The Sim Cafe~ Interview with Amy Cowperthwait

Starting many years ago as an ER nurse, Amy Cowperthwait found her educational niche in 2006 as a simulation faculty at the University of Delaware. In 2009 she co-founded Healthcare Theatre with Theatre Faculty at the University of Delaware. The simulated participant program has grown exponentially over the years leading to the development of an approved minor at the University. Her entrepreneurial journey started in 2011 with a tracheostomy simulation gone awry. Through a new partnership with Engineering, the first wearable simulators were developed and patented. Amy’s mission to include Simulated Participants in every possible simulation-based learning experience challenges the outdated precepts of traditional manikin-based learning. The combination of wearable simulators and simulated participants brings simulation to life, adding the vital human element when teaching the essentials of patient-centered compassionate, connected care. After numerous awards and recognition for her work from the simulation community, Amy began balancing her workload at the university with a new title, CEO of Avkin Inc in 2015. Today, she continues to be recognized by her academic colleagues for her contributions to the simulation andragogy while at the same time ensuring Avkin is established as the company that is focused on excellence in simulation education. 

Amy Cowperthwaite: Amyc@avkin.com

SimGHOSTS Website: https://simghosts.org/

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Transcript

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Intro: 1:10

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: 1:44

Welcome to another episode of The Sim Cafe. Today. We are truly blessed to have Amy Cowperthwait with us from AVKIN. She started her journey many years ago as an emergency room nurse, and then found her educational niche in 2006. Amy, why don't you share your journey into simulation with our guests? Thank you for being here today.

Amy: 2:06

Well, thanks so much. I appreciate it. I'd love to share my journey. So essentially, as you mentioned, I came out of the years and years of experience as the emergency department nurse and got a little bit tired of working weekends and holidays, and was a really interested in my educational opportunities because I didn't have a great educational experience. You know, I left out of the University of Delaware, but I felt as though when I started in nursing, I really needed more mentorship or more help. And so I was really excited when, um, a job posting came available to work in the skills and simulation lab. At the time I was the coordinator for skills and simulation, and I didn't know what simulation was. Obviously it was pretty new to everybody, but they had gotten a high fidelity mannequin, and they asked me to get that integrated into the curriculum. And I always joke, but it's kind kind of half true that I had to Google what curriculum meant, because at the time I really didn't, I wasn't an educator. I, I wasn't an academic. I didn't really know what that meant. And I wanted to make sure I was doing a good job. So after I got kind of the skills part of it under control and really started looking into the simulation part of it and really understanding what this high fidelity mannequin was getting more training, I began integrating simulation experiences, and I loved the idea of really preparing these students from, for going into the clinical setting. You know, they were, they were, these students were, that were coming to me, were students before their, their clinical experiences. So I, I love that idea of being able to prepare them ahead of time, but I really struggled with how to use these mannequins effectively, you know, what, how to make it so that the communication piece of it was so strong and the students really struggled with it. I remember saying to them, talk to it, like it's a real person. Just talk to i t, explain what you're doing and talk to it. Like it's a real person. And then one day I went i n to do the model a s a procedure or something along those lines. And I remember I was having difficulty talking to the mannequin, like it was a real person. And I thought to myself, you w ho has 25 years of experience as a, a s an emergency department nurse and could talk to paint, drying on a wall is struggling to talk to this mannequin. How can you expect these novices with very little experience to n o experience, to talk to that mannequin? Like it's a real person. So that's really, you know, kind of my first steps into it. And that's when I contacted the theater department and really began working hard to integrate live people into our simulation experiences, even i f they were the family member for the mannequin, but some type of communication with a real human was essentially important in my book,

Deb: 4:40

Amy, what were some of the challenges you found when you first started to use the theater group? What were some of the hurdles I'm curious about standardized patients, cuz that was cutting edge. I'm sure at that time.

Amy: 4:53

We did it at very unusual program where we had a course. So we started with an independent study course and we had four students that were theater minors and that worked real well cause it was really consolidated. It did two weeks of time. It was part of my workload cuz I was doing the simulation anyway, the theater faculty member came over and helped me because he was mentoring these students in the independent study. So that was easy. But as the program began to grow, you now need more administrative help. So I'm coordinating at this point about 20 student schedules and I have them all on Google calendar and I'm trying to make sure that they're lining up with our needs for the simulation experiences. So I always advocate that, um, when you're embarking on this journey, if you want to begin SPS that you need to advocate very early for administrative help because I didn't, I used very suggestive language. What, something like it would be very nice to have an administrator to help me. It would be wonderful. We really need an administrator. And then until I said, this program will not continue unless we have administrative help. That's when I got the help. So it's being very specific.

Deb: 6:05

Yeah, that makes a lot of sense. So I know, I remember being at NASCIL in 2016 and actually seeing th e p r o a nd I remember just being overwhelmed with how amazing it was. I mean the thought of, I remember doing my first suctioning on a patient, on a live patient in the emergency department and I was so scared and when I saw that, I thought, wow, this is really going to change the way people can learn with the haptic. Um, a nd some of our, ou r l isteners may not know what haptic means. So maybe you wanna explain that as you go along and tell the story.

