The Sim Cafe~ An interview with Margaret Verkuyl

Margaret Verkuyl is a nursing professor at Centennial College in Canada. Since, 2013, she has been a leader in developing and researching virtual simulations and interactive textbooks. Over the years, she has received numerous prestigious local and international awards for her work. While gaining international attention, virtual simulations have become pervasive in nursing education globally. More recently, she developed an open-access Virtual Healthcare Experience consisting of eleven virtual gaming simulations that have had over 2 million plays! Concurrently, she has been involved in numerous research projects and OERs related to embedding virtual simulation effectively in the curriculum and different ways to debrief virtual simulations. Recently, she was recognized for her work with the following awards: the 2020 INACSL “Academic” Leadership Excellence Award; 2018 INACSL, Research Excellence Award, Hayden Vanguard Lectureship, and the Society for Simulation in Healthcare: 2021 Article of Influence. She has published numerous articles in peer-reviewed journals and authored books and disseminated them at national and international conferences.

LinkedIn: https://www.linkedin.com/in/margaret-verkuyl-b83aa633/
Email:  mverkuyl@centennialcollege.ca

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Transcript

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Intro: 0:35

Welcome to The Sim Cafe, a podcast produced by the team at Innovative Simsolutions, edited by Shelly Houser. Join our host Deb Tauber, as she sits down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation. Sit back, tune in and learn something new from The Sim Cafe.

Deb: 1:08

Welcome to another episode of The Sim Cafe. Today. We are blessed to have Margaret Verkuyl. She's a nursing professor at Centennial college in Canada. Since 2013. She's been a leader in developing and researching virtual simulations and interactive textbooks. Over the years, she's received numerous prestigious, local and international awards for her work while gaining international attention, the virtual simulations have become pervasive in nursing education globally. Most recently, she developed an open excess virtual healthcare experience consisting of 11 virtual gaming simulations that have over 2 million place. Congratulations. And with that, we'll get started with you. Would you like me to call you?

Marg: 1:59

Margaret's fine. Or Marg

Deb: 2:01

Margaret. Okay. Thank you for being on. And why don't you share with our guests, how you got into simulation, how you actually started in it?

Marg: 2:10

Yeah. I started, um, teaching full time in the BS CM program in 2005. And about that time we were given all kinds of simulation equipment. And so I was the one that helped take the simulation equipment out of the box and learned how to run it and so forth and did a number of things. As many of you have an in person simulation, but what happened in 2013? And that's what I really wanna talk about is the change to virtual simulation. We were doing in person simulations and we were trying to get over 550 nursing students through maternal newborn, three maternal newborn, pediatric in person simulations. And we sat there one day and said, this is almost impossible. And why don't we do this virtually? And so there started the journey in 2013 of receiving an innovation award for creating a virtual simulation related to pediatric care. We actually had applied only for 5,000 and the reviewers looked at our proposal, laughed and said, you're gonna need more than this. We're giving you 20,000 and good luck did little, did we know this would be, we needed good luck and that this would just be our passion for many, many years. So we started creating virtual simulations that were video based. They were branching scenario type and with some gaming elements in it, our first one took us two and a half years to create. And we learned a lot along our journey. And we got a little faster after that.<laugh> creating some of these, but what we also started doing is embedding them in curriculum at that time, very different than pen, the pandemic time, where everybody wanted virtual simulations. At that time, when we went to our teaching team of 12 faculty and said, this virtual simulation we created on mental health assessment would fit so nicely in this health assessment course, the team were like, eh, maybe I don't know, do you think that's a good idea? And they agreed to let us try it. And what they said is, well, you need to evaluate it. So we did focus groups of students that engaged in the virtual simulation to find out how they liked it. And at that time we did like many people have done throughout the pandemic is we thought this virtual simulation has learning modules with it attached to it. It has feedback. It has a summary report of other student did. And it's like this great packages, great learning package all in one. So we just send students a link and then they play the expert. They do the experience and they've learned, that's all we need to do. Our study told us something different. We actually had so many students come to the focus groups. We actually had to stop enrollment. And usually if you're into research, you know, getting participants is always the challenge in this study. It was not because they actually came to our focus groups to, to debrief their virtual experience. And what we learned is that you cannot provide a virtual simulation and think it's a nice package without doing pre-work pre-work as a faculty pre-briefing and pre-briefing looks a bit different in the virtual world, thinking about enactment and, and really enactment is very, very different. There's different ways to enact and virtual simulation as opposed to, um, an in-person simulation and then debrief it. And, and how do you debrief an asynchronous experience? And so we realized that there was a lot more to it than just sending students the link to a virtual simulation. We needed to embed the experience into some kind of pedagogy and the simulation pedagogy fits nicely with it, of course, but looking at the nuances of what it means to pre-brief a virtual experience, what's different than in person. And there are many different things what's different on how you enact it, what's different for debriefing it. And how do you evaluate it? And many of us forget to evaluate your experiences. And so we learned a lot and our next experiment looked at different ways to debrief a virtual experience. And we looked at self debrief and virtual synchronous debrief, and in person debrief the gold standard and compared them, what would they be like? And the big learning that we had was it really there's learning that occurs with the debrief. It's so important that you do it. It's not as, um, particular on which way you do it. All of them students learned and they had added learning from having that debrief. So what's nice about that is that you have options as a faculty. If you're going to, um, if you going to have students play a virtual simulation, that there are different ways to debrief it and you don't have to think, you always have to meet together in an in person, group debrief. So it, that was a really big learning for us.

