Academic journal article Journal of Teacher Education

Core Pedagogy: Individual Uncertainty, Shared Practice, Formative Ethos

Academic journal article Journal of Teacher Education

Core Pedagogy: Individual Uncertainty, Shared Practice, Formative Ethos

Article excerpt

As an Emergency Room (ER) nurse, my mother worked the 3:00 to 11:00 p.m. shift in a county hospital. On occasion, my father, sister, and I sat in the waiting room until she had a chance to join us for an evening meal in the hospital cafeteria. I was never bored while waiting. Ambulances dispatched, helicopters landed, and I had an unobstructed view of the public in crisis. ER work is unpredictable. My mother and her colleagues never quite knew who was going to show up at the ER door, and in what condition. One thing was certain, though. ER nurses were expected to act quickly. They often triaged, responding to the conditions of addicts, accident victims, and abusive relationships with ethical, decisive judgment. Many of their actions and communications were routine standards of care, well rehearsed and to which everyone was held accountable. Gloves were mandated, interventions were documented, and mortality rates were examined.

As a young teacher in a family full of nurses, I grew to understand that medicine and teaching share a sense of professional uncertainty. Responding to the unknown and unexpected, nurses and teachers engage and serve the broader public. Through experience, mistakes, and appropriate professional challenges, they form increasingly mature, reasoned, and professional identities. Through these tenets of practice--uncertainty, engagement, and formation--novices learn their professions' actions, communications, and measures of accountability.

This article outlines the concept of clinical simulations as a core pedagogy within teacher education. 1 begin with a description of simulations in medical education, and the design framework (Barrows, 1987, 2000) that guides the construction and selection of medical simulations for use in the preparation of physicians, nurses, and physical therapists. Then, I outline recent attention that scholars have given to core practices in classrooms and the need for core pedagogies in teacher preparation. From that impetus, I describe a clinical simulation model, its use within five different U.S. teacher preparation institutions, and data excerpts from those implementation sites. This broad background on simulations--originating within medical education, called for by teacher educators, and implemented across different teacher education contexts--sets the stage for this conceptual article: clinical simulations as a core pedagogy of uncertainty, engagement, and formation (Shulman, 2005a, 2005b).

Medical Simulations With Standardized Patients

In 1963, Howard Barrows began using standardized patients to enhance the preparation of medical residents at the University of Southern California. Standardized patients are lay persons, actors, or real patients, who are carefully trained to present distinct symptoms and communicate questions/concerns to future medical professionals in a standard, consistent manner (Barrows, 1987, 1993, 2000; Barrows & Abrahmson, 1964). Face-to-face with the standardized patient in the exam room, each medical resident was challenged to move beyond a traditional, distant analysis of a "case." Instead, each resident had to conduct a diagnostic assessment, thoughtfully communicate with the patient, and construct a plan of action or regimen of treatment. As the concept grew and diffused to other medical preparation institutions, Barrows outlined a framework for simulation design. His design tenets--prevalence, instructional importance, clinical impact, and social impact--supported selection and implementation decisions, helping determine when and how cohorts of medical residents would engage with specific simulations in their programs of study. For example, Barrows's prevalence tenet outlines the use of simulations (in the preparatory environment) that mirror the common challenges medical personnel would likely encounter later in practice. In contrast, the clinical impact tenet suggests simulating a situation that might be experienced rarely in medical practice, but that presents a variable of great importance or has a potentially high impact if it is overlooked or mishandled by the professional. …

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