The Benefits of Using Didactic Training Equipment

Teaching PFA-O through simulation

In the course of their missions, military personnel are subjected to intense physical and psychological stress, which can lead to the development of stress reactions and psychological disorders, most importantly depression and post-traumatic stress disorder [1]. In order to disseminate the knowledge necessary to identify the signs of psychological suffering, adapt the caregiving relationship and guide referral for care in the earliest stages, different armed forces around the world have developed psychological first aid (PFA) teaching modules [2, 3]. It is in this perspective that a module to develop basic skills for Psychological First Aid in Operations (PFA-O) was developed by the French Armed Forces Health Service in [4]. This training, conducted by a nurse and a psychologist working in tandem, aims to develop basic skills in a group of around ten trainees belonging to the military population as part of their operational preparation. The sessions take place over three hours: one hour of theoretical training followed by two hours of practical training including three successive relational simulations.

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Simulation tools provide a controlled, realistic environment, which allows trainers to recreate combat and operational stress scenarios and better prepare soldiers [5]. They are particularly well-suited to the field of psychiatry, where interpersonal and relational dimensions are essential [6]. The effectiveness of this training depends to a certain extent on how well it is implemented, and in particular on improving trainees’ practical skills and memorization processes. This has led to growing interest in simulation-based pedagogy in both medical and military training [7, 8].

Certain obstacles which prevent widespread use of this type of teaching technique have been identified in the literature. For example, the very theme of psychological first aid may arouse resistance in military circles, where value is often placed on force of character [9]. Moreover, the centralized coordination of trainers throughout the entire country entails greater difficulties than teaching provided within a single dedicated training center [10]. Another factor that seems decisive in the success of training programs is trainers’ adherence to the educational tool, which has a direct influence on their motivation as well as the quality and effectiveness of their teaching [11]. This is in line with the well-established observation that trainers do not always adopt or systematically commit to the use of the educational tools made available to them [10]. Nevertheless, trainers play a crucial role in determining how teaching is delivered.

Teacher motivation

According to Ryan and Deci’s self-determination theory, motivation can be intrinsic (driven by personal interest and satisfaction) or extrinsic (driven by demands or rewards external to the individual). Intrinsically motivated trainers are more likely to embrace innovative teaching practices and use new tools effectively [12]. Although the importance of teacher motivation in the medical field has long been recognized [13], little research has focused on the intrinsic or extrinsic factors that may influence trainers’ adoption of and commitment to a simulation-based educational tool. It has been established that motivation can be sustained by extrinsic factors such as financial incentives (payment for training) or institutional and scientific feedback [10, 14,15,16]. Qualitative research carried out on trainers using simulation has highlighted certain external facilitators, notably good training coordination and the importance of pairing trainers with previously trained colleagues [10]. These findings corroborate data from other international studies, which underline the importance of support from institutional authorities, a sufficiently large team of trainers, effective coordination, adequate administrative support and regular feedback [17, 18].

With regard to the intrinsic factors motivating trainers’ level of commitment, one study highlighted: teachers’ sense of responsibility, the pleasure of teaching, the desire to maintain and develop new skills, the satisfaction of seeing students progress and the creation of positive relationships with students [19]. In addition, physicians’ motivation for teaching was positively associated with greater educational investment [20], as well as better educational outcomes according to student evaluations [21]. Nevertheless, certain obstacles to the spread of simulation-based training have been reported in the literature, such as the lack of suitable infrastructure and equipment (which can be very expensive), lack of time, and the reluctance of some trainers to embrace “simulation” as a teaching method [10, 14, 15, 22].

Didactic model

In educational science, the field of didactics is concerned with issues related to teaching and knowledge acquisition in various academic disciplines. It is an applied science, promoting techniques designed specifically to improve the quality of teachers’ work. A number of studies have shown that simply informing teachers, or even convincing them of the merits of a practice on the basis of scientific evidence, is not enough to bring them to change their conceptions of learning and their teaching practices [23]. Moreover, a certain amount of adaptation always takes place, particularly when simulation is involved, between the theoretical training framework as it is taught and the reality in the field, requiring a form of transposition according to the context [10, 24].

Successful dissemination of educational tools requires strategies informed by a theory of change in professional practice. New teaching techniques are often disseminated without taking into account their future users (teachers), teaching contexts and professional attitudes. Two main factors influence the chances of successful acceptance of a pedagogical innovation: its compatibility with teachers’ usual practices, and its efficiency, i.e. the cost-benefit ratio for teachers [23].

