Technology Integration Through Modality Mapping Initiative (TIMMI)

Definitions
Examples
Cognitivism is concerned with the complex cognitive processes of a learner, such as information processing and problem solving. Cognitivist learning theories describe the mind as akin to a computer, with terms like “working memory” and “long-term memory”
Pattern RecognitionPattern Recognition
  • Identifying anomalies
  • Applying a diagnostic algorithm
Multi-Tasking Attention Redirection and Multitasking
  • Collecting a history while conducting a physical exam
  • Recovering from an interruption during medication administration
Decision Making Decision Making
  • Deciding to honor a patient’s wishes
  • Choosing a course of action in treatment
Knowledge RetentionKnowledge Recall and Retention
  • Listing steps of a procedure
  • Describing anatomical features
Constructivism explains how individual learners create meaning from new knowledge and experiences. Constructivist learning theories facilitate the formation of new knowledge structures that are reconciled and integrated with previous understanding, primarily through active experiential learning in collaboration with other learners. Constructivism uses terms like “scaffolding”.
Reflection on Action Reflection on Action
  • Identifying strengths and weaknesses in performance
  • Recognizing a system failure
Clinical Reasoning Clinical Reasoning
  • Formulating working and differential diagnoses
  • Responding appropriately to clinical cues
Knowledge Application Knowledge Application
  • Practicing the SPIKES model of delivering bad news
  • Administering the appropriate dosage of a medication
Prioritization Prioritization
  • Ranking steps
  • Recognizing a patient that needs urgent or emergent care
Adaptability Adaptability
  • Reacting to a change in patient status
  • Modifying the approach to care when new information is presented
Socio-constructivism (or social constructivism) asserts that learning occurs first at an interpersonal level before transitioning to a personal one. Socio-constructivist learning theories consider the socio-cultural context of both teaching and learning, with a particular focus on language and communication as mediating factors. Collaboration identifies collaboration as central to the formation of deep understanding for both an individual and their group.
LeadershipLeadership
  • Identifying and challenging suboptimal practice
  • Facilitating productive collaboration
CommunicationCommunication Skills
  • Breaking bad news
  • Patient education
Emotional Intellegence Interpersonal Skills
  • Cultural humility
  • Emotional intelligence
Situational Awareness Situational Awareness
  • Recognizing the importance of seemingly unimportant things
  • Considering environmental factors
Teamwork Teamwork
  • Neonatal resuscitation protocol
  • Rehabilitation of a chronically ill patient
Conflict Resolution Conflict Resolution
  • Deescalating volatile situations
  • Productive disagreement
Professional Identity Formation Professional Identity Formation
  • Assuming the practicing healthcare role
  • Modeling professional standards and ethics
Behaviorism describes how a relationship between a stimulus and a response is established, embedded, and sustained by a learner. Behaviorist learning theories focus on the reactions within and consequences of an observable performance; they seek to reinforce responses to increase the probability of retention and recall.
Hand-Eye CoordinationPsychomotor Skills
  • Suturing
  • Injection
Procedural SkillProcedural Skills
  • Changing a wound dressing
  • Central line placement
Technical Skill Technical Skills
  • Canulation
  • Intubation
Immersive XP Modality Immersive XR Modality A category that encompasses the hybrid combination of virtual reality environments and reality (e.g., real environment, standardized patient, normal manikin simulator). Often encompasses the definition of Augmented Reality (AR), but has more virtual features than typical AR. The blend of what is physically present to what is 100% computer-generated is expressed in this continuum: Reality – Augmented Reality – Mixed Reality – Virtual Reality (Hsieh and Lee, 2017).1
Manikin/Full Modality Full Body Manikin Modality A term often used to refer to the broad range of full-body manikins that have the ability to mimic, at a very high level, human body functions. Also known as a high-complexity simulator. Other types of simulators can also be considered high-fidelity, and that fidelity (realism) has other characteristics beyond a particular type of simulator.1
Standardized Patient Actor Modality Standardized Patient Actor Modality A person who portrays a patient (simulated patient), family member, or health care provider in order to meet the objectives of the simulation; a simulated person may also be referred to as a standardized patient/family/health care provider if they have been formally trained to act as real patients in order to simulate a set of symptoms or problems used for health care education, evaluation, and research. Simulated persons often engage in assessment by providing feedback to the learner (Palaganas, et al., 2012).1
Task trainer/Partial ModalityTask trainer/Partial Modality A device designed to train in just the key elements of the procedure or skill being learned, such as lumbar puncture, chest tube insertion, central line insertion or part of a total system, for example, ECG simulator (Center for Immersive and Simulation Based Learning [CISL] & Levine et al). A model that represents a part or region of the human body such as an arm, or an abdomen. Such devices may use mechanical or electronic interfaces to teach and give feedback on manual skills such as IV insertion, ultrasound scanning, suturing, etc. Generally used to support procedural skills training; however they can be used in conjunction with other learning technologies to create integrated clinical situations (Australian Society for Simulation in Healthcare).1
Screen Based Modality Screen Based Application Modality A simulation presented on a computer screen using graphical images and text, similar to popular gaming format, where the operator interacts with the interface using keyboard, mouse, joystick, or other input device. The programs can provide feedback to, and track actions of learners for assessment, eliminating the need for an instructor (Ventre & Schwid, in Levine Chapter 14). A computer-generated video game simulator that can create scenarios that require real-time decision-making (Bonnetain, Biese, et al., 2009).1
Mobile Applications Modality Mobile Application Modality A mobile application, most commonly referred to as an app, is a type of application software designed to run on a mobile device, such as a smartphone or tablet computer. Apps are generally small, individual software units with limited function.2
Serious Games Modality Serious Games Modality A mental contest played with a computer in accordance with specific rules, which uses entertainment to further training, education, health, public policy, and strategic communication objectives (Zyda, 2005). A game designed for a primary purpose other than pure entertainment. Serious games have an explicit and carefully thought out educational purpose, and are not intended to be played primarily for amusement (Michael and Chen, 2006). Serious games are simulations of real-world events, or processes designed for the purpose of solving a problem. The “serious” adjective is generally appended to refer to products used by industries like defense, education, scientific exploration, healthcare, emergency management, city planning, engineering, religion, and politics.1

