Finding strengths and solutions: computer-based simulation for experiential learning in social work

Posted June 1, 2022

Bobbi L’Huillier, Allison Nilsen, LCSW, Kate Whitney, LMSW, Maura Lavelle, MS, OTR/L, CHSE, Katie Ondo, MA, CCC-SLP, CHSE

Introduction

The primary objective of learning is to change specific behaviors by acquiring and discovering how to use new information. Content that offers opportunities to apply current comprehension, test knowledge acquisition, and form a connection with the information through storytelling and other engagement techniques all support student learning while fostering retention through active participation. With the advent of computer-based learning, the education field itself has had to identify and implement new approaches to meeting learning demands. As well, multiple social and environmental factors contribute to the need to train students where they are—in traditional classrooms, through online and distance education, synchronously and asynchronously, via real-time communications or using computer-based simulations. Still, the primary objective remains constant: to learn is to change; to achieve competency is to develop these changes into cohesive understanding.

The methods for reaching this understanding continue to evolve. As educators grapple with optimal pathways to reach the most students while maintaining critical standards, computer-based simulation provides a viable, adaptable solution for communicating necessary content and allowing experiential interaction across many professional fields. In the field of social work, for example, educators must develop programs that include specific methods for students to demonstrate knowledge, values, skills, and cognitive and affective processes for behaviors of engagement, assessment, intervention, and evaluation. Meeting these requirements can be challenging under any circumstances, but especially in a field placement setting with limited resources and extremely complex cases (Gursansky & Sueur, 2011; Hunter, Moen, & Raskin, 2015).

Environmental factors also act as a catalyst to spur adoption of new teaching approaches. For example, when the Affordable Care Act passed in 2010, the need for clinical social workers increased (Lundgren & Krull, 2014). In response, practice settings such as the Mount Sinai Hospital Department of Social Work Services began offering professional development to their large social work staff, with administrators implementing an elearning management system and using standardized patient simulations to satisfy the learning requirements of new and experienced social workers (Xanakis, 2018). Academia, too, reflects the problem of demand versus supply: the number of social work programs and, consequently, students who require field placements, far outpaces the availability (Smith, et al., 2021).

More recently, the COVID-19 pandemic has had a significant environmental impact on education, forcing educators to rethink teaching methodologies as well as program requirements, including how best to achieve experiential clinical hours (Tabatabai, 2020). By providing a virtual environment that allows students to practice clinical skills with actual case scenarios, computer-based simulations have emerged in social work research as a complement and potential substitute for some in-person practice experiences (Todd, 2012; Logie, et al., 2013; Bogo, et al., 2017).

The History of Experiential Learning in Social Work

The Council on Social Work Education (CSWE) considers experiential learning as part of field placement the signature pedagogy of social work education (CSWE, 2008) and critical in preparing students for clinical practice (Bogo, 2015). Through direct practice experiences, students endeavor to integrate Kolb’s Experiential Learning Cycle to evaluate concrete experiences they may have in their field placements and work toward reflective observations, abstract conceptualization, and active experimentation (Cheung & Delavega, 2014).

Historically, social work programs have also included role-playing to allow students to demonstrate their basic clinical skills such as interviewing. Limitations of this technique include failure to create a realistic scenario of an agency setting and a lack of sufficient feedback for effective learning. Supplementing role-playing with simulation, however, provides support both for practicing skills and for learning to regulate students’ own emotional responses when working with clients in crisis (Katz, et al., 2014).

In the last decade, social work educators have explored using simulation with standardized clients (actors) as a method for introducing students to real-life case scenarios and to assess practice skills needed in the field (Bogo, et al., 2014; Logie, et al., 2013; Rawlings, 2012). In 2014, CSWE sponsored a Field Summit to review simulation as a possible method for readying students for social work practice (CSWE, 2015). Following the summit, CSWE published the 2015 Educational Policy and Accreditation Standards (EPAS), which states that social work education programs may use simulations as a method for students to accumulate field experience hours. The EPAS standards also called for social work to embrace holistic competence, or “the integration of knowledge, skills, and values[,] and add[ing] the internal cognitive and affective processes of students” (Roberson, 2019, p. 6). As Roberson suggests, with this requirement to introduce students to a broader spectrum of experiential learning, simulation offers a pathway to help reduce the demand versus supply problem and augment field experience while satisfying EPAS standards (2019).

