Exploring Collaborative Training with Educational Computer Assisted Simulations in Health Care Education: An Empirical Ecology of Resources Study


This study explores collaborative training with educational computer assisted simulations (ECAS) in health care education. The use of simulation technology is increasing in health care education (Issenberg et al., 2005; Bradley, 2006), and research is addressing the techniques of its application. Calls have been made for informing the field with existing and future educational research (e.g. Issenberg et al., 2011). This study investigates and examines collaboration as a technique for structuring simulation training. Part of a larger research and development project (H?ll et al., 2011; H?ll & S?derstr?m, 2012), this paper primarily utilizes qualitative observation analysis of dentistry students learning radiology to investigate the challenges that screen-based simulation technology poses for collaborative learning. Grounded in Luckin’s ecology of resources framework (Luckin, 2010) and informed by computer-supported collaborative learning (CSCL) research, the study identifies some disadvantages of free collaboration that need to be dealt with for collaboration to be a beneficial technique for ECAS in health care education. The discussion focuses on the use of scripts (Weinberger et al., 2009) to filter the interactions between the learner and the more able partner, supporting the collaborative-learning activity and enhancing learning with ECAS in health care education.

Share and Cite:

Hall, L. (2012) Exploring Collaborative Training with Educational Computer Assisted Simulations in Health Care Education: An Empirical Ecology of Resources Study. Creative Education, 3, 784-795. doi: 10.4236/ce.2012.326117.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Aronson, B., Blaney, N., Stephan, C., Sikes, J., & Snapp, M. (1978). The jigsaw classroom. Beverly Hills, CA: Sage.
[2] Aggarwal, R., & Darzi, A. (2006). Technical-skills training in the 21st century. New England Journal of Medicine, 355, 2695-2696. doi:10.1056/NEJMe068179
[3] Aggarwal, R., Grantcharov, T., Moorthy, K., Hance, J., & Darzi, A. (2006). A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill. American Journal of Surgery, 191, 128-133. doi:10.1016/j.amjsurg.2005.10.014
[4] Blaye, A., Light, P. H., Joiner, R., & Sheldon, S. (1991). Joint planning and problem solving on a computer-based task. British Journal of Developmental Psychology, 9, 471-483. doi:10.1111/j.2044-835X.1991.tb00890.x
[5] Bradley, P. (2006). The history of simulation in medical education and possible future directions. Medical Education, 40, 254-262. doi:10.1111/j.1365-2929.2006.02394.x
[6] Brunner, W. C., Korndorffer, J. R., Sierra, R., Massarweh, N. N., Dunne, J. B., Yau, C. L., & Scott, D. J. (2004). Laparoscopic virtual reality training: Are 30 repetitions enough? Journal of Surgical Research, 122, 150-156. doi:10.1016/j.jss.2004.08.006
[7] Cohen, E. G. (1994). Restructuring the classroom: Conditions for productive small groups. Review of Educational Research, 64, 1-35. doi:10.3102/00346543064001001
[8] Debas, H. T., Bass, B. L., Brennan, M. R., Flynn, T. C., Folse, R., Freischlag, J. A., Friedmann, P., Greenfield, L. J., Jones, R. S., Lewis, F. R., Malangoni, M. A., Pellegrini, C. A., Rose, E. A., Sachdeva, A. K., Sheldon, G. F., Turner, P. L., Warshaw, A. L., Welling, R. E., & Zinner, M. J. (2005). American surgical association blue ribbon committee report on surgical education: 2004. Annals of Surgery, 241, 1-8. doi:10.1097/01.sla.0000150066.83563.52
[9] De Leng, B. A., Muijtjens, A. M., & Van der Vleuten, C. P. (2009). The effect of face-to-face collaborative learning on the elaboration of computer-based simulated cases. Simulation in Healthcare, 4, 217- 222. doi:10.1097/SIH.0b013e3181a39612
[10] Dieckmann, P., & Rall, M. (2008). Designing a scenario as a simulated clinical experience: The TuPASS scenario script. In R. Kyle, & B. W. Murray (Eds.), Clinical simulation: Operations, engineering, and management (pp. 541-550). Burlington: Academic Press. doi:10.1016/B978-012372531-8.50096-0
[11] Dillenbourg, P., Baker, M., Blaye, A., & O’Malley, C. (1996). The evolution of research on collaborative learning. In E. Spada, & P. Reiman (Eds.), Learning in humans and machine: Towards an interdisciplinary learning science (pp. 189-211). Oxford: Elsevier.
