title: Operationalising elaboration theory for simulation instruction design: a Delphi study.
abstract: OBJECTIVE
  The aim of this study was to assess the feasibility of incorporating the Delphi process within the simplifying conditions method (SCM) described in elaboration theory (ET) to identify conditions impacting the complexity of procedural skills for novice learners.
  
  
  METHODS
  We generated an initial list of conditions impacting the complexity of lumbar puncture (LP) from key informant interviews (n = 5) and a literature review. Eighteen clinician-educators from six different medical specialties were subsequently recruited as expert panellists. Over three Delphi rounds, these panellists rated: (i) their agreement with the inclusion of the simple version of the conditions in a representative ('epitome') training scenario, and (ii) how much the inverse (complex) version increases LP complexity for a novice. Cronbach's α-values were used to assess inter-rater agreement.
  
  
  RESULTS
  All panellists completed Rounds 1 and 2 of the survey and 17 completed Round 3. In Round 1, Cronbach's α-values were 0.89 and 0.94 for conditions that simplify and increase LP complexity, respectively; both values increased to 0.98 in Rounds 2 and 3. With the exception of 'high CSF (cerebral spinal fluid) pressure', panellists agreed with the inclusion of all conditions in the simplest (epitome) training scenario. Panellists rated patient movement, spinal anatomy, patient cooperativeness, body habitus, and the presence or absence of an experienced assistant as having the greatest impact on the complexity of LP.
  
  
  CONCLUSIONS
  This study demonstrated the feasibility of using expert consensus to establish conditions impacting the complexity of procedural skills, and the benefits of incorporating the Delphi method into the SCM. These data can be used to develop and sequence simulation scenarios in a progressively challenging manner. If the theorised learning gains associated with ET are realised, the methods described in this study may be applied to the design of simulation training for other procedural and non-procedural skills, thereby advancing the agenda of theoretically based instruction design in health care simulation.
authors.affiliation: Wilson Centre, University of Toronto, Toronto, Ontario, Canada.|SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada.|Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
authors.forename: Faizal A
authors.initials: FA
authors.lastname: Haji
authors.affiliation: Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rabia
authors.initials: R
authors.lastname: Khan
authors.affiliation: Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Glenn
authors.initials: G
authors.lastname: Regehr
authors.affiliation: Faculty of Business and Information Technology, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Ng
authors.affiliation: Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
authors.forename: Sandrine
authors.initials: S
authors.lastname: de Ribaupierre
authors.affiliation: Division of Emergency Medicine, Memorial University, St John's, Newfoundland, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Dubrowski
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003697:Delphi Technique; D005240:Feasibility Studies; D006801:Humans; D017145:Models, Educational; D000066908:Simulation Training / Q000379:methods*; D013129:Spinal Puncture / Q000592:standards