U N I V E R S I T Y  O F  P I T T S B U R G H

Linking Lectures to Experiences

Richard Henker, School of Nursing A Winner of the Chancellor’s Award for Distinguished Teaching Photo by Jason Blair, CIDDE

Teaching in a clinical discipline such as nursing, I have found that maintaining my clinical expertise has enriched my teaching. When I apply a particular concept to a clinical scenario, students invariably are more engaged. Because they go into nursing to care for people, students are much more interested in what I have to say when I provide a clinical example during a lecture. Ideally they would receive lecture content that matches the patients they care for that week, but, unfortunately, it is not easy to have a large class all care for a patient with a particular disease. Therefore, providing clinical examples of how to apply a concept starts integrating classroom learning with clinical application.

Clinical Teaching

I enjoy lecturing and it is an efficient method to provide content to many students, but critical thinking and application of content occur at a higher level when I work with students in the clinical setting. Spending time in the clinical area helps support my teaching several ways. First, it validates my lecture. When students observe me in a clinical setting, they realize that my lectures are not only based on what is presented in textbooks and the latest information from journal articles but also from hands-on experience. The other benefit of working in the clinical area is that I have the opportunity to help the students link what I have taught them in lecture with the way a patient presents or responds to clinical therapies.

In the Nurse Anesthesia Program, students often work with nurse anesthetists and anesthesiologists who are clinically proficient but may not always know what is expected of individual students at a particular point in their curriculum. One of the advantages that I have when working in the clinical setting is that I have accurate understanding of the students’ preparation. This allows me to set realistic goals for knowledge and performance within the context of the clinical day.

Simulation Teaching

Of all the methods that I use, I enjoy simulation the most. Simulation teaching combines key aspects of classroom teaching while incorporating the “feel” or emotion that permeates the clinical environment. The Winter Institute for Simulation and Education Research (WISER) provides an excellent setting for high fidelity human simulation. One of the simulation rooms at WISER has been modified to replicate one of the operating rooms at UPMC-Presbyterian Hospital. Simulation mannequins incorporate many physiologic functions (e.g., pulses, breath sounds, blood pressure, and airway changes). The voice of the mannequin is fed into the room from a control room; physiologic functions are controlled by a software program. Five or six students assume various roles during a scenario (e.g., circulating nurse, scrub tech, or surgeon). Typically two students are assigned as the nurse anesthetists for the scenario.

An advantage of simulation teaching is that scenarios can be developed based upon lecture content during the past term or from actual clinical events. For example, if students received a section of lecture content on anesthesia care of the trauma patient, one of the simulation scenarios might involve caring for an injured motorcyclist. Elements of real trauma cases can also be added, and students reaffirm that simulation sessions are more effective than lecture alone.

Another benefit of simulation is that students learn how to care for a patient who has an unusual clinical event. Rare anesthetic emergencies such as malignant hyperthermia can be realistically presented with a patient scenario. Students are expected to assess the situation, go through differential diagnosis, identify a plan of care, implement the plan, and evaluate the plan. Consequently, management of a rare event is more likely to be retained with simulation teaching.

Interprofessional Communication

Although management of the patient is an important piece of how a student responds during the scenario, appropriate interprofessional communication is emphasized during the debriefing of the simulation. Debriefing often occurs in a conference room following the simulation and typically includes review of a video of the session and a log of events and treatments. Led by faculty, debriefings include the students involved in the scenario. They are asked to critique themselves and encouraged to reflect and describe how they might revise their performance.

In program evaluations, nurse anesthesia program students frequently ask for more simulation teaching. Simulation is an effective and exciting way to teach but it does require a great deal of faculty time and energy. The faculty in our Nurse Anesthesia Program fully support simulation and have become experts in the field. The staff at WISER have been supportive and have contributed to both the quality and quantity of the simulation teaching within the Nurse Anesthesia Program.

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