Scenario-Based e-Learning: Benefits for Emergency Medical Professionals

How can someone gain experience efficiently, quickly, and without the stress of learning in high-stress situations? One answer is scenario-based e-Learning. According to Dr. Ruth Colvin Clark, a renowned specialist in instructional design and technical training, scenario-based education is at its core “job experience in a box.” A learner can enter a simulated, true-to-life environment and, depending on learning objectives, make choices accordingly. This begs the question: what makes it ideal for continuing education for emergency medical services professionals? For that, we must turn to the primary benefits of scenario-based education.

What Is Scenario-Based Education?

Scenario-based education is a student-centered, immersive learning modality using situated cognition through simulation to create authentic learning experiences. In scenario-based education, the learner becomes an actor assuming the role of a character who must make relevant choices depending on the situation presented. Once the learner assumes this role, they are able to make meaningful decisions that will affect the outcome of the scenario based on the information and data they gather. Giving the learner the ability to make such decisions also comes with the ability for them to make mistakes, which are the most powerful opportunities for learning. In the words of Niels Bohr, Nobel Prize-winning physicist, “An expert is someone who has made all of the mistakes that can be made in a limited domain.”

Benefits of Scenario-Based e-Learning

Productive Failure

An unguided, problem-solving experience is what Dr. Manu Kapur termed “productive failure.”¹⁸ Evidence shows that learners who are allowed to make mistakes significantly outperform their direct instruction counterparts in learning transfer and long-term learning.¹⁸ In scenario-based education, learners are given a safe, controlled environment where they are free to explore and engage concepts confidently. The concept of productive failure encourages them to make mistakes and use this experience to solidify conceptual understanding, ultimately avoiding similar errors in actuality. Scenario-based learning help mitigate risks and improve patient outcomes in the field.

Contextualization of Concepts

The theories of situated cognition and cognitive apprenticeship assert the critical importance of context for learning and instruction to be effective. Moreover, a learner’s readiness to learn is increased when the learning relates to knowledge required in the real world.⁴² Essentially, if a learner is able to contextualize the real-world benefit from this training, they are more likely to push beyond their comfort zones and explore their cognitive boundaries.³⁶ Not only does this allow for experimentation, improvisation, and a more complete understanding of the concepts being taught, but it also helps contextualize new knowledge by showing the learner how it matters in an authentic example. Scenario-based education excels at placing learners in authentic situations where their skills and knowledge are challenged, ultimately rewarding them with more confidence in their abilities than would be gained through traditional guided instruction.⁴⁶

But what if you wanted to teach concepts that apply in situations with heightened risk and stress? Consider this: if an inexperienced provider were to arrive on the scene of a pin-in where gaining access to the patient is difficult or even impossible, or a hazardous materials (HAZMAT) situation, they could make a grievous mistake that could put their lives, the lives of their crew, or the lives of potential patients or bystanders in grave danger. While these environments could be recreated authentically using props, actors, and moulage to set the stage of such a scene, think of the financial and logistical nightmare that such an undertaking could require. This is where scenario-based e-Learning comes in.

Safe Learning Environment

E-Learning can provide a wealth of benefits for designing and implementing scenario-based education. In our previous example of a difficult pin-in or HAZMAT scenario, the logistical and financial hurdles of recreating such an event can be staggering. Depending on the environment, the lives of the students and actors could even be put at risk. E-Learning avoids these pitfalls completely by creating virtual worlds where users are free to choose whatever decisions they see fit. The most inhospitable and risk-prone environments and situations are recreated and delivered in a safe learning space while still providing learners with a realistic stage where they can gain valuable real-world experience (authentic learning). More importantly, effective learning occurs when psychologically safe conditions are present.⁴⁸

For example, one scenario involves a case where the patient has suffered severe lacerations in a bar fight. Law enforcement manages to separate the aggressors and maintain a tenuous level of control, but tensions are still running high, and violence could erupt at any moment. While the potential for violence is clearly illustrated and can be accentuated by images, video, or sounds, the learner will never be in any real danger. If a learner makes a poor decision, they can see the outcome of that choice without any chance of harm to themselves or any other individuals involved.

Expediency

Personal safety is not the only positive aspect of providing students with the opportunity to gain practical experience through scenario-based e-Learning; it can also save time. Gaining experience through apprenticeships requires a large time commitment and carries a factor of chance as well. One learner can do an entire 200-hour clinical rotation and seldom encounter critical situations while another learner’s 200-hour clinical rotation could be littered with them. Even though both learners completed the same amount of time in clinical rotation, they received largely different experiences. Moreover, actions, procedures, and ongoing assessments require time to perform, resulting in a learning experience with a gross time on task exponentially greater than the net time to learn the key objectives and outcomes from that experience.

Scenario-based e-Learning can compress time, allowing actions that are not strictly part of the objective at hand to be condensed temporally.⁹ Extended care or critical care, such as an extended transport, could potentially take hours to complete. This same scenario can be condensed into minutes or even seconds while still managing to convey the appropriate concepts to the learner. For example, let’s explore a scenario involving a young woman pinned in her car after a particularly violent motor vehicle collision (MVC). A rescuer character informs the learner that it could take 20 minutes to extricate her from the vehicle. With the benefits of time compression, what would take 20 minutes in the real world can be reduced to a single, instantaneous click. This allows the learner to accomplish the learning goals in a shorter time-span and effectively gain considerably more experience in less time.

