Book Review
Computer Assisted Instruction
1991; Medi-Sim Inc, Edwardsville KS;
Lee D Parker
School of Commerce, University of Adelaide, Adelaide 5005
Nursing Education - Tutorial Demonstration Disk
Critical Care Nursing - Simulations Demonstration Disk
Clinical Simulations for Nursing Education
Mosby-Williams and Wilkins Pty Limited are distributing software programmes from Medi-Sim - computer assisted instruction for nurses. The range is diverse and includes critical care, medical-surgical, mental health, paediatric, pharmacology, women's health, nursing management, labor and delivery (over 50 titles in all). Prices vary.
Medi-Sim publishes more than 200 computer assisted instructional programs for nurse education including tutorials and simulations. This review is based on two disks containing a number of demonstrations of various incomplete simulations and a disk of partial nurse education tutorials, all ranging over a variety of topics.
The programs are predominantly text based with occasional medium resolution graphics used to illustrate aspects of the simulations or tutorials. The user interface is common for all the programs making usage very easy once the learner has become familiar with the design of the software. Menu choices are clear and easy to follow and all the options required for the program appear on screen except for the key used to exit the program at any point. The learner either types in a number or uses the arrow keys to choose a menu bar option from the bottom of the screen. A person with minimal computer knowledge should be able to use the program without too much difficulty. Instructions on using the software are offered to the user at the beginning. This can be by-passed if desired. No help is provided as the program is running - a glaring omission when compared with most modern software. One very useful feature of the programs is the glossary option that provides definitions of terms related to the simulation or tutorial. This can be accessed at any time during the session.
The simulations consist of the presentation of real life scenarios. The student responds to a series of practical questions requiring assessment skills and patient management decision making skills. Responses are in the form of actions that need to be made in response to the scenarios. Actions are presented in the form of multiple choice lists. Each decision point may have a single answer or require multiple responses. Attempts are made at single answers until the right one is selected. Those decision points that permit multiple options allow for the necessity to respond to some situations with more than one concurrent action. Answers are provided by typing in a number from a list of options and pressing the <ENTER> key. The student can continue on from a multiple answer question whenever they wish and feedback or further information is provided. Some questions may also have additional information available such as current medications, laboratory reports, doctor's orders and patient profiles that assist the learner in making decisions. Immediate feedback is provided for choices that are made. Some of the feedback provides additional information or information in response to an enquiry. For example, the student may choose to perform an observation of some sort. The feedback will provide the data in response to this choice. Explanations are also given as to why an action may be appropriate or inappropriate. Neutral actions are also recognised as possible and comments are provided on these if they are chosen.
As the session progresses, the computer keeps track of responses and scores are provided at the end informing students of their progress. These scores include an information gathering score (which rates the individual's ability to identify relevant assessment data) and a decision making score (which rates the student's ability to make patient management decisions).
The student's performance, in relation to learning objectives provided at the start of the session, is also analysed and a score given for each. A case summary and bibliography are also presented at the end of the session.
The scores, summary, and bibliography can be printed but this feature was not available in the demonstration copies. The length of a complete session is approximately 2030 minutes.
The nursing education tutorials are very similar in design to the simulations. These, however, are not designed to test assessment and decision making skills but provide theoretical education in an interactive manner. Information is presented to the student and this is interspersed with multiple choice questions for which there is only one correct answer. Students can continue trying to answer the questions until the correct response is obtained after which, the tutorial moves to the next screen. Once again, graphics are used to illustrate the text. A self-assessment option is also provided with each tutorial so the user can test the level of knowledge following the tutorial session. American users can use these tests as part of their CEU program.
There are a few annoying features. Text and graphics are not presented on the same screen. This means that it is impossible to read the question that relates to the graphics at the same time as viewing the graphics. Even though it is possible to review the question at any time and re-examine graphic material, this becomes a little cumbersome. If graphics and text are not able to appear at the same time, a single keystroke would be useful to toggle between the two. One potentially inconvenient absence from the software is the ability to exit and return later and continuing from the exit point.
Limited movement is provided within the simulations. The learner can review the current question at any time but is unable to go back and redo previous questions. This is probably appropriate because corrections are provided as the session progresses. The nursing education tutorials provide the facility to move back and forth within the session reviewing any information that is desired.
Australian users also need to be aware that the programs use American terminology. It was impossible to meaningfully evaluate the content of the programs as the demonstration software only provided a few questions for each session.
It must also be pointed out that the simulations do not proceed on the basis of the student's responses. Some very sophisticated simulation software allows students to make decisions and, if they are incorrect, the consequences of that decision are played out to the end. In the case of the simulations reviewed here, the student is informed of incorrect responses and the session proceeds or the simulation does not proceed until a correct choice is made.
The full simulation software also includes a score retrieval system. At the beginning of the session the user is asked to enter their name, ID number, and date and, in the full version, these details are recorded on disk along with the scores. If the score retrieval system is chosen from the main menu a list of past users is presented from which a name can be selected providing scores for that person. The tutorial software does not have the same capability as far as can be determined from the demonstrations.
From a design point of view, this software offers a simple to use interactive approach to evaluating assessment and decision-making skills and learning and reviewing theoretical material. However, decisions to purchase and use the software may need to be made by individuals after examining the content of those topics in which they are interested.
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