These factors have led to a research approach combining disciplinary didactics, ergonomics and psychology: Design-Oriented Research (DOR). This model calls for bidirectional interaction between the educational tool (the simulation module) and teachers’ practice. Teachers modify their practice under the influence of the tool (instrumentation) and the tool is adapted according to the their practice (instrumentalization). Areas for improvement in the educational tool can be identified by studying these changes [23]. When this concept is applied to simulation as a teaching practice in mental health, trainers’ involvement comes to be understood as an integral part of the dissemination of simulation as an educational tool. In other words, if the aim is to disseminate this way of teaching psychological first aid through simulation, feedback from trainers is essential to improve the simulation module, coordination of introductory training courses and the motivation of trainers involved in the promotion of PFA-O on a daily basis.

Usability, usefulness and acceptability

The adoption of educational technologies and tools by teachers has been widely studied through various theoretical models, including Davis’ Technology Acceptance Model (TAM) () [25] and Venkatesh’s Unified Theory of Acceptance and Use of Technology (UTAUT) [26]. These models explain how users are influenced in their intention to use a technology and how they adopt it. The first model emphasizes perceived usability and perceived usefulness, while the second incorporates other social and organizational factors (social influence, facilitating conditions, etc.). This theory has been successfully applied in various contexts, including education, to understand teachers’ adoption patterns [27]. In order to analyze teachers’ use of experimental pedagogical prototypes and integrate their feedback to improve educational tools (co-design), Renaud has recently proposed a methodological procedure for continuing improvement in use [28]. The aim is to identify the strengths and weaknesses of the educational tool, and specify the changes needed to improve it. No typology suited to educational tools has yet been established in the scientific literature. Renaud therefore adapted and refined certain criteria previously suggested elsewhere, in particular in the field of ergonomic psychology, design ergonomics and in the teachers’ competency framework [23]. In this way, she defined fifteen criteria belonging to the previously selected three dimensions: usefulness, usability and acceptability [28], as presented in Table 1. Usefulness is a means to define the educational effectiveness of the tool and thus to determine whether the activities that the tool offers are conducive to achieving the intended objective and whether they are relevant for students in terms of motivation and learning. Usability measures how well teachers can use and reuse the tool in its current state, as well as modify or adapt it to their practices and/or students. Acceptability concerns the decision to use or not use the tool after its introduction. The aim, overall, is to measure how well the tool responds to institutional requirements, its interest and its compatibility with teaching styles and approaches representative of the profession. While these criteria have been used in several studies, to the best of our knowledge they have never been used to evaluate teaching in the field of medical simulation [29, 30].

In the present study, we adopted this structured model—based on 15 criteria across the dimensions of usability, usefulness, and acceptability—and employed a semi-open-ended questionnaire to evaluate trainers’ motivation, engagement, and the model’s relevance within the population of PFA-O simulation trainers.

Questionnaire

As a first step towards this objective, a questionnaire was developed by a group of psychiatrists and psychologists qualified as PFA-O trainers. It consists of 38 questions offering a combination of response styles (i.e. Likert-type, dichotomous and open-ended responses, with multiple free fields for clarification) designed to collect as much information as possible. A mixed approach, such as this, provides different types of information in the form of qualitative and quantitative data which take into account the complexity of the techniques, despite the small sample size [31]. The questionnaire was designed with methodological rigor, incorporating multiple question types—such as dichotomous and open-ended questions—in addition to the Likert-scale items used to evaluate each of the 15 criteria. This approach provided a comprehensive basis for evaluating each of the three dimensions (usability, usefulness, and acceptability) across the 15 criteria. To ensure content validity, the questionnaire was reviewed by experts and pilot-tested, allowing us to confirm the clarity and relevance of items in accurately capturing educators’ motivation and experiences with the model. For each of the 15 criteria, the evaluation consisted in expressing agreement on a scale of 1 to 5. For example, the criterion of adjustability (A5) was evaluated as follows: “- In your opinion, the introductory PFA-O module can be easily adjusted to the student population: 5) Strongly agree, 4) Agree, 3) Neither agree nor disagree, 2) Disagree, 1) Strongly disagree.” One of the criteria, the workload cost, was listed in reverse order for the purpose of calculating an overall score for each of the three dimensions (average of the score for each of the component items).