Using Computer-based Simulation to Meet Experiential Learning Needs

Formal research on simulation as an experiential learning technique in education began in the 1960s. Since that time, research indicates simulation provides an active learning approach that interfaces well with current technological advancements to capture students’ attention and “enable them to go beyond the surface understanding of disciplinary content” (Hallinger & Wang, 2020, p. 25).

As the literature supporting simulation use has grown and technological advances have altered access and approaches to educating more students, many disciplines within healthcare, law enforcement, aviation, military, and other settings have implemented computer-based simulation to enhance professional and practical skills (Roberson, 2019). Other allied health professions have also integrated computer-based simulation into curricula, including speech-language pathology (Johnson, et al., 2014), physical therapy (Ghergel, Lavelle, & Ondo, 2019), and occupational therapy (Lavelle, Johnson, & Ondo, 2019).

In the early 2000s, the National Association of Social Workers and the Association of Social Work Boards detailed a framework for using technology in social work in the Standards for Technology and Social Work Practice. The organizations then updated this framework in 2017 in collaboration with the CSWE and the Clinical Social Work Association to provide additional guidance on using virtual reality and computer simulation (Huttar & BrintzenhofeSzoc, 2020). A growing body of subsequent research suggests that in light of the problem of demand outstripping the supply of field placements and educational accessibility in multiple areas, “more asynchronous training will be needed and simulations that are delivered via the internet are highly scalable” (Smith, et al., 2020, p. 194). Statistics support the trend toward online social work programs: as of 2015, 60% of master’s level programs in the United States provided fully online or a hybrid approach for students (CSWE, 2016). With more social work education programs adopting technology to enhance their ability to provide experiential learning, using computer-based simulation to deliver on this need has promising implications as an augmentation and possible alternative to social work field experience.

Support for Computer-based Simulation

For most social work students, their field placement is the first time they serve in the role of a professional social worker. In particular, it is difficult to prepare students for the emotional and psychological impact of working with clients in crisis (Didham, et al., 2011). Computer-based simulation presents a low-risk environment that allows students to develop clinical knowledge while simultaneously reducing the anxiety of making potentially harmful mistakes with clients and offering opportunities to refine skills through repeated practice (Smith, et al., 2020).

As a best practice when using computer-based simulation, students typically receive prebriefing on the clinical setting, client population, and the social worker’s role within the simulation. Students also receive an introduction to the technology they will use and review the expectations of the simulation experience. Within the learning environment, they have different decision choices to make for which they receive immediate feedback. If they find they are making poor choices, students may restart or retake a simulation to improve their performance or to explore the results of using a different approach. Once they complete a simulation, students should discuss their experience, ask questions, and reflect and process personal responses in a debrief with faculty (Stead, Michael, & Ondo, 2022). The debrief component is especially critical for supporting long-term success: as Dreifuerst (2009) states, after experiencing debriefings, students indicate they are more comfortable discussing their personal limitations and feel more confident in their abilities when they work through future simulations. Debriefing has also been shown to improve learner outcomes (Fraser, K., Meguerdichian, M., Haws, J., et al., 2018).

Another benefit to using computer-based simulation is students’ ability to engage with real-life scenarios while receiving scaffolded support from faculty, assistance they may not receive in the field when engaging with clients in need of real-time intervention (Chernikova, et al., 2020). Practicing in a safe, low-stakes holding environment where they can receive constructive feedback helps students build confidence (Dudding, Brown, Estis, et.al, 2019). This support aligns with the do-no-harm mentality of the Social Work Code of Ethics while still providing a learning opportunity for students (Asakura & Bobo, 2021). Computer-based simulation also allows students to engage with clients from varying cultures and provides the opportunity to reflect on these interactions and seek training to provide multicultural care in practice settings (Asakura, et al., 2020).

