scope of the instructional objectives.
What components or parameters are necessary in an online training program to best promote the utilization and the transfer of skills to the workplace? This is the crux of the matter.
Effective
instructional designers seem to draw from a multitude of diverse fields to
arrive at an exceptional product that more than satisfies the needs of
learners. i.e. learning theory, communication theory, marketing, technology
diffusion theory, change theory, play theory, instructional design,
human-interface design, human factors research, computer programming,
engineering, sociology, business management theory, neural physiology and
psychology. While a separate paper could address the contributions of each
field of study, of particular importance in the development of this online
training prototype is: 1)
2) Csikszentmihalyi’s Flow theory; 3)
Bandura’s model linking the role of self-efficacy to human performance; and 4)
the influence of time as a separate parameter.
Diffusion of
Innovations
“Instructional technology is a field of innovation” (Surry, 1998, p. 2). Online
training incorporates several innovations such as the Internet, web browsers,
computer technology, newer learning paradigms such as constructivism and
computer-mediated communication. The diffusion of technologies as innovations
does not follow an expected trajectory. For example, the superior Beta video
format was beaten to extinction by the more convenient but technologically
inferior VHS video format (VHS could fit an entire movie on one tape whereas
Beta often required two tapes). Benefits of an innovation do not guarantee its
adoption. Daniel Surry points out that adoption of an innovation, “far from
being a spontaneous, hit and miss, mystical act, is, at least in theory, the
result of a fairly well defined, orderly process” (p. 3). Whether an individual
adopts or rejects an innovation is dependent on a host of personal, social and
technical factors (Farquhar & Surry, 1994; Norman, 1998; Rogers, 1995;
Surry, 1998; Zemke, 2000).
Everett M.
Rogers is regarded as the eminent scholar in the field of diffusion theory. In
the fourth edition of his book Diffusion of Innovations, two distinct
applications of diffusion theory are applicable to the instructional design and
development of the ECG simulator: 1) a broader insight of the learner with
regards to whether they are typically early or early majority adopters; and 2)
the characteristics of innovations that determine their rate of adoption
(1995).
The rate of
adoption of an innovation or technology often follows a
The early
majority account for a third of potential adopters and typically are more
cautious about accepting new ideas and technologies. At the present growth of
the Internet, most of those online are considered part of the early majority.
As a result, online training companies must cater to this group, providing a
product/service that meets or exceeds those already available in training
facilities. Advantages of the innovation must be clearly communicated and the
friction common with change should be minimized.
Closely
tied to adopter categories are the attributes of an innovation and their
influence on an innovation’s rate of adoption.
Once online
training is perceived and respected as an innovation, diffusion theory provides
welcome direction to the qualities of the online training product. Since the
market largely consists of early majority adopters, a training program may
benefit considerably from a design that is attentive to the five attributes
that influence rate of adoption. While the early adopters may be more willing
to overlook weaknesses of a product, the early majority will focus on an
innovation’s compatibility, trialability and level of complexity. By designing
a training program according to these criteria, an online training program is much
more likely to be utilized by the learner.
Flow Theory
Don
Tapscott claims that interactive learning is shifting for the free agent
learner (FAL) from “learning as torture to learning as fun” (1998, p. 147).
Online training companies such as Ninth House, Decision Architects and
Corporate Gameware have built their training programs and their businesses on
entertaining, interactive learning games (Filipzcak, 1997). Marshall Jones, who
has studied computer games, believes that online training programs can benefit
from the level of engagement commanded by many computer games (1999).
From a
business perspective, a learner who enjoys a learning experience will return
again and will feel obliged to share their experience from others. From the
position as instructional designer, learning concepts such as attention and
retention are encouraged when learning is engaging and enjoyable (Bandura,
1995). The question, then, is what conditions yield an enjoyable, memorable
experience? A decade of research by Mihaly Csikszentmihalyi resulted in a
popular book called Flow: The Psychology of Optimal
Experience. While several psychological theories explain enjoyment, Flow
theory also provides guidance on how to create effective learning conditions
for Flow and enjoyment to occur.
Csikszentmihalyi
believes that enjoyment is intimately related to learning, to increasing the
level of complexity in consciousness (growth) and to a sense of accomplishment.
