Theory for Simulation
Informal Learning: Relevance and Application to Health Care Simulation

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Highlights

  • There is strong applicability of informal learning for health care simulations.

  • The design and implementation of simulations should arouse student enthusiasm, interest, and motivation.

  • Much valuable informal learning is significantly tacit and whole-person embodied learning.

Abstract

This article presents a learning framework which has been used in other disciplines but has relevance for health care simulation. Given the interest in simulation pedagogy, informal learning is presented for consideration within this contemporary learning field. In contrast to formal learning, the concept of informal learning aligns well with important aspects of contemporary health care simulation strategies. Formal learning typically incorporates a specified curriculum, is taught by a designated teacher(s), and involves assessment or certification. These are predominantly planned and prespecified activities which take place in colleges, universities, and schools. Informal learning on the other hand lacks at least one of the characteristics of formal learning and typically is indeterminate, is opportunistic, involves both internal and external goods, and is an ongoing process. There are strong connections between informal learning and health care simulations which feature students and clinicians engaging in highly contextual unfolding scenarios. Such simulations are multidimensional and their unfolding nature can be somewhat unpredictable, irrespective of predetermined learning objectives. Health care simulation can provide opportunities for whole-person embodied learning, including the affective dimensions of practice. Compared with traditional, formal learning approaches, simulations highlight the values and attributes which are central to practice, thereby offering valuable informal learning opportunities for participants to develop their tacit knowledge and to engage significantly in the process of becoming a health care professional. A case study example of a nursing student as she enters practice illustrates some additional and perhaps unintended outcomes of health care simulations.

Section snippets

Overview of Informal Learning Theory

“Informal learning” is a concept that has had a relatively low profile. Hager and Halliday (2006, p. 29) suggest that this is so because, as the adjective “informal” implies, informal learning is usually defined by the particular characteristics that it lacks in relation to its more illustrious sibling “formal learning.” As Hager and Halliday (2006, p. 29) note, three essential features are usually required for an instance of learning to count as formal. They are that it:

  • (a)

    Involves a specified

Key Features of Informal Learning

As discussed at length in Hager and Halliday (2006), key features of informal learning are that it is indeterminate and opportunistic, involves internal and external goods, and is an ongoing process as described in the following.

Relevance and Application of Informal Learning Theory Within Health Care Simulation

More and more, teaching is for surviving in a testing regime rather than for engagement with a discipline. Because internal goods are closely connected with whole person know how and the tacit, they have been increasingly neglected as the focus has shifted to formal learning and assessment. So, much of the present educational climate is simply not conducive to the internal goods that are central to rich informal learning and to learning in general. This is why, perhaps unknowingly, health care

Simulation and Informal Learning—A Case Study

A case study describing how simulation enabled informal, in addition to formal, learning opportunities for a final-year nursing student illustrates the relevance of this framework and the impact on learning for subsequent professional practice. The research, which the case study is drawn from, investigated how simulations contributed to students' learning, clinical judgement, and subsequent clinical practice and was approved by the university's ethics committee. Data were collected during two

Indeterminate

Excerpts from Benita's account of participating in the interdisciplinary simulation illustrate the indeterminate benefits afforded to her in experiencing two deteriorating patient scenarios. Eight students signed up for a half-day session, four nursing and four medical students. The group was divided into two, and one half participated in a simulation, whereas the other four observed the unfolding scenario via real-time audiovisual streamed to an adjacent room. Working in pairs, the nurses

Opportunistic

In a 2nd-year deteriorating patient simulation, one intended learning objective was for students to appreciate intravenous fluid resuscitation regimes appropriate for an elderly woman with comorbidities. During the first phase of this simulation, Benita did not perceive that the rate of intravenous fluid administration was problematic, but rather quite “standard” for a postoperative patient. However, during the second phase, the patient showed respiratory signs of fluid overload. Throughout the

Internal and External Goods

The simulation scenarios Benita experienced were all formative learning activities. As such, students should be able to demonstrate authentic actions and react as they see fit to the evolving scenario. One attraction of simulation as a learning approach is that connections can be made between knowledge and decision-making. But, greater value is often realized in how participants' values, tacit knowledge, and professional behaviours can be brought to the fore. These are, respectively, examples

Ongoing Process—One of Becoming

In addition to the “turning point” comment, participating in the interdisciplinary simulation was an epiphany for Benita, as she was now “noticing everything” in subsequent clinical practice. To use her words, “the penny had dropped”—and Benita was now applying her theoretical knowledge to practice in more meaningful ways. Two accounts which Benita shared illustrated how she now noticed more things in clinical practice—not just in relation to her own patients but about others she had not been

Summary

A number of learning theories have been aligned with health care simulations, but the focus and range of activities associated with contemporary simulations are such that they should also be informed by practice-related frameworks (Boud, 2012). Elements of several learning theories are applicable to health care simulations, but in general terms, this research suggests that these types of learning activities are powerful because they also facilitate opportunities for informal learning (Hager,

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    Informal learning is unplanned, it applies values, beliefs, and behaviors to the capability and competency of the learner in an ever developing context. The strength (of this method) expects the learner to observe and make continuous decisions about a situation (Kelly and Hager, 2015). This means informal learning is particularly suited to nursing where the learners are part of the context and learning is constantly emerging.

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