[12] Dillenbourg, P. (2002). Over-scripting CSCL: The risks of blending collaborative learning with instructional design. In P. A. Kirschner (Ed.), Three worlds of CSCL. Can we support CSCL? (pp. 61-91). Heerlen: Open Universiteit Nederland.
[13] Dillenbourg, P., & Hong, F. (2008). The mechanics of macro scripts. International Journal of Computer-Supported Collaborative Learning, 3, 5-23. doi:10.1007/s11412-007-9033-1
[14] Dillenbourg, P., J?rvel?, S., & Fischer, F. (2009). The evolution of research on computer-supported collaborative learning. In N. Balacheff, S. Ludvigsen, T. de Jong, A. Lazonder, & S. Barnes (Eds.), Technology enhanced learning (pp. 3-19). Berlin: Springer. doi:10.1007/978-1-4020-9827-7_1
[15] Dubrowski, A., & MacRae, H. (2006). Randomised, controlled study investigating the optimal instructor: Student ratios for teaching suturing skills. Medical Education, 40, 59-63. doi:10.1111/j.1365-2929.2005.02347.x
[16] Fior, M. N. (2008). Self and collective ef?cacy as correlates of group participation: A comparison of structured and unstructured computer- supported collaborative learning conditions. Unpublished master’s thesis, Victoria: University of Victoria.
[17] Fischer, F., Kollar, I., Mandl, H., & Haake, J. M. (Eds.) (2007). Scripting computer-supported collaborative learning: Cognitive, computational, and educational perspectives. New York, NY: Springer. doi:10.1007/978-0-387-36949-5
[18] Fonseca, B. A., & Chi, M. T. H. (2010). Instruction based on selfexplanation. In R. E. Mayer & P. A. Alexander (Eds.), Handbook of research on learning and instruction (pp. 296-321). New York: Routledge.
[19] Fraisse, J. (1987). Study of the disruptive role of the partner in the discovery of a cognitive strategy in children 11 years during social interaction. Bulletin de Psychologie, 382, 943-952.
[20] Gaba, D. M. (2004). The future vision of simulation in health care. Quality and Safety in Health Care, 13, 2-10. doi:10.1136/qshc.2004.009878
[21] Hassan, I., Maschuw, K., Rothmund, M., Koller, M., & Gerdes, B. (2006). Novices in surgery are the target group of a virtual reality training laboratory. European Surgical Research, 38, 109-113. doi:10.1159/000093282
[22] Heath, C., Hindmarsh J., & Luff, P. (2010). Video in qualitative research. London: Sage.
[23] Hmelo, C., & Day, R. (1999). Contextualized questioning to scaffold learning from simulations. Computers & Education, 32, 151-164. doi:10.1016/S0360-1315(98)00062-1
[24] Hmelo-Silver, C. E. (2003). Analyzing collaborative knowledge construction: Multiple methods for integrated understanding. Computers & Education, 41, 397-420. doi:10.1016/j.compedu.2003.07.001
[25] Holzinger, A., Kickmeier-Rust, M. D., Wassertheurer, S., & Hessinger, M. (2009). Learning performance with interactive simulations in medical education: Lessons learned from results of learning complex physiological models with the Haemodynamics Simulator. Computers & Education, 52, 292-301. doi:10.1016/j.compedu.2008.08.008
[26] H?ll, L. O., S?derstr?m, T., Nilsson, T., & Ahlqvist, J. (2009). Integrating computer based simulation training into curriculum—Complicated and time consuming? In K. Fernstrom, & J. Tsolakidis (Eds.), Readings in technology and education: Proceedings of ICICTE 2009 (pp. 90-98). Fraser Valley: University of the Fraser Valley Press.
