Initial Design and Train the Trainer

The initial design of the iPad workshops was based upon what we had learned in the Essential Teaching Skills (ETS) program (MacDonald et al, 2013). The ETS program used a train-the-trainer model for the initial role out of the program. Each of the units within the department were asked to send one person to attend the train-the-trainer. The attendees were then expected to teach the course at their units. This has had a mixed review. It was successful at getting the content delivered to each of the units, and to create a body of expertise. However, the trainers were not confident in delivering the workshops, and some of the trainers were not good at it. This meant the the quality of what was delivered at the units was mixed.

At the time I created the initial design for the iPad workshops, the train-the-trainer model was seen as a success. We are now, after further reflection, looking at abandoning it for the ETS program. The change we are now considering is to have champions at each site attend the pilot delivery, however, they will not be expected to teach the course. Rather, we will be selecting two or three people who will be champions of each ETS course. After the first year, each course is offered once or twice per year. As a result, we do not need an instructor at each unit, rather we need a select few instructors who can go to where ever the given course is needed.

For the iPad program, it became apparent during the initial round of interviews that a train-the-trainer program would not work. This is largely because so few preceptors felt comfortable with facilitating iPad workshops. Actually, very few people saw their skills as enough to even be interviewed! A theme during the interviews was “I’m not an expert” or “I don’t have much to say” – and yet, they all had useful things to say.

I’m wondering now – although it may be too late – if the new model would work better. If offering the course and asked each unit to send one person for the course – would that be effective? If after sending one person per course, that person could then judge whether or not the course would be valuable for their unit. It might actually make for a better dissemination process.

OtoSim Companion

App: OtoSim Companion
Cost: Free App ($4.99 to unlock)
Function: Enhances


Teaching ear examination in the clinical setting can be very challenging. The first problem is that it may be difficult to provide the learner with the opportunity to see all of the pathological entities that they might encounter in practice. The second problem is that most books present a complete picture of the tympanic membrane rather than the small segments that are often seen with the otoscope. There are stimulators that can be purchased to offer trainees a wide range of clinical content. However, the OtoSim Companion app for the iPad provides a cost effective alternative. By selecting an image and then having the learner examined the image through an ear speculum from approximately 10-15 cm away from the iPad screen, it is possible to simulate what they would actually see through an otoscope.

The OtoSim Companion app contains a series of images with descriptions that include both common presentations and conditions that occur rarely and as such are unlikely to be encountered by a trainee. The simulation allows learners to observe a much wider breadth of clinical material than they would be likely to see during their regular rotations.

The app itself is free, but the free version only contains a few sample chapters. The remaining chapters can be unlocked through an in-app purchase for $4.99.

Challenge Activity

In groups of two, one person open the OtoSim app and choose an image. The second person, using an ear spec, examine the image and determine what they are seeing.

SimulusDM

App: Simulus DM by Simation Medical Ltd.
Cost: free
Function: Provides something new


The SimulusDM App provides simulation around various diabetes treatment options for patients . It allows the user to select a patient from several patient profiles with diverse variable (type of DM, age, weight, past treatment and lab results etc.). Once a patient profile has been determined, the app user can modify the patient’s glycemic physiology through modifications in lifestyle choices and medications. The app will then provide a visual representation of the effects of the modification on blood sugar over the course of three months. . The app supplies information in both metric and US units.

Note that this app requires that you be connected to the Internet. It is memory intensive, so you may wish to close any apps you do not need before using this.

From a teaching point of view, one of the biggest benefits to this type of simulation app is that you can allow residents to make treatment decisions that you would not be feasible or appropriate in real time clinical settings. It allows residents to see the consequences of various management decisions and learn from their mistakes without risk to patients.