GEN

GEN is a virtual learning management system that relies on principles of active observational practice, sharing of videos, and peer-to-peer, expert facilitated feedback. 

How is active observational practice achieved?  We use a combination of computer based video instructions (CBVI) and "spot the difference" approaches. More specifically, we use scripted vignettes of performances some flawless, and some with flaws.  The learners need to watch all of the videos and pick the flaws using checklists and global rating scores. 

• The theoretical underpinnings for this come from The Levels of Processing model, created by Fergus I. M. Craik and Robert S. Lockhart in 1972. The model describes memory recall of stimuli as a function of the depth of mental processing. Deeper levels of analysis produce more elaborate, longer-lasting, and stronger memory traces than shallow levels of analysis. Depth of processing falls on a shallow to deep continuum. Shallow processing (e.g., processing based on phonemic and orthographic components) leads to a fragile memory trace that is susceptible to rapid decay. Conversely, deep processing (e.g., semantic processing) results in a more durable memory trace.
• In this conception, by asking the learners to not only watch the videos, but look for mistakes in a series of videos that are seemingly the same, we are forcing them to engage in deeper levels of analysis, hypothetically resulting in deeper levels of learning.

Why share videos? In the lab or at home, learners can practice independently. However, we do not want them to develop bad habits, therefore every now and then, whenever they feel like they are ready, they need to "challenge" a test. This consists of capturing the performance and uploading it to GEN, where their peers and instructors are notified to provide feedback.

• Is this a feasible approach?  More than a decade ago, we have studied this phenomenon. Using  a randomized controlled study design, we asked the question whether junior medical students can learn suturing skills to the same degree when using computer based video institutions and self-directed learning, as they do  when instructed by experts during a prescribed learning session. What we have shown was supporting this idea. Students who engaged in self-directed learning (i.e. they could quit practice whenever they "felt" like they are proficient)  learned the skills to a similar proficiency than   students who were forced to practice in a more traditional way. Furthermore, forcing the self-directed learners to work a little more (extra practice after they felt they were proficient) did not result in extra learning, suggesting that when they felt that they were done - they were done! 

• Jowett N, LeBlanc V, Xeroulis G, MacRae H, Dubrowski A. Surgical skill acquisition with self-directed practice using computer-based video training. Am J Surg. 2007;193(2):237-242. doi:10.1016/j.amjsurg.2006.11.003

What about feedback? All learning theories agree that next to practice, feedback is the most important variable facilitating learning. Here, we employ a number of techniques: peer-assessments, peer-feedback, checklists, discussion boards, with or without experts. At present, most of our research focusses on the question of what is the best way to provide peer and expert facilitated feedback, and how does this interact with the types of learner and skills. 

Where is the gamification in GEN? Gamification elements were recently introduced to motivate the learners. After endless cycles of user testing, our parsimonious gamification set utilizes three techniques:

• Point-based system: implemented in a manner similar to the “Reddit” entertainment, social networking, and news website which supports peer- based assessment where-by peers rate the quality of others comments or interactions;
• Leaderboard: this social comparative feedback component provides learners with information regarding how well they are doing with respect to their peers. Such comparative information is provided both individually and in a general context by showing the learner position on a private individual leaderboard (e.g., ‘Forum likes: #2’) ensuring that the learners do not have access to the scores of their peers, avoiding comparisons that could be a detriment to motivation. Learners also get access to how many points they received in each course section through an individual scoreboard; 
• Module division: implemented as segmented progress bar, that allow learners to track their progress in each course and also in each individual course component. 