[27] H?ll, L. O., & S?derstr?m. (2012). Designing for learning in computer-assisted health care simulations. In J. O. Lindberg, & A. D. Olofsson (Eds.), Informed design of educational technologies in higher education: Enhanced learning and teaching (pp. 167-192). Hershey, PA: IGI Global. doi:10.4018/978-1-61350-080-4.ch010
[28] H?ll, L. O., S?derstr?m, T., Nilsson, T., & Ahlqvist, J. (2011). Collaborative learning with screen-based simulation in health care education: An empirical study of collaborative patterns and proficiency development. Journal of Computer Assisted Learning, 27, 448-461. doi:10.1111/j.1365-2729.2011.00407.x
[29] Issenberg, S. B., McGaghie, W. C., Petrusa, E. R. I., Lee, G. D., & Scalese, R. J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Medical Teacher, 27, 10-28. doi:10.1080/01421590500046924
[30] Issenberg, B., Ringsted, C., Ostergaard, D., & Dieckmann, P. (2011). Setting a research agenda for simulation-based healthcare education: A synthesis of the outcome from an utstein style meeting. Simulation in Healthcare, 6, 155-167. doi:10.1097/SIH.0b013e3182207c24
[31] Johnson, D. W., & Johnson, R. T. (1999). Learning together and alone. Cooperative, competitive and individualistic learning (5th ed.). Boston, MA: Allyn & Bacon.
[32] Jordan, B., & Henderson, A. (1995). Interaction analysis: Foundations and practice. The Journal of the Learning Sciences, 4, 39-103. doi:10.1207/s15327809jls0401_2
[33] Kollar, I., Fischer, F., & Hesse, F. W. (2006). Collaboration scripts—A conceptual analysis. Educational Psychology Review, 18, 159-185. doi:10.1007/s10648-006-9007-2
[34] Koschmann, T., LeBaron, C., Goodwin, C., & Feltovich, P. (2011). “Can you see the cystic artery yet?” A simple matter of trust. Journal of Pragmatics, 43, 521-541. doi:10.1016/j.pragma.2009.09.009
[35] Krippendorff, K. (2004). Content analysis: An introduction to its methodology. Thousand Oaks, CA: Sage.
[36] K?ssi, J., & Luostarinen, M. (2009). Virtual reality laparoscopic simulator as an aid in surgical resident education: Two years’ experience. Scandinavian Journal of Surgery, 98, 48-54.
[37] Liu, H. C., Andre, T., & Greenbowe, T. (2008). The impact of learner’s prior knowledge on their use of chemistry computer simulations: A case study. Journal of Science Education and Technology, 17, 466- 482. doi:10.1007/s10956-008-9115-5
[38] Luckin, R. (2010). Re-designing learning contexts. Technology-rich, learner centered ecologies. London: Routledge.