Deb: 7:25

So Margaret, did you guys use any specific debriefing models?

Marg: 7:29

There are different debriefing models and we in our studies used a lot of the 3d debriefing model and that's with your questions, right? They help formulate your questions, really looking at the learner and the experience that they've had. Um, and I think that the, the bigger thing is when you look at the standards for debriefing, you can use those, but then you have to look at the nuances to do with virtual simulation and what we found, like even doing a self debrief, you know, that provides that immediate debrief after an experience. And it's also facilitated cuz you actually give questions to the learner that's based on a theoretical model. So you have those elements in, it's just done differently than we have within the in person simulation world. So, so we've got come. Um, so we've continued to go on this journey about how do you embed virtual simulations effectively into curriculum? Cuz that's even a bigger thing. Our in person simulation world is ni is a nice package. It's in a room it's scheduled there's simulationist that are trained that do the simulation. It's very organized in control and you know exactly what simulation students have gone through. Virtual simulation is different. It's kind of blown away the walls of the simulation department because you can use a virtual simulation in a theoretical class. You can play it at, do it as a group with your, with your learners there, or you can have them do it at home. Um, they don't have to be in a simulation department. Your clinical instructors can use them because they, they can't get into the clinical setting that day. So they use virtual simulations and in a small group with their students or the labs themselves can be used. So it's like your, uh, other labs, not your simulation labs, but your skills labs can use virtual simulation. So suddenly virtual simulation has allowed it to be accessible to every faculty or clinical instructor or lab instructor who is engaged with students. The challenge here is how are we gonna train faculty to do this effectively? And that's really our big challenge in our big learning along this pandemic.

Deb: 9:51

And you know, it's fascinating that you guys were doing this in 2013. I mean that, that's almost 10 years, whereas many schools were like, and I'm sure you had one or two people that said, you know, we're not gonna do this. We're not, we're not gonna play right.<laugh> and ultimately they either started to play or they found themselves a, a different, you know, place to, to go. Um, but I think having been so ahead of the curve, probably when the pandemic came, you had a lot of things really figured out and were able to really fine tune things that maybe you didn't have perfected by then. So I, I can only imagine that your learners really receive a lot of benefit from everything that you guys have done.

Marg: 10:39

Yeah. And you're right. You know, there's always the naysayers, the ones that don't wanna be involved, as I said, we evaluated the first experience that we did. And, but, um, which was really good and, and really important to do. But what we found is students love the experience and that propelled things further in that very similar course. We now have four virtual simulations that students do and it's a course. They don't go to the simulation lab. It's part of the theoretical part of the course. And so it is a very different opportunities with virtual simulation as opposed to the in person simulation model.