Literature supporting the use of GEN:

Here we are summarizing key/selected papers from our research group published in the last 2 decades that led to the development of GEN, along with its predecessor OPEN (Observational Practice and Educational Networking):

Cognitive load

• Do not teach me while I am working! Dubrowski A, Brydges R, Satterthwaite L, Xeroulis G, Classen R. Am J Surg. 2012 Feb;203(2):253-7. doi: 10.1016/j.amjsurg.2010.08.020. PMID: 22269657
• Thrive or overload? The effect of task complexity on novices' simulation-based learning. Haji FA, Cheung JJ, Woods N, Regehr G, de Ribaupierre S, Dubrowski A. Med Educ. 2016 Sep;50(9):955-68. doi: 10.1111/medu.13086. PMID: 2756289
• Measuring cognitive load: performance, mental effort and simulation task complexity. Haji FA, Rojas D, Childs R, de Ribaupierre S, Dubrowski A. Med Educ. 2015 Aug;49(8):815-27. doi: 10.1111/medu.12773. PMID: 26152493 Clinical Trial.
• Measuring cognitive load during simulation-based psychomotor skills training: sensitivity of secondary-task performance and subjective ratings. Haji FA, Khan R, Regehr G, Drake J, de Ribaupierre S, Dubrowski A. Adv Health Sci Educ Theory Pract. 2015 Dec;20(5):1237-53. doi: 10.1007/s10459-015-9599-8. Epub 2015 Mar 12. PMID: 25761454
• The impact of secondary-task type on the sensitivity of reaction-time based measurement of cognitive load for novices learning surgical skills using simulation. Rojas D, Haji F, Shewaga R, Kapralos B, Dubrowski A. Stud Health Technol Inform. 2014;196:353-9. PMID: 24732535 Clinical Trial. 6.

Observational Practice and Computer Based Video Instructions 

• Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Xeroulis GJ, Park J, Moulton CA, Reznick RK, Leblanc V, Dubrowski A. Surgery. 2007 Apr;141(4):442-9. doi: 10.1016/j.surg.2006.09.012. Epub 2007 Jan 25. PMID: 17383520 Clinical Trial.
• Computer-based video instructions for acquisition of technical skills. Dubrowski A, Xeroulis G. J Vis Commun Med. 2005 Dec;28(4):150-5. doi: 10.1080/01405110500518622. PMID: 16503567
• Surgical skill acquisition with self-directed practice using computer-based video training. Jowett N, LeBlanc V, Xeroulis G, MacRae H, Dubrowski A. Am J Surg. 2007 Feb;193(2):237-42. doi: 10.1016/j.amjsurg.2006.11.003. PMID: 17236854
• Computer-assisted assessment of one-handed knot tying skills performed within various contexts: a construct validity study. Brydges R, Classen R, Larmer J, Xeroulis G, Dubrowski A. Am J Surg. 2006 Jul;192(1):109-13. doi: 10.1016/j.amjsurg.2005.11.014. PMID: 16769286
• Verbal feedback from an expert is more effective than self-accessed feedback about motion efficiency in learning new surgical skills. Porte MC, Xeroulis G, Reznick RK, Dubrowski A. Am J Surg. 2007 Jan;193(1):105-10. doi: 10.1016/j.amjsurg.2006.03.016. PMID: 17188099 Clinical Trial.

 R&D in GEN

• The role of collaborative interactivity in the observational practice of clinical skills. Grierson LE, Barry M, Kapralos B, Carnahan H, Dubrowski A. Med Educ. 2012 Apr;46(4):409-16. doi: 10.1111/j.1365-2923.2011.04196.x. PMID: 22429177 Clinical Trial.
• Preparation With Web-Based Observational Practice Improves Efficiency of Simulation-Based Mastery Learning. Cheung JJ, Koh J, Brett C, Bägli DJ, Kapralos B, Dubrowski A. Simul Healthc. 2016 Oct;11(5):316-322. doi: 10.1097/SIH.0000000000000171. PMID: 27388862 Clinical Trial.
• Evaluation of tensiometric assessment as a measure of skill degradation. Cheung JJ, Rojas D, Weber B, Kapralos B, Carnahan H, Dubrowski A. Stud Health Technol Inform. 2012;173:97-101. PMID: 22356965 4.
• Acquisition of technical skills in ultrasound-guided regional anesthesia using a high-fidelity simulator. Cheung JJ, Chen EW, Al-Allaq Y, Nikravan N, McCartney CJ, Dubrowski A, Awad IT. Stud Health Technol Inform. 2011;163:119-24. PMID: 21335773
• The use of web-based learning for simulation-based education and training of central venous catheterization in novice learners. Cheung JJ, Koh J, Mackinnon K, Brett C, Bägli D, Kapralos B, Dubrowski A. Stud Health Technol Inform. 2013;184:71-7. PMID: 23400133