This sense of optimal experience also seems to be cross-cultural. Enjoyment is
associated with the presence of eight major components:
1.
we confront tasks we have a chance of completing
2.
we must be able to concentrate on what we are doing
3.
the task has clear goals
4.
the task provides
immediate feedback
5.
one acts with a deep but effortless involvement that
removes from awareness the worries and frustrations of everyday life
6.
people can exercise a sense of control over their
actions
7.
concern for the self disappears, yet paradoxically the
sense of self emerges stronger after the flow experience is over; and
8.
the sense of
the duration of time is altered; hours pass by in minutes, and minutes can
stretch out to seem like hours.
Flow, or experiential enjoyment,
occurs when reading, playing sports, engaging in a chess game or being
challenged by a computer game for example.
Games are a
natural fit with flow experiences. Clearly stated goals, the use of a variety
of skills, a time clock to prompt us to focus on the present, a sense of risk
and rules that demand complete involvement all seem to provide an ideal
environment for an enjoyable, albeit challenging experience (Pearce, 1998).
Flow theory provides rationale for learning activities that are, or are not,
enjoyable. The first series of ECG training prototypes may have appealed to
some learners but many more would find them dry. Previous prototypes had clear
goals and the means to accomplish the goals but qualities such as learner
control and program feedback was minimal.
Deciding on
a simulator and game format for online ECG training follows directly from Flow
theory. By including features such as are outlined by Csikszentmihalyi within a
learning environment, the learner is more likely to enjoy the experience,
retain knowledge through the experience, and share the experience with others.
Self-Efficacy
Diffusion
theory affected the efficiency and utility of the ECG Simulator. Flow theory helped
with its design, promoting a high level of engagement while indirectly strengthening
the program’s effectiveness in facilitating knowledge acquisition and
retention. Attention to the work of Albert Bandura on self-efficacy offers much
to increase the likelihood that the ECG training is successfully implemented in
the workplace.
Bandura, a
learning theorist known for the Social Cognitive Theory of learning, sensed
that a key component was missing with his theory. Why were there significant
disparities between learning and subsequent performance? Bandura believed, as
did Piaget, that learning was an inherent human capability, even a human need.
Learning, though, did not naturally lead to performance. In other words, a
person knew how to perform but chose not to perform. Bandura realized that this
bridging factor between learning and performance was not reinforcement as
behaviorists claimed. Even with substantial external or internal reinforcement,
performance was often absent. Constructivism could not explain this phenomenon
adequately. Allowing for exploration and understanding on the part of the
learner and increasing probability of success with inclusion of suitable
reinforcement did not always result in improved or sustained performance.
Bandura came to see this bridging factor as a self-belief called self-efficacy.
Self-efficacy is defined as “the belief in one’s capabilities to
organize and execute the sources of action required to manage prospective
situations” (Bandura, 1986). Bandura and his colleagues came to believe that “how
people behave can often be better predicted by their beliefs about their capabilities than by what they are
actually capable of accomplishing” (Pajares, 2000). Michael Jaffe describes
self-efficacy:
Success
raises efficacy self-evaluations and failure lowers them, especially if one is
a novice or at some early point in the learning sequence. Once established,
enhanced self-efficacy tends to generalize to other situations, though
generalization effects occur most predictably in activities that are most
similar to those in which self-efficacy has been improved (1995).
Bandura (1999) and Pajares (2000)
are quick to caution that self-efficacy pertains to a distinct task, process or
skill. Self-efficacy is not a personality trait. Thus, teaching must remain an
individualized, task-specific process with attention to self-efficacy important
despite a student’s proficiency in other domains.
Bandura
proposes that there are four main influences on the development of
self-efficacy:
·
Mastery beliefs: this is
perhaps the most powerful and authentic determinant of self-efficacy. Mastery
beliefs result from successful or unsuccessful performances. Performances that
are successful lead to increased confidence in one’s capabilities for that
specific task. If one’s self-efficacy is directly related to whether one
chooses to perform, then one will choose to perform only those skills
associated with some prior success (Tripp, 1999);
·
Vicarious experiences:
internalized beliefs based on observation of role models;
·
Social Persuasion: referred
to as the weakest of all contributors to self-efficacy, verbal and emotional
coaching from others at least temporarily affects self-efficacy. Often, social
persuasion and appropriate reinforcement is an effective combination to
initiate performance. One or more acceptable experiences ensures sustained
performance (mastery);
·
Physiological and
Research into self-efficacy
provides further insight into human performance. First, high self-efficacy is
strongly related to the effort one makes in accomplishing a task. Perhaps this
explains why people that are confident in their abilities work harder to
completion (which then strengthens one’s high self-efficacy). Third,
individuals with high self-efficacy persist in tasks longer to achieve
successful completion. Fourth, high self-efficacy is associated with stronger
resilience. If people are more influenced by their sense of self-efficacy than
by their expectations of outcomes, significant attention should be placed on
the self-efficacy of learners.