Not only can time be compressed in this manner, but the learner is given control over the pacing of the scenario itself. An individual learner can progress through the scenario at whatever speed they prefer without having to wait for any lengthy actions to take place. This not only saves time and resources during the education itself but also keeps the learner focused on gaining the pertinent experience and therefore more engaged.

Engagement & Immersion

Learner engagement is bolstered by the active learning promoted by scenarios, where “the learner [is] placed in a scenario where his/her decisions affect, or alter subsequent events leading to new events.”³⁷ Learners directly interact with the material itself by interpreting relevant data and making choices accordingly. For this reason, the learner is never told explicitly where to look and what to look for when performing a patient assessment. The learner is in control of their “character,” and the onus to thoroughly assess their patient is on them alone. This is not to say the scenario environment is one of high pressure pure discovery learning, as evidence shows this is ineffective.⁹ Instead, it offers them the agency necessary to make their decisions confidently. There is a theory in ludology called player agency, or the ability for a player of a game to meaningfully change the course of their experience, both objectively through tangible effects and subjectively through how much control they perceive themselves to have.⁴⁵ While a scenario is not a game, the concept is comparable; the learner must feel they have adequate and realistic control over their decisions in the scenario and that their decisions make an appreciable difference in the world of the scenario. This is directly influenced by the overarching principle of learner immersion.

Immersion is defined by Herrington et al as “providing compelling and realistic experiences.”¹⁶ These experiences can be cultivated using cognitive realism to create the scenario itself, accomplished by thoroughly describing well-realized characters; rich depictions of locations, objects, and actions in the world; and providing a realistic setup for the events in the scenario. While not every learner will have the intrinsic motivation to see a specific piece of learning through to the end, a compelling event, person, or location properly crafted in a scenario can engage them, providing the extrinsic motivation necessary to succeed.

Narrative structure and techniques help deliver extrinsic motivation in spades. Vivid imagery can be used to describe locations and objects to help paint the exact picture of the scenario in the mind of the learner and can be reinforced by appropriate images and sound. The use of second-person present tense helps the learner feel the immediacy of any occurrences in the world and makes them feel like they are part of the scene. Narrative hooks and cliffhangers grab the learner’s attention and create dramatic tension; for example, in the aforementioned MVC scenario, events leading up to the crash itself are thoroughly described. However, the outcome of the incident is not revealed immediately until the call comes through and the learner arrives on-scene. By utilizing such storytelling techniques, the learners are drawn deeper into the world of a scenario and can find more enjoyment in the learning than they otherwise would. A learner’s enjoyment is not the most important aspect of training, but it greatly impacts learner retention and desire to return. Studies show scenario-based education increases learning retention among learners and results in greater satisfaction with the learning experience.^{3, 4, 20, 25, 31}

With today’s technology, immersion and simulation can achieve an astounding level of fidelity, offering realistic, multi-sensory learner engagement up to and including the use of virtual and augmented reality. However, these types of simulations are not only often cost-prohibitive for most EMS educational programs and services but also require an exorbitant amount of time to complete (42hr – 143hr per hour of instruction).¹³ Research shows that the fidelity is not as important as the realism of the problem and its relevance to the learner.¹⁶ A realistic trauma scenario delivered by simple text will be more effective than an outlandish multi-casualty space-craft incident delivered in virtual reality. Simple images, storytelling, and audio cues can be used to effectively enhance immersion and realism while not exhausting the training budget. Well-designed scenarios are built around realistic problems first and foremost; enhancements can then be made to increase fidelity as time and budget allow.

Critical Thinking Skills

Problem-based learning has been shown to improve critical thinking skills and is used extensively throughout medical education.¹⁴ For medical providers, including EMTs and paramedics, critical thinking skills are paramount. Scenarios require the learner to act as the primary caregiver for a simulated patient, making decisions based on their assessment and findings. These assessments and findings point to a variety of potential diagnoses; however, the learner must think through these possibilities to make a clinical decision and diagnosis before implementing a treatment plan. Well-designed e-Learning scenarios afford the learner these opportunities and provide substantive, constructive feedback when the learner makes an incorrect decision, creating durable learning through these productive failures.

Conclusion

As with any education, Malcolm Knowles’ adage rings true: “the learner… is central to the educational process.” Evidence suggests that by focusing the content, context, and pacing of the learning process on the learner, there is a higher likelihood of achieving “meaningful learning.”^{27, 28, 29, 30, 34} Scenarios are littered with evidence-based theories synergistically providing an authentic learning experience that engages, entertains, expedites, and endures.

L. Kelly Kirk III—AAS, BS, MSEd—is the president and CEO of 911 e-Learning Solutions, LLC in Thomasville, NC, and has been an active paramedic since 1994. Having developed online EMS courses since 2000, he is recognized throughout North Carolina as a pioneer in online learning for emergency services. In his quest to improve distance education as a whole, he has served on and with multiple state-level committees and organizations, received a master’s degree in instructional design for online learning, and is nearing completion of his Ph.D. in instructional design for online learning.

David M. Robertson is a photographer, videographer, voiceover artist, and musician who has been developing e-Learning content with 911 e-Learning Solutions since 2017. He is based in High Point, NC, and studied at UNC-Greensboro’s School of Media Studies.

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