[39] Luengo, V., Aboulafia, A., Blavier, A., Shorten, G., Vadcard, L., & Zottmann, J. Novel technology for learning in medicine. In N. Balacheff, S. Ludvigsen, T. de Jong, A. Lazonder & S. Barnes (Eds.), Technology enhanced learning (pp. 105-120). Berlin: Springer. doi:10.1007/978-1-4020-9827-7_7
[40] McGaghie, W. C., Issenberg, S. B., Petrusa, E. R., & Scalese, R. J. (2010). A critical review of simulation-based medical education research: 2003-2009. Medical Education, 44, 50-63. doi:10.1111/j.1365-2923.2009.03547.x
[41] Mulryan, C. M. (1992). Student passivity in cooperative small groups in mathematics. Journal of Educational Research, 85, 261-273. doi:10.1080/00220671.1992.9941126
[42] Naughton, P. A., Aggarwal, R., Wang, T. T., Van Herzeele, I., Keeling, A. N., Darzi, A. W., & Cheshire, N. J. W. (2011). Skills training after night shift work enables acquisition of endovascular technical skills on a virtual reality simulator. Journal of Vascular Surgery, 53, 858- 866. doi:10.1016/j.jvs.2010.08.016
[43] Nilsson, T., S?derstr?m, T., H?ll, L. O., & Ahlqvist, J. (2006). Collaborative learning efficiency in simulator-based and conventional radiology training. The 10th European Congress of DentoMaxillo- Facial Radiology. Leuven [Not Published].
[44] Nilsson, T. A. (2007). Simulation supported training in oral radiology. Methods and impact in interpretative skill. Doctoral Dissertation, Ume?: Ume? University.
[45] O’Malley, C. (1992). Designing computer systems to support peer learning. European Journal of Psychology of Education, 7, 339-352. doi:10.1007/BF03172898
[46] Palincsar, A. S., & Brown, A. L. (1984). Reciprocal teaching of comprehension-fostering and comprehension-monitoring activities. Cognition and Instruction, 1, 117-175. doi:10.1207/s1532690xci0102_1
[47] Prins, F. J., Veenman, M. V. J., & Elshout, J. J. (2006). The impact of intellectual ability and metacognition on learning: New support for the threshold of problematicity theory. Learning and Instruction, 16, 374-387. doi:10.1016/j.learninstruc.2006.07.008
[48] Renkl, A. (1997). Lernen durch Lehren—Zentrale Wirkmechanismen beim kooperativen Lernen. Wiesbaden: Deutschber Universit?ts-Verlag.
[49] Rogoff, B. (1990). Apprenticeship in thinking: Cognitive development in social context. Oxford: Oxford University Press.
[50] Rogoff, B. (1991). Social interaction as apprenticeship in thinking: guided participation in spatial planning. In L. Resnick, J. Levine, & S. Teasley (Eds.), Perspectives on socially shared cognition (pp. 349- 364). Washington, DC: APA Books. doi:10.1037/10096-015
[51] Roschelle, J., & Teasley, S. (1995). The construction of shared knowledge in collaborative problem solving. In C. E. O’Malley (Ed.), Computer supported collaborative learning. (pp. 69-97). Heidelberg: Springer-Verlag. doi:10.1007/978-3-642-85098-1_5
[52] Rummel, N., & Spada, H. (2005). Learning to collaborate: An instructtional approach to promoting collaborative problem solving in computer-mediated settings. The Journal of the Learning Sciences, 14, 201-241. doi:10.1207/s15327809jls1402_2
[53] Rystedt, H. (2002). Bridging practices: Simulations in education for the health care professions. Doctoral Dissertation, Gothenburg: Gothenburg University.
[54] Rystedt, H., & Lindwall, O. (2004). The interactive construction of learning foci in simulation-based learning environments: A case study of an anesthesia course. PsychNology Journal, 2, 165-188.
[55] See, L. C., Huang, Y. H., Chang, Y. H., Chiu, Y. J., Chen, Y. F., & Napper, V. S. (2010). Computer-enriched instruction (CEI) is better for preview material instead of review material: An example of a biostatistics chapter, the central limit theorem. Computers & Education, 55, 285-291. doi:10.1016/j.compedu.2010.01.014
[56] Slavin, R. E. (1983). Cooperative learning. New York, NY: Longman.
[57] Slavin, R. E. (2010). Instruction based on cooperative learning. In R. E. Mayer, & P. A. Alexander (Eds.), Handbook of research on learning and instruction (pp. 334-360). New York: Routledge.