An online training simulator could encourage one’s mastery beliefs and lead to positive emotional connections with the activity of interpreting ECGs, particularly if the simulator was simple to operate. A simulator’s availability would be directly related to its ability to influence self-efficacy through vicarious experiences or social persuasion. Human performance could theoretically be enhanced by learning activities that were similar to the workplace while removing some of the emotional behaviours such as anxiety. The concept of self-efficacy and its associate parameters point to the potential effectiveness of an online simulator to facilitate successful interpretation of ECGs in the workplace.
Time Parameters
Time
permeates through virtually every decision, every design and every technology.
Over the past ten years, the Internet has helped to redefine acceptable time
parameters. The term Internet time has recently been coined to refer to the
action/reaction cycle occurring almost instantaneously (Grove 1999; Tapscott,
1996; Tapscott, 1998). Marketers, experts in identifying social trends, refer
to the attention economy (Drucker, 1999;Godin, 2000).
Products and services that are designed to account for a customer’s lack of
available time have a distinct advantage.
Training
and education is not immune to the influence of Internet time. A short decade
ago, training and education was offered as courses that ranged in duration from
days to months with specified start and finish dates. Today knowledge objects,
anywhere/anytime learning modules, and immediate automated performance
evaluation are becoming the norm in a competitive learning market. Surging
training companies like Ninth House successfully utilize a business model that
provides short (less than 15 minutes) learning experiences online.
Seth Godin,
a marketing guru, speaks of a product’s friction in the market (Godin, 2000).
One significant contributor to friction by most online training programs is the
inordinate time demands placed on the learner. The free agent learner wants to
become knowledgeable and skilled in the shortest period possible. An online
learning program that is able to facilitate knowledge integration in less than
five minutes would fit well with the FAL’s expectations. Attention to time
shaped much of the design of the simulator and helped to revise the learning
environment to one that is more efficient than the first series of prototypes.
The ECG Simulator
Technology
A weakness
of the first series of ECG training prototypes was their dependence on various
technologies such as dynamic HTML, JavaScript, and RealAudio that are not
ubiquitous across all web browsers. A suitable technology in the development
and deployment of an online simulator for most online learners was not
available at the time that the first prototypes were released. Today, a
technology called Flash can replace the functionality offered by several tools
with over 75% of web browsers equipped with a Flash Player (Macromedia, 2000).
The
ECG simulator was created with Flash 4.0 technology of Macromedia Inc. Flash is
a program generally used to create animated web pages. Two years ago, it
released version 4.0 with expanded features including the ability to create a
high level of interactivity within a web page. Flash has been bundled with both
Internet Explorer and Netscape since their third generation releases. As a
result, Flash technology is almost ubiquitous for those accessing the Internet
(Macromedia claims that 200 million Flash players have been distributed).
Designed as a web-based multimedia development tool, Flash applications can
include text, graphics, sound, video and animations within a highly interactive
environment. Its vector-based graphics and advanced compression algorithm
enables developers to offer small applications sufficient to those with slower
modems.
For the learner, Flash is often transparent. Learning applications reside within web pages. The user may be prompted to download a newer version of Flash (i.e. Flash 5.0) if the application warrants the functionality of the latest version. While the newest Flash 5.0 was available, the simulator was released in Flash 4.0 to make the learning experience as smooth, frictionless and simple as possible (Godin, 2000;Rogers, 1995). Sound was not included in the ECG simulator at this point due to the existing diversity in the processing power of personal computers, with the expectation that some computers would be heavily taxed with the use of sound as well. Applications created in Flash also possess significant security features, protecting the integrity of the training program for both the learner and the course developer.
Structure and Function
The ECG
simulator took over three months and over fifty alpha versions to arrive at the
beta version released at the site http://www.skillstat.com/ECG_Sim.html.
The simulator is 100k in size and downloads through a 56k modem in about 8
seconds. Overall, the simulator functions as a learning tool for learners who
are novices with limited prior exposure to ECG interpretation.
The cardiac rhythm simulator begins with an introductory screen where the participant is prompted to enter their name or nickname and then click Start. This introduction displays the progress of downloading and also makes the experience more personal with later feedback that uses the learner’s name in the message.
Figure 1.