Deb: 11:17

Right. Right. And when you started out, you said the words and you know, I came to the school and there were so many simulators in the box. And I, I think, I think at some point we should count the time simulators in the box comes out on the SIM cafe because it's almost like almost everyone says it, the simulator was in the box was in the box and yeah, they're, they're out of the box now out of the closet,

Marg: 11:39

They're totally outta the box, you know, and there's so many opportunities and really, what's nice about this. It's experiential learning and students are engaged in experiential learning. It's not that didactic learning. And it's really us as faculty that have to adjust related to that.

Deb: 11:58

Yes. Yes. And I think recognizing that there are so many opportunities to encourage utilize, put in experiential learning. We, I say it a little bit differently than you do. I completely agree those faculty members who say, you know, well, we're not doing simulation. We're not, you know, sure. If you're gonna be doing a level one trauma simulation, you're gonna need some subject matter experts. But if you're gonna be doing glow germ in the classroom, there's not a lot of expertise you need. Okay. Just get the glow germ wash, have'em wash their hands, get the black light. Okay. But you know, it's broadening, people's thinking, but I think you, you had to take it to a new level when you went to virtual reality at that time. I mean, you're a pioneer, right? You guys are pioneers and you should be proud of that.<laugh>

Marg: 12:51

Well, it has been quite a journey and really we're on the journey of not just us creating these experiences. We've involved students in creating the virtual simulations and they are on advisory committees for us. Some of them have acted in our virtual simulations and they actually are really proud of the education. The learning that comes from it and, and this learning object says virtual simulation. They're like, oh, look what I did. And they show their friends and their family that they're involved in it and they're helping create their own learning resources and they themselves know what students need.

Deb: 13:33

No, it's, it's very, very true. Yep. The, their peers, they're when you can help your peers learn that's and you guys are raising the bar for, you know, the future generation of nurses so hits off.

Marg: 13:45

Yeah.

Deb: 13:45

<laugh> cheers. Um, so my next question is gonna be, why don't you share with our listeners your most impactful or favorite simulation story?

Marg: 13:58

Yeah. And again, it's gonna be around virtual simulation. I have a lot of them, but my most impactful one was that a student who I had in year one, it's a four year degree program. I had this student in year one and he played this mental health virtual simulation that we had created in year one. I had not seen him until year four. Saw him in the hallway was almost at the end of his year four just before graduating. And he sees me in the hallway, he says, mark, mark, I gotta talk to you.<laugh> like, oh, what's up? You know? And you're, you're thinking, okay, I know I had him in a couple years ago and I wonder what this is about. He said, I have to tell you, you know, that virtual simulation, you made me play in year one. And I said, yeah, the mental health one, he goes, I live it every day in clinical. And what that meant to me is in year one, something we taught him, came back when he was in clinical he's, he was doing a community mental health placement. And that, that was the virtual simulation. That's the topic it was on. And he felt that his experiences mimic what he had done in the virtual simulation and that he remembered it. Like, they're unsure. He barely remembered my name, let alone anything. I taught him didactically, but he remembered the virtual simulation that he played and he played it on his own actually. And he could transfer it to his clinical practice in year four.

Deb: 15:30

Wow. Do you recall like what that mental health simulation was, was like, how did you, I know a lot of people do that. Dr. Dugin Deens, uh, hearing voices, which is, you know, just profound work. Um, so what was your simulation?

Marg: 15:46

Yeah, it was about a nurse going into a home visit and there is evidence of domestic violence and depression and potentially suicide risk. So it was fairly heavy topics. And the student comes in and They're very early on within the second decision points have to make a decision whether they stay and this angry person comes out and, and is very aggressive with them and they have to make a decision. Do they stay, do they go, what do they do? And then how do they handle the domestic violence? You know, how do you ask questions about it? How do you ask questions about depression and suicide risk? So it really was a heavy topic and what we have found with our virtual simulations. And again, this is through our research is that there's a number of our virtual simulations, that students get that visceral response that their heart starts racing. They they're sweaty. They know that their actions have consequences, and this is what they tell us. And you wonder how much of that then stays with them because of that dopamine epinephrine flood in their brain, right? When you look at how we remember things and is that why they remember it because they get that visceral response to the experience.