Self-directed learning

• Safir O, Williams CK, Dubrowski A, Backstein D, Carnahan H. Self-directed practice schedule enhances learning of suturing skills. Can J Surg. 2013;56(6):E142-E147. doi:10.1503/cjs.019512
• Do not teach me while I am working! Dubrowski A, Brydges R, Satterthwaite L, Xeroulis G, Classen R. Am J Surg. 2012 Feb;203(2):253-7. doi: 10.1016/j.amjsurg.2010.08.020. PMID: 22269657
• A new concept of unsupervised learning: directed self-guided learning in the health professions. Brydges R, Dubrowski A, Regehr G. Acad Med. 2010 Oct;85(10 Suppl):S49-55. doi: 10.1097/ACM.0b013e3181ed4c96. PMID: 20881703 Review.
• Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training. Isaranuwatchai W, Brydges R, Carnahan H, Backstein D, Dubrowski A. Adv Health Sci Educ Theory Pract. 2014 May;19(2):219-32. doi: 10.1007/s10459-013-9464-6. Epub 2013 Jun 1. PMID: 23728476 Clinical Trial.
• Surface exploration using laparoscopic surgical instruments: the perception of surface roughness. Brydges R, Carnahan H, Dubrowski A. Ergonomics. 2005 Jun 10;48(7):874-94. doi: 10.1080/00140130500123704.PMID: 16076743
• Coordinating progressive levels of simulation fidelity to maximize educational benefit. Brydges R, Carnahan H, Rose D, Rose L, Dubrowski A. Acad Med. 2010 May;85(5):806-12. doi: 10.1097/ACM.0b013e3181d7aabd.PMID: 20520031 Clinical Trial.
• Evaluating the influence of goal setting on intravenous catheterization skill acquisition and transfer in a hybrid simulation training context. Brydges R, Mallette C, Pollex H, Carnahan H, Dubrowski A. Simul Healthc. 2012 Aug;7(4):236-42. doi: 10.1097/SIH.0b013e31825993f2. PMID: 22722705 Clinical Trial.
• Pediatric urology training: performance-based assessment using the fundamentals of laparoscopic surgery. Brydges R, Farhat WA, El-Hout Y, Dubrowski A. J Surg Res. 2010 Jun 15;161(2):240-5. doi: 10.1016/j.jss.2008.12.041. Epub 2009 Jan 24. PMID: 19457495
• Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training. Brydges R, Carnahan H, Rose D, Dubrowski A. J Adv Nurs. 2010 Aug;66(8):1832-44. doi: 10.1111/j.1365-2648.2010.05338.x. Epub 2010 Jun 16. PMID: 20557388 Clinical Trial.
• Application of motor learning principles to complex surgical tasks: searching for the optimal practice schedule. Brydges R, Carnahan H, Backstein D, Dubrowski A. J Mot Behav. 2007 Jan;39(1):40-8. doi: 10.3200/JMBR.39.1.40-48. PMID: 17251170

We are happy to work with Canadian professional schools. Please reach out to us with any questions:

Dr. Adam Dubrowski: adam.dubrowski@ontariotechu.net

Technical Contacts: 

Andrei Torres: andrei.torres@ontariotechu.net 

Dr. Bill Kapralos: bill.kapralos@ontariotechu.ca