[58] Smith, C. D., Farrell, T. M., McNatt, S. S., & Metreveli, R. E. (2001). Assessing laparoscopic manipulative skills. American Journal of Surgery, 181, 547-550. doi:10.1016/S0002-9610(01)00639-0
[59] Soller, A. (2001). Supporting social interaction in an intelligent collaborative learning system. International Journal of Arti?cial Intelligence in Education, 12, 166-187.
[60] Stahl, G. (2011). Past, present and future of CSCL. The Knowledge Building Summer Institute 2011 and CSCL2011 Post-Conference at the South China Normal University. Guangzhou [Not Published]. URL. http://GerryStahl.net/pub/cscl2011guangzhou.ppt.pdf
[61] Stegmann, K., Weinberger, A., & Fischer, F. (2007). Facilitating argumentative knowledge construction with computer-supported collaboration scripts. International Journal of Computer-Supported Collaborative Learning, 2, 421-447. doi:10.1007/s11412-007-9028-y
[62] Stegmann, K & Fischer, F. (2011). Quantifying qualities in collaborative knowledge construction. The analysis of online discussions. In S. Puntambekar, G. Erkens, & C. Hmelo-Silver (Eds.), Analyzing interactions in CSCL: Methods, approaches and issues (pp. 247-268). Berlin: Springer. doi:10.1007/978-1-4419-7710-6_12
[63] S?derstr?m, T., H?ll, L. O., Nilsson, T., & Ahlqvist, J. (2008). How does computer based simulator training impact on group interaction and proficiency development? In Proceedings of ICICte 2008: Readings in Technology and Education (pp. 650-659). Fraser Valley: University of Fraser Valley. URL. http://www.icicte.org/ICICTE2008Proceedings/soderstrom065.pdf
[64] S?derstr?m, T., & H?ll, L. O. (2010). Computer assisted simulations— Students’ experiences of learning radiology. The conference of the Australian Association for Research in Education. Melbourne [Not Published].
[65] S?derstr?m, T., H?ll, L. O., Nilsson, T., & Ahlqvist, J. (2012). Patterns of interaction and dialogue in computer assisted simulation training. Procedia—Social and Behavioral Sciences, 46, 2825-2831. doi:10.1016/j.sbspro.2012.05.571
[66] Tanner, C. A. (2004). Nursing education research: Investing in our future. Journal of Nursing Education, 43, 99-100.
[67] Van Sickle, K. R., Gallagher, A. G., & Smith, C. D. (2007). The effect of escalating feedback on the acquisition of psychomotor skills for laparoscopy. Surgical Endoscopy and Other Interventional Techniques, 21, 220-224. doi:10.1007/s00464-005-0847-5
[68] Webb, N. M. (1989). Peer interaction and learning in small groups. International Journal of Educational Research, 13, 21-39. doi:10.1016/0883-0355(89)90014-1
[69] Weinberger, A., Ertl, B., Fischer, F., & Mandl, H. (2005). Epistemic and social scripts in computer-supported collaborative learning. Instructional Science, 33, 1-30. doi:10.1007/s11251-004-2322-4
[70] Weinberger, A., Kollar, I., Dimitriadis, Y., M?kitalo-Siegl, K., & Fischer, F. (2009). Computer-supported collaboration scripts. Perspectives from educational psychology and computer science. In N. Balacheff, S. Ludvigsen, T. de Jong, A. Lazonder, & S. Barnes (Eds.), Technology enhanced learning (pp. 3-19). Berlin: Springer. doi:10.1007/978-1-4020-9827-7_10
[71] Wertsch, J. (1998). Mind as action. New York, NY: Oxford University Press.
[72] Wood, D., Bruner, J. S., & Ross, G. (1976). The role of tutoring and problem solving. Journal of Child Psychology and Psychiatry, 17, 89-100. doi:10.1111/j.1469-7610.1976.tb00381.x
[73] Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.