Deb: 17:04

Those are great points. And I know in the United States, between 2019, uh, between 20, 20 and 2021, the suicide rates are up by 30%. I, I wanna say it's, I think it might even be 33, but you, you think about that jump when historically it had been going down and the pandemic created this surge of mental health issues, you know, are they based on isolation and loneliness? Are they based on, you know, I don't know, but hopefully you guys are continuing that simulation in helping your learners learn how to address some of those once again, heavy topics, as you stated.

Marg: 17:42

Yeah. And honestly, our virtual simulations are free. They're open access. They are played in 25 different countries. We've had millions of views, um, users, which is really awesome that they can be so transferable to all different courses and different countries because the topics in them are topics that are true. It really doesn't matter where you live depression, suicide, risk, domestic violence are all topics that transcend borders.

Deb: 18:18

Oh, absolutely. None of them are specific to one culture. Absolutely. And you know, we'll put that in the show notes. So if our guests and listeners wanna find those free resources, I think in your notes, you said that, um, yeah, that they have been, uh, in over, you said 2 million plays over 2 million.

Marg: 18:40

Yeah. We're probably up to 3 million now, but it's, they've just been used so much, especially over this pandemic.

Deb: 18:46

I love it. That's fantastic. We'll put that in the show notes. So people know where to get that. The links for that. Thank you for that. Now, Marg, I'm gonna ask you the next question, which is where do you see simulation going in the future? Where do you see the future?

Marg: 19:02

Yeah, that's a good question. So the first thing I'm gonna say, and I'm gonna talk again about virtual simulation, cuz that's probably what I know. Well, it is what I know best virtual simulation post pandemic is here to stay. It's not going away. There are so many needs that we have unearthed with using virtual simulation that were present before the pandemic. Like it's really difficult getting all students through when you have 550 students in each year, uh, through a labor and delivery rotation or a pediatric rotation, your specialty rotations, it's really hard to give them all those experiences. But I also think the other thing we've realized that you could give students all the in person placement experiences, that they need to be a, an effective nurse and they might still not get the experience you want them to get, just because it didn't happen that day, such as, you know, an unresponsive patient, they might never get one in their clinical practice. So why not get some standardized experiences through virtual simulations? So you can actually say at the end of my four years, every student or end of the four year program, every student will have dealt with an unresponsive patient, a domestic violence situation, a depression situation, a labor and delivery or whatever it is. And they have done it virtually ours because they're videoed are very real and students become attached to the patient too. They, you know, we get pro professional actors for most of our virtual simulations. So it becomes really real for them. And it seems like the real thing. And that's really important as we do these virtual simulations. What also I see is the pandemic is unearth this huge, huge need for faculty to go through professional development on how to embed virtual simulation in curriculum. And this is a huge need because I've heard it again and again from students I have studied or from faculty themselves, and they had no idea just like us, you know, you just send them the link. That's what we did. We sent them the link and as, and they got their completion certificate. That's all we need to do. And that is, we've learned so much that that is not the way to do it. And we wanna make these experiences as impactful and the best learning experience we wanna optimize on that learning. And the only way we can do it is to effectively embed them in simulation, um, pedagogy and using the nuances we learned. And I have a resource that we just finished. It's called virtual simulation and educators toolkit. And it will take you through all different things you need to think about before using virtual simulation, some free re uh, virtual simulations. How do you, pre-brief a virtual simulation? What are the nuances in there? And for example, with the virtual simulation we did with mental health and domestic violence, I always wrote that it's a safe environment. It's safe because there's no one else around the students are playing it on their own. What I didn't realize is the content is not safe. So we still have to set up a psychologically safe environment for students, even though they're doing virtual simulation asynchronously. We also have to talk a lot about technology for anyone who's used virtual simulation, you know, there's technology issues. Have you identified that in the pre-brief? Have you talked about what are they gonna do if they have technology issues, if they're doing it on their own also, how are you gonna debrief it? The other thing that lends itself to it is virtual simulation can be played a number of different ways. And in this, um, open educational resource that we have just developed, and that is out there for you, it talks about the different ways you can embed it and what you need to think about. Then when you do it, even doing a facilitated virtual synchronous debrief, it is not the same as doing it in person facilitated debrief, because the in person facilitate a brief debrief. Do you have to talk about technology in the chat? No, you don't. You're there. You can see it. So, but when you do a virtual synchronous debrief, you have to think about things of people coming on. Are there mics working, should they show their face or not? Um, should their video on, what about the chat? Are you gonna let people individually chat? And this is supposed to be a group discussion and so forth. And so we have a whole list of things to consider when you're doing these different ways of debriefing virtual experiences. And then we have a chapter on how to evaluate and really looking at evaluation of your virtual simulation.