As this is an original work and the criteria have never been published into this form, an English version of the questionnaire used in this study is provided in the Appendix.

Population and methodology

Our questionnaire was tailored to the 112 PFA-O trainers (psychiatrists, psychologists or nurses) listed in our national register and trained between and .

This was a descriptive cross-sectional study, carried out using a self-administered online questionnaire hosted on the Wepi platform (a web-based questionnaire creation and management tool developed by EpiConcept®, which stores data in a highly secure data center with approval to host personal health data, usable on any Internet-connected device).

Recruitment was carried out by sending a personalized link to the questionnaire to the professional address. Over the following 4 weeks, a weekly reminder was sent until the study was concluded.

Regulatory aspects

This study received approval from the ethical review committee, and is registered as IRB.

All procedures, including data collection, storage and analysis, complied with the ethical standards of national data protection laws and institutional requirements. Before taking part in the survey, all participants gave their informed consent. The study was carried out in accordance with the principles of the Helsinki Declaration.

Statistical analyses

Descriptive analyses include: number of occurrences (N), percentage (%), mean and, if necessary, standard deviation (SD).

The content of the open-ended questions was interpreted following qualitative research methodology: semantic categories were defined through consensus by a team of psychiatrists familiar with this type of methodology and PFA-O teaching.

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To assess correlations between the different variables within the didactic model, Spearman’s correlation coefficient (non-parametric correlation) was used, given the ordinal nature of most of the data in the questionnaire. The normality of the data distribution was verified using the Shapiro-Wilk test.

In accordance with recommendations, a Spearman coefficient between 0.20 and 0.29 was considered as a weak correlation, between 0.30 and 0.39 a moderate correlation, between 0.40 and 0.69 a strong correlation and > 0.70 a very strong correlation [32].

We first used network analysis to validate our didactic model [33]. Then, in order to develop a predictive model for trainer motivation based on the criteria of usability, usefulness and acceptability, we used multiple linear regression.

All statistical analyses were performed using JAMOVI ® for Windows® (version 2.5.3) [computer software] (retrieved from https://www.jamovi.org, (Sydney, Australia)) and Microsoft Excel®. The significance level was set at p < 0.05.

Of the 112 trainers contacted, 59 (52.68%) completed the questionnaire. Among these, 74 (66.10%) were women. Respondents were divided equally between nurses and psychologists, as would be expected given that this type of teaching is typically carried out by a nurse/psychologist pair of trainers working in tandem.

As training for trainers has been available since , about half of the participants had more than 3 years of experience as trainers and the other half less than 3 years of experience (mean = 3.37 years since receiving training, SD = 1.94). Among respondents, 76.27% had already conducted at least one introductory PFA-O training session (Table 2).

Of the 45 trainers who had already conducted a training course, 43 provided information on the frequency of their teaching practice. On average, they had conducted 6.6 introductory sessions (SD = 6.20, median = 4.00), which corresponds to 1.94 sessions per year (SD = 1.66, median = 1.66) since the completion of the training course for trainers.

Trainers expressed the feeling that teaching PFA-O strengthened the following skills: interpersonal skills (76.27%), identification of people in a state of psychological distress (72.88%), early referral to care (71.19%), identification of risk situations (64.41%) and technical know-how (59.32%). A majority (81.13%) felt that this teaching was well received by trainees’ units. Findings from the assessment of motivation to conduct training show that 13.79% (n = 8) were highly motivated, 34.48% (n = 20) well motivated, 36.21% (n = 21) somewhat motivated, 13.79% (n = 21) weakly motivated and 1.72% (n = 1) very weakly motivated. The total scores for the various dimensions and associated criteria are given in Table 3.

We then studied the correlations between the 15 criteria in the didactic model, teachers’ motivation to conduct training and the number of introductory training sessions actually undertaken, adjusted for the number of years of practice as trainers. Significant correlations were observed between the 3 dimensions under assessment (usability, usefulness and acceptability), as well as between these dimensions and teacher motivation. In addition, a strong correlation was found between the motivation of the teacher and the number of introductory training sessions undertaken per year. These results are shown in Fig. 1.