Additionally, computer-based simulation can help facilitate interprofessional education. Research shows that students who take part in interprofessional simulations better understand their roles within interdisciplinary teams and how to interact on a clinical level with team members from different disciplines (Murphy & Nimmagadda, 2015). Many social work students will go on to share patient care with other professionals throughout their career, so this early experience with a systems perspective allows students to develop best practice strategies that help serve their clients holistically.

Multiple small studies indicate overall satisfaction from most students exposed to computer-based simulation, underscoring the benefit of its use for training professionals. Educators can address concerns such as cost by working with outside resources to ensure robust content. Educators must also consider support for mastering all associated technology as it is critical that students have a thorough understanding of how to use the specific simulation platform to avoid creating an unnecessary barrier to success (Bay, et al., 2021).

While social work may currently lack a large body of research to draw upon as empirical support for computer-based simulation, the field can extrapolate its potential benefit from research into role-playing and in-person simulation, as well as supportive data from computer-based simulation use in other allied health professions. All modalities face some limitations, but computer-based simulations’ adaptable and scalable nature offers inherent flexibility for overcoming many barriers.

The Simucase® Computer-based Platform and Experiential Learning

Social work practice has integrated simulation in academic programs and clinical settings to support experiential learning as a significant component of its core pedagogy. Expanding to employ computer-based simulation seems a logical progression in the field’s efforts to provide training to many students while offering access to a wide patient population. To help meet this need, Simucase develops clinical, real-case simulations in the fields of speech-language pathology, audiology, occupational therapy, physical therapy, and social work that allow students to engage, assess, and apply theory and evidence-based interventions for virtual clients. Throughout its platform, Simucase employs known strengths of computer-based simulations, including a low-risk clinical environment, prebrief and debrief supports, learning objectives mapped to field of practice standards, faculty scaffolding, clients with multiple demographic attributes, the capability for repeated practice to bolster understanding and skills, and interprofessional interactions. Additionally, Simucase provides a solution to factors that historically limit computer-based simulation adoption such as the cost for developing in-house simulation, maintaining user access, faculty training, and performing necessary updates.

For social work, implementing computer-based simulation through Simucase offers advantages that include set costs for services; up-to-date practice environments that correlate with EPAS standards; supplemental activities that encourage critical thinking about theory, application, and self-reflection; and licensed content developers and subject matter experts who strive to enhance simulation experiences. Additionally, Simucase’s proficiency supporting simulation in other healthcare fields helps underscore the efficacy of its training model and its ability to contribute valuable interprofessional content and insight. Finally, Simucase follows best practice in social work field education, identified by Bogo (2015) as having the following components: (a) safe learning environment; (b) collaborative relationships; (c) assessment of competency; (d) multiple practice opportunities; (e) integration of evidence-informed practice; and (f) quality feedback.

Conclusion

Learning is an act of courage: of letting go old beliefs and assimilating new knowledge into action to become stronger, more efficient, and more able to provide useful intervention as needed. With its commitment to helping people identify the need and the pathways to effect change, the field of social work demonstrates deep understanding of learning’s criticality in all aspects of life. Thus, social work educators are embarking on the next phase of training future professionals by adopting computer-based simulation as part of experiential learning.

Research shows the efficacy of simulation in facilitating experiential learning for students in allied health professions. The union between simulation and technology provides an adaptable, scalable method for social work students to develop holistic competence by exploring multidimensional approaches to problem-solving, gaining exposure to a range of clients and interprofessional collaboration, and practicing skill acquisition and demonstration in a nonthreatening environment. By tapping the strengths of this approach, educators in the social work field as well as other professions can continue to innovate solutions that better serve their communities.

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