Deb: 23:54

No, I, I love it. And you actually brought up something that I'm pretty, I feel very strongly about also is the mental health thing. And do you feel psychologically safe? I mean, if you're doing a simulation and it suddenly triggers some kind of a guttural response about, you know, yourself, a family member, a friend who you have, you know, seen, how do you, what are your, what are your, how do you change there, right?

Marg: 24:17

Yeah. Yeah. I think even when you do these virtual simulations in a group, so you're like, okay, well I'm gonna be there. And it, it, whatever the topic is, um, how do you engage all learners in the experience when you're doing it as a group? Right. So, yes. And so we have ice tips for that on what to do and, and how to engage learners. But, um, it, it really, we really need to facilitate these well and think about them well, and what we've also learned too, is that you, as the facilitator have to have an intimate knowledge of that virtual simulation. It can't be the first time you're seeing it when you're facilitating it with others, because that, that doesn't work. And what we found is that so many, um, additional things come out of it such as when you debrief it, such as we have a prenatal one and we dip the urine for protein. And the answer course is eclampsia that we're checking for. And in my debrief comes things like, well, why is eclampsia a problem? When do, when should we start worrying about it? What are the signs and symptoms, you know, and, and so forth. So a bigger discussion comes out. And so you as a facilitator and do not just have to know that, answer that, oh, you dip it the urine for protein, for eclampsia. You have to know what eclampsia is. When is it concern, you know, so forth in the debrief, just in case that comes out.

Deb: 25:42

No, that's, those are really good points. Now, if our listeners wanna get a hold of you, are there any places that you can be reached at?

Marg: 25:51

I am on LinkedIn and definitely I have an email, uh, my work email. You're very welcome to email me if you have any questions.

Deb: 25:59

Perfect. I will put that in the show notes. And once again, I think I'm gonna send that out a little bit sooner, and it has been a pleasure and an honor to have this interview with you. Is there anything else you'd like to leave our guests with today?

Marg: 26:15

Well, if you're using virtual simulation, think about what professional development you have, what resources you have, how do you embed this effectively within your curriculum? How do you ensure that when you use virtual simulation, it's optimized to be the best learning experience for the student and not just something for them to do, to, to have a learning experience, right? So really think about different ways of doing it. And I think that part of our virtual simulation in educators toolkit our resource is a combination of different experiences that we've had and learn from. And if you can learn from some of the mistakes we've made so that you don't make them, that's awesome. And I hope you'll look at this free resource. That's open. All you need is an internet, and you can download it if you want, although you can't get all the interactive activities when you download something and you actually, because it's open it's by creative commons, you actually can take parts of it and use it within whatever you need for teaching or sharing with your peers.

Deb: 27:26

Thanks. Thanks so much, Morgan. I will put that once again in the show notes. And I think that that's very generous of you to share with our listeners ways to learn, because obviously you guys have been doing this for almost a decade.

Marg: 27:38

Yeah.

Deb: 27:39

Right.<laugh> and it wasn't like you guys were a gaming company that came up with, Hey, let's do virtual Sims.

Marg: 27:45

Yeah. And the thing is, I'm not even a gamer.

Deb: 27:47

<laugh>, I'm

Marg: 27:48

Not, I don't play the games really. Except the ones we make<laugh>

Deb: 27:52

No, I, I, yeah, I get it. I agree. All right. Well, this has been fantastic. And guests happy simulating, Marg. Thank you so much for being here.

Marg: 28:01

My pleasure.

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Outro: 28:17

Thanks for joining us here at The Sim Cafe. We hope you enjoyed connect with us at www.innovativesimsolutions.com and be sure to hit that like and subscribe button. So you never miss an episode of The Sim Cafe.