To investigate the capacity of the model to predict variations in trainer motivation, we successively added each of the 15 criteria to a model based on multiple linear regressions. Factors were added incrementally, step by step (forward selection method) in order to systematically maximize the variance explained by the factors in the model (coefficient of determination R2). The model finally reached data saturation at the fourteenth criterion. All 15 criteria were included in the final model. The final model showed an R2 coefficient of determination of 0.71 (i.e. 71%, F = 4.91, p < 0.001). A description of the model is given in Table 4 and shown in Fig. 2.

Analysis of the open-ended questions proved helpful in clarifying certain aspects. For example, 42 participants mentioned factors likely to increase their motivation to conduct introductory training. Among the most common categories, 40.48% (n = 17) mentioned the value of financial incentives (compensation for trainers), 35.71% (n = 15) stressed the importance of being able to choose their partner for training in order to coordinate with them beforehand, 19.05% (n = 8) highlighted the importance of institutional recognition for conducting introductory training (expression of satisfaction, medals, etc.), 19.05% (n = 8) mentioned the importance of having time dedicated to these training courses in their schedule and 16.67% (n = 7) the importance of organization (notification of participants, reception of the trainer on the training site, etc.).

At the same time, 39 participants indicated other factors which, in their opinion, limited the dissemination of introductory PFA-O training. The following ideas were found in decreasing order of frequency: (1) lack of time or scheduling conflicts (n = 20, 51.28%), (2) lack of prior knowledge among potential trainees about the training courses and how they are carried out (n = 14, 35.90%), (3) lack of trainers (n = 11, 28.21%), (4) overly complex formalities involved in organizing training courses, particularly in terms of coordination between the national level and the unit in need of training (n = 10, 25.64%), (5) lack of suitable equipment (n = 4, 10.26%).

To our knowledge, this is the first study to evaluate the motivational factors of mental health simulation trainers, and to propose a model that could be used to design ergonomic healthcare teaching tools.

Validity of the didactic model

One of the strengths of our study lies in the response rate to the questionnaire (52.68%). The population consisted mainly of nurses and psychologists, working in tandem to conduct training courses. Three-quarters had had the opportunity to conduct introductory PFA-O training, with an average of two simulation sessions conducted per year. As a result, our research data can be considered representative of trainers’ experience using a novel educational tool. However, external factors, such as prior training experience and military culture, may have influenced trainer engagement.

One of the main findings of our study is the correlation between the dimensions of usefulness, usability and acceptability, as defined in our introduction, and teacher motivation (significant moderate or strong correlation ranging from rho = 0.34 to 0.53), correlated in turn with the frequency of conducting training sessions (strong correlation with rho = 0.45). Although causality can not be inferred from this statistical correlation, the strength of the correlation nevertheless indicates that the proposed criteria are satisfactory for evaluating teachers’ motivation, which is shown to be associated with objective behaviors (the number of introductory training courses actually undertaken). This is a major finding: a connection exists between the way teachers embracethe PFA-O educational tool, their motivation to use it and the objective implementation of teaching sessions. This is consistent with another previously published study showing that physicians’ intrinsic motivation for teaching was positively associated with greater investment in teaching [20].

We have developed an innovative modeling framework of criteria evaluating teachers’ adherence to a medical educational tool. In total, our model indicated that these criteria could predict nearly 71% of the variance in motivation and that they were not redundant with each other in the dimensions under investigation since the prediction continued to improve as each of the criteria was added to the model, following the forward approach, with the exception of the last criterion (B5, evidence of the students’ interest in this tool). Nevertheless, given that multiple linear regression was only used to check the relevance of the criteria, not to select them, we chose to keep this criterion in the model, as it was theoretically relevant and not conceptually redundant with the other criteria. This approach also showed that the model was optimal by alternately adding criteria corresponding to the dimensions of usefulness, usability and acceptability, thus supporting the idea that these criteria are not redundant but complementary.

Advantages of using this didactic model to promote PFA-O training

Analysis of the model revealed that three criteria individually predicted a significant proportion of trainer motivation: (1) criterion C4, assessing how the tool contributes to the trainer’s personal development (R2 = 0.241); (2) criterion A1, assessing how easily trainers can understand the tool (R2 = 0.207); and criterion A2, assessing user-friendliness (R2 = 0.195). This didactic model thus provides a means to evaluate criteria for intrinsic adherence to an educational tool, and to identify those that most strongly influence trainer motivation. Our use of this model stands out from traditional methods by not only addressing practical training aspects but also incorporating didactic elements that are design-oriented and informed by ergonomic psychology. This unique focus facilitates the adaptation of educational tools to real-world settings, making it particularly relevant for psychological first aid training within military contexts. Despite relatively high scores overall, certain criteria such as workload cost (criterion A4, rated on average at 3.29/5) and the capacity of the tool to account for trainee progress (criterion B6, rated at 3.53/5) obtained lower scores, which calls for reflection and adjustments to improve these aspects. The didactic model presented in this study could be used for regular assessment as updates are made in the educational tool, such as revisions of the pedagogical reference framework.