Welcome Screen 
Upon clicking on Start, the next screen is displayed. This default screen is the learning mode of the simulator. You can access either the Learn mode or the Game mode through the Option menu title at the upper left corner of the screen. Note that the 'Start' button begins an animated sinus tachycardia across a blank window. The Freeze button stops the rhythm and places a grid under the rhythm for reference. For example, once frozen, the rhythm's intervals and rate can be quickly determined. For a closer look, right click the mouse on the screen that you want magnified and choose Zoom In. Note that resolution is not lost (the graphics are vector art rather than pixilated images). To return to the original screen magnification, right-click again and choose Zoom Out, Show All or 100%.
Figure 2. Display of the Learn mode.
Each rhythm named is a functional button that begins an animated cardiac rhythm of its namesake. Note the blue box at the bottom of the screen. This is a reference window, providing brief details on the characteristics and significance of each rhythm.
Choosing Game mode adds a few extra features to the interface. First, a time clock is docked on the left side of the rhythm window and to the right is a scoreboard. Also find a Reset button that begins the game anew with each click. The objective of the game or challenge is to correctly identify as many rhythms as possible within a certain time frame. The Time menu offers three choices: one minute, three minutes, and no limit to the time taken. The learner can choose a suitable time after choosing Game mode for feedback at the end of the time frame chosen. Default time for a game is one minute.
Figure 3. Display in Game mode. Note the time clock and scoreboard. Once the Start button is clicked, the reference window disappears during the game.
In Game mode, the Freeze button will stop the rhythm and make visible the reference grid (like Learn mode) but the time clock does not stop. After beginning the game by clicking on Start, animated rhythms are generated randomly. Click on the appropriate rhythm name to identify the rhythm. If the choice is correct, Correct is displayed below the rhythm names. A Correct stops the clock. Click on Continue to continue the game and the clock. If the rhythm name chosen does not fit the cardiac rhythm displayed, a Try Again will be displayed and the clock will continue.
If a time frame of one minute or three minutes were chosen, the game/challenge concludes at the end of the respective time period. At the conclusion of the game, personal feedback is provided on total attempts tried, percent correct, and the average time taken to correctly identify cardiac rhythms along with a little personalized encouragement. Choosing Reset and then Start begins a new game.
Support is
provided to the learner/user through the Help menu. The Help Index
is a one-stop web page to access various resources such as a selection of
learning modules in ECG interpretation, a quick guide to ECG interpretation,
directions on using Flash and links to outside resources or the course
developer. Subsequent buttons of the drop menu allow for direct link to the
respective web page.
Time and the User-Interface
The
simulator takes as little as two minutes to review ECG rhythms or assess one’s
proficiency at ECG interpretation. This
short time frame is in keeping with the available time of the FAL. Time is used
within the Game mode in a time clock to make the game a finite entity.
By having a time clock, learners are encouraged to fully immerse themselves in
the learning/assessment activity. Together with clearly stated game objectives
and a high level of user control, the immersive nature of the simulator
potentially facilitates a state of flow or enjoyment for the learner/user.
With an
activity that can be accomplished in less than a few minutes, the opportunities
for frequent visits increase. With frequent visits, learners are expected to be
more successful at ECG interpretation, thus fostering a sense of self-efficacy
and the application of ECG interpretation skills in the workplace. Note that
the animated quality of the ECG simulator closely reflects an ECG rhythm at the
patient’s bedside. Realistic, repeated reinforcement promotes retention on the
knowledge and skills. The learners could cyclically assess their knowledge and
knowledge gaps (Game mode) then quickly address the knowledge gaps (Learn
mode).
The
interface was designed to be as simple as possible while allowing maximum
functionality. The design process strived to continually balance white space,
functionality, and simplicity to minimize complexity for the learner. By using
virtually identical interfaces in Game mode and Learn mode, the
user was not required to learn a new interface. Colors were used to highlight
buttons (i.e. Start button is consistently red) and to categorize the
ECG rhythms (i.e. all ventricular rhythms are black). Flow theory, the concept
of time, diffusion theory and self-efficacy served as perceptual filters not
only with the design of the interface but throughout the full iterative process
of the development of the ECG simulator.
Deployment
Deployment
is an important component of instructional design and development.
Instructional designers should be mindful of the deployment strategies
throughout all stages of design (Milano & Ullius, 1998). Diffusion theory,
with its description of the learner adoption qualities and the preferred
characteristics of an innovation with regards to its rate of adoption, supports
deployment strategies. The ECG simulator was created to be used. Therefore, attention
to the five factors that affect rate of adoption is vital.