Modality Reverse Mapping
Examples
Pattern Recognition Pattern Recognition
  • Identifying anomalies
  • Applying a diagnostic algorithm
Multi-Tasking Attention Redirection and Multitasking
  • Collecting a history while conducting a physical exam
  • Recovering from an interruption during medication administration
Decision Making Decision Making
  • Deciding to honor a patient’s wishes
  • Choosing a course of action in treatment
Knowledge recall and retention Knowledge Recall and Retention
  • Listing steps of a procedure
  • Describing anatomical features
Reflection on ActionReflection on Action
  • Identifying strengths and weaknesses in performance
  • Recognizing a system failure
Clinical ReasoningClinical Reasoning
  • Formulating working and differential diagnoses
  • Responding appropriately to clinical cues
Knowledge Application Knowledge Application
  • Practicing the SPIKES model of delivering bad news
  • Administering the appropriate dosage of a medication
Prioritization Prioritization
  • Ranking steps
  • Recognizing a patient that needs urgent or emergent care
Adaptability Adaptability
  • Reacting to a change in patient status
  • Modifying the approach to care when new information is presented
Leadership Leadership
  • Identifying and challenging suboptimal practice
  • Facilitating productive collaboration
Communication Skills Communication Skills
  • Breaking bad news
  • Patient education
Interpersonal Skills Interpersonal Skills
  • Cultural humility
  • Emotional intelligence
Situational Awareness Situational Awareness
  • Recognizing the importance of seemingly unimportant things
  • Considering environmental factors
Teamwork Teamwork
  • Neonatal resuscitation protocol
  • Rehabilitation of a chronically ill patient
Conflict Resolution Conflict Resolution
  • Deescalating volatile situations
  • Productive disagreement
Professional Identity Formation Professional Identity Formation
  • Assuming the practicing healthcare role
  • Modeling professional standards and ethics
Hand-Eye Coordination Psychomotor Skills
  • Suturing
  • Injection
Procedural Skill Procedural Skills
  • Changing a wound dressing
  • Central line placement
Technical Skill Technical Skills
  • Canulation
  • Intubation
Immersive Reality Modality Immersive XR Modality
  • Behaviorism
  • Cognitivism
  • Constructivism
  • Socio-Constructivism
Full Body Manikin Modality Full Body Manikin Modality
  • Behaviorism
  • Cognitivism
  • Constructivism
  • Socio-Constructivism
Standardized Patient Actors/Simulated Patient Modality Standardized Patient Actors Modality
  • Cognitivism
  • Constructivism
  • Socio-Constructivism
Partial Task Trainer Modality Task Trainer/Partial Modality
  • Behaviorism
  • Cognitivism
Screen Based Application Modality Screen Based Application Modality
  • Cognitivism
  • Constructivism
Mobile Application Modality Mobile Application Modality
  • Cognitivism
  • Constructivism
Serious Games Modality Serious Games Modality
  • Constructivism
  • Socio-Constructivism
 
The TIMMI is designed to aid in the design of effective simulation activities; it is not intended to be prescriptive or inflexible.
Developed By The Technology CommitteeSSH Logo
Authors:
  • A.J. Kleinheksel, PhD, MEd, CHSE-A
  • Valorie MacKenna, PhD, RN, CNE, CHSE
  • Natasha Taylor, EdD, MSc, MEd, MEd, BSc (Hons)
  • Daniel Katz, MD
  • Mariano R Loo, BBA
References
  1. Lioce L. (Ed.), Lopreiato J. (Founding Ed.), Downing D., Chang T. P., Robertson J. M., Anderson M., Diaz D. A., and Spain A. E. (Assoc. Eds.) and the Terminology and Concepts Working Group (2020), Healthcare Simulation Dictionary – Second Edition. Rockville, MD: Agency for Healthcare Research and Quality; September 2020. AHRQ Publication No. 20-0019.
  2. Rouse, M. (2020, August 7). Techopedia.com (2023). Retrieved August 4, 2023 from https://www.techopedia.com/definition/2953/mobile-application-mobile-app
  3. Ertmer, P.A., & Newby, T.J. (2013). Behaviorism, cognitivism, constructivism: Comparing critical features from an instructional design perspective. Performance Improvement Quarterly, 26(2), 43-71.
  4. Miller, C. L., Manderfeld, M., and Harsma, E. A., "Learning Theories: Socio-Constructivism" (2020). All Resources. 144.
  5. Richey, R. C., Klein, J. D., & Tracey, M. W. (2011). The instructional design knowledge base: Theory, research, and practice. New York: Routledge.