Moreover, these 15 criteria could serve as a reference in health education research, to assess how an educational tool is perceived by teachers and help to promote continuing improvement in use. The semi-qualitative approach used in this study enabled us to confirm certain extrinsic motivational factors previously identified in the literature. Unsurprisingly, financial incentives, institutional recognition [10, 14,15,16] as well as the ability to choose one’s partner [10] feature prominently. This last point is particularly important, and probably neglected too often by training coordinators who organize sessions according to the availability of trainers. Indeed, the ability to choose one’s partner emerged as a major motivating factor in our study (mentioned by 35.71% of respondents). Moreover, lack of time dedicated to training (51.28% of respondents) and lack of trainers (28.21% of respondents) are obstacles that prevent training from taking place [10, 14, 15, 22]. However, lack of equipment was only mentioned in 10.26% of cases, suggesting that sufficient resources are available. Lack of awareness about training in the units to be trained is a limiting factor specific to our field of activity (mentioned by 35.90% of respondents), linked to the difficulty of providing psychological first aid training in a military context. Such training can incite resistance in an environment where force of character and resilience are highly praised. Nevertheless, the dissemination of mental health concepts is vitally important for leadership in the armed forces [9]. PFA-O thus contributes to improving knowledge and skills while reducing stigmatization [7, 34].

Limitations

The main limitation of this study, which must be considered before interpreting the results, is the specificity of the population under investigation, made up of military caregivers (psychologists and nurses), who have volunteered for this type of training, are convinced of its usefulness and practicing in an institutional setting benefiting from substantial material resources. Additionally, the potential for biases, such as social desirability bias, must be considered, as participants might have provided responses they deemed favorable rather than completely objective answers. These findings may not be generalizable to other populations. It would be interesting to use the didactic model in populations of trainers practicing in other working conditions, in order to observe differences in how the educational tool and its dissemination are perceived. This model’s structure and focus on usability, usefulness, and acceptability may also make it adaptable to civilian and non-military training contexts, potentially benefiting a wider range of educational settings. Originally developed within the French National Education system to evaluate pedagogical tools for younger populations, the model has already demonstrated versatility when adapted for adult military settings, suggesting it could similarly be effective for other civilian groups. Moreover, although our didactic model based on 15 criteria divided into three dimensions showed a good capacity to predict teacher motivation, it is surely not exhaustive. The range of potential predictors is vast, and other factors could probably be found to help explain variations in trainer motivation. Responses to this questionnaire should be supplemented with an interview-based survey, in order to maintain an ongoing dialogue with trainers, which is at the heart of the continuing design-in-use process [28]. Future studies could incorporate qualitative methods, such as interviews or focus groups, and consider a longitudinal follow-up to capture more nuanced insights into trainer experiences and observe changes in motivation over time. Additionally, gathering feedback from students or patients could provide valuable insights into the model’s impact on learning outcomes and refine its application in real-world settings. Our study reveals certain factors likely to influence teacher motivation, but we did not collect data on students’ experience. Gathering feedback from students or patients would provide valuable insights into the model’s impact on learning outcomes and could help refine its application in real-world settings. It would be interesting to combine these criteria with student feedback to determine whether teachers’ adherence to the educational tool influences the way they conduct the training session and their performance in transmitting skills [21].

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TEACHING-LEARNING MODEL BASED ON THE DESIGN OF DIDACTIC EQUIPMENT FOR LABORATORY PRACTICES IN ENGINEERING SCHOOLSUniversity of Castilla-La Mancha (SPAIN)

About this paper:

Appears in: EDULEARN16 Proceedings
Publication year:
Pages: -
ISBN: 978-84-608--4
ISSN: -
doi: 10./edulearn..Conference name: 8th International Conference on Education and New Learning Technologies
Dates: 4-6 July,
Location: Barcelona, Spain