The
relevant advantage of the ECG simulator over the first prototype is inherent in
many features mentioned earlier. The ECG simulator closely approximates a
learning program that is efficient, effective and engaging. Pilot testing of
the simulator to over sixty nurses and paramedics yielded much insight into its
design, weaknesses and strengths. While revisions are planned, the majority of
the feedback was very positive. Learners claimed to visit the simulator
regularly, to be able to navigate through both modes in less than a minute, to
enjoy the experience and to quickly fill in the gaps in their knowledge with
regards to interpreting ECGs.
Simplicity,
the opposite of complexity, was one of the main themes in the development of
the ECG simulator. Mention has already been made of the work towards a simple
user interface. The choosing of Flash 4.0 instead of the latest version favored
simplicity of download. Within the web site, access to the simulator is only
two mouse clicks away. The ECG simulator is planned to expand to include over
100 rhythms and additional features as a sellable product. By providing the
basic version, the user is able to quickly become familiar with the interface
without the complexities of a full-featured product.
The ECG
simulator’s close resemblance to current practice enhances its rate of
adoption. By offering the simulator free, its trialability and observability
are encouraged. The presence of a Share Me button in the right upper
corner enables the learner to quickly share the simulator with one or more
online colleagues. The potential dissemination by this method is exponential
provided the innovation does foster steady rates of adoption and minimal
friction exists in the innovation’s implementation (Godin, 2000).
The
learner’s comments included “The CardiacSim offers a quick review. I feel as
though I can now identify the rest of the rhythms that I don’t see regularly. A
useful tool.” The ECG simulator seems to foster a positive self-efficacy, a
crucial criterion in the transfer of learning to performance in the workplace.
Other learners reported how time “seemed to fly by”, that they wanted to try
and better their game scores, and that the game was “fun”. Two learners
challenged each other in a competition for the highest accuracy of ECG
interpretation and the greatest number of correctly interpreted ECGs. All of
these descriptors are in line with parameters of Flow.
The ECG
simulator is designed to enhance its rate of adoption by attending to Roger’s
five aforementioned attributes of a successful innovation. The simulator’s
strength in creating an engaging, positive learning experience support the
direction provided by the literature with regards to Flow theory and
self-efficacy respectively.
The ECG
simulator is currently in its beta version. Expected revisions include linking
every rhythm’s reference content with an online training module that provides
sufficient depth for the motivated learner. Each of the modules would include a
smaller, tailored simulator to help the learner retain and reinforce knowledge
and skills. One of the Internet’s greatest strengths is in its ability to
deliver bits, connect with resources and share globally. It is this feature
that is utilized in the ECG simulator. The inclusion of a button within the
interface to publish the learner’s score live on a web site may be included if
a new round of user testing proves this a desirable feature.
Additional
challenging games will supplement the existing game. For example, the learner
could be challenged to identify other pertinent components of an ECG such as
its relationship with cardiac output, atrial kick, ST changes, myocardial
ischemia and electrolyte imbalances. A separate simulator to assess or
reinforce each of these components could be developed. The full complement of
features could be included in a training program to be downloaded upon
purchase. Each revision would be designed based on principles of instructional
design, diffusion theory, flow theory, and self-efficacy with attention to the
scarcity of the learner’s time.
Conclusion
Recently,
Nursecom launched an initiative to augment its training programs with online
training programs and online learning tools. The first training program to be
available online is The Six Second
ECG, a course in electrocardiogram interpretation. One hurdle facing Nursecom was to provide an
online learning program that was effective, efficient and engaging within the
technological constraints of the Internet. The second hurdle was facilitating
the adoption of this training innovation.
Over the past few years, several prototypes were developed. The latest prototype benefited from the failures of earlier ones together with new insight into what factors may be significant in developing an online training program that is efficient, effective, engaging, and utilized. The influence of Rogers’ Diffusion theory, Csikszentmihalyi’s Flow theory, Bandura’s work linking self-efficacy with human performance and the important parameter of time have all provided a complex, non-linear lens to viewing instructional design. The ECG simulator reflects a culmination of these four factors together with the countless contributions of other fields of study towards exemplary instructional design.
Several questions remain. From a training standpoint, are learning tools ideal for the FAL? Are modular text and graphic learning environments a match for the career-focused professional? Would the typical online training module benefit from the inclusion of a selection of learning games or other engaging activities?
The ECG Simulator
has enjoyed a favorable reception as a standalone learning tool and as a
technology to support the classroom workshop, The Six Second ECG. Nursecom may
have found its unique selling position: create training experiences that are
effective, efficient, engaging and utilized for the free agent learner.
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