Amy: 6:46

Sure. I can tell you, I had a very noxious first suctioning experience as well. And that's really why it was our first product made. But long story short, I began doing exclusively SP simulations with the program that we created. And then I got called back to do mannequin simulation because the person they had hired to replace me left in the middle of the semester. So when I was doing a tracheostomy simulation with the students, they, the students walked in and they said, Mr. Jones, what's your date of birth and you know, your name or whatever they said. And I remember that I didn't speak because I wanted them to understand that tracheostomy patients typically do not have the ability to verbalize. And all of a sudden they were doing CPR and Mr. Jones because they thought Mr. Jones was dead. And I thought to myself, how could I make my piece sicker without cutting holes in their neck? You know, I, can't obviously there's students at a class that are helping us to do our simulation experiences, but learning at the same time. But how do I translate this? You know? And that's when we began working with the engineering department to create a tracheostomy device and, and being an educator and also being an experienced nurse, I was able to really say what was absolutely necessary for this product. And so what happens is if you are suctioning a patient or if you're changing out the dressings at the face plate of the, of the tracheostomy, their sensors. So if they students are pushing too hard on the face plate or go too deeply and hit the Corona while they're suctioning, the healthy person wearing this device will be able to react and respond because they get a vibration like similar to a cell phone vibration on their back. It's actually the exact same vibratory thing that you have as a cell phone, but they get that vibration so that the students that are doing the procedure do not know that they have gotten a buzz because it's quiet, it's just felt, but the person can then react and respond. Um, at the time I obviously was just training them very early on. I was the one that was teaching them. We didn't, we didn't have training videos like we do now, but anybody that's wearing the device now gets a training video on how they would, would respond based off of the sensors that are triggered. It's kind of like the game of operation, but you know, slightly different. No, no buzzer sounds cuz we don't want the students to know when they have tripped that we want them just to see the reaction and a big thing with this was when I very first had my ver first prototype and we were testing it. I had no aspirations to start a company. I just wanted something better for my students. But when we were testing it, not only did I get to see the students doing the procedure, but I also got to see how they reacted to the patient's reaction, which was extremely important because then you could really talk to them about critically thinking this it wasn't a planned event, right. So how do they respond utterly to what's going on right before them? Did they, you know, de sterilize their cannula like I did as a brand new nurse, you know, I remember like when my patient reacted that way, I threw my catheter down because I was nervous. I didn't know what to do. Most of my students maintained sterility, but then also put oxygen on the patient and allow them to recover, which is exactly what you would want them to do. But we got to talk about that in the debrief and how they reacted to the patient's reaction is, is almost as important as if they're doing the procedure correctly. So how they interact with the patient obviously and how they're reacting is, is so vitally important. And it's something that I really feel that is very unique to the akin product line.

Deb: 10:14

No, I would have to agree that that's um, that's wonderful. Please share your favorite or most impactful simulation story with our listeners.

Amy: 10:25

Mm that's a hard one. I would say that tracheostomy simulation, where I saw the student doing CPR on a person who was alive pretty impactful for me because it obviously led me in a completely different direction professionally than I ever thought I would be. But I think the other big impactful ones was very early on. When we began using live people in simulation, we were doing a head injury simulation. It was an interprofessional simulation where they physical therapy students and the nursing students had to ambulate a head injured patient to the door and back. And I can remember there was a previous to that, those simulations in their, that was a junior level simulation, but in their sophomore level, they were doing diversity simulations where they were just doing basic vital signs and discharge instructions for patients and this head injured patient, the physical therapist gave lots and lots of instructions to this head, injured patient at once about getting up out of the bed. And I can remember my student to this day, I, the student said whatever his name was, Mr. Jones, before we get you up, I just want you to repeat what you're supposed to do. And it was one of those Hollywood moments. So when we discussed it, I said, so Elizabeth, tell me why you had this patient repeat the instructions. She said, well, the patient was head injured. And there was a lot of instructions given. And I was worried that the patient was gonna fall when they got up. So I just wanted to make sure they knew what, what they were supposed to do before they got up. And that was taking a teachback discharge instructions that she had learned a semester previous and applying it into the, a completely different situation. But it was really that kind of transformational experience that really made me see that this is actually translating. Now. It was obviously from one simulation to the next, but the interesting thing was it wasn't just at discharge instructions where she asked for the teach back. This was a situation where she was concerned about the patient's safety in a different way. And she still applied that learning in that experience. And I thought it was so important and so valuable. We've had lots of experiences where we do depression assessment where the patient's suicidal and we've had students actually come to their clinical instructors and say, I'm concerned this patient's suicidal and feel comfortable asking those questions because they had that simulation experience. So those are the things to me where you're seeing it translate into different places that makes it all worthwhile, makes you feel as though all the work that you're doing to help these students is actually paying off in the end.

Deb: 12:56

Right. I totally agree. Excellent. Excellent. Thank you. And where do you see the future of simulation going? Where, what are your thoughts on this?

Amy: 13:07

Everybody asks that question, right? Everyone's saying, where are we going? Especially after COVID and everything that's happened. I definitely see that most people would probably comment on AR and VR. And though I think that those are very valuable tools. I think that they're, in my opinion, um, that they're more on that kind of like early level when they're learning those tactical things. And I think eventually that AR and VR is gonna get to a very wonderful place. It's just not quite there yet. I do like to repeat what David Hollowell says is that the future of simulation is in hybrid simulation where you're combining a live person with a wearable simulator and some people choose to use TA static task trainers, but that communication is so important. And we can't negate that conversation because they say that one in five nurses leaves the profession within the first year. This is a post COVID document that I read the other day. And a lot of the reasons why they're leaving is that they don't feel emotionally prepared for what they're going to face. So unless you're giving them those opportunities to really face some very difficult and challenging simulation experiences and talk, let's talk through it. Let's talk through how to deal with this. Let's talk through how to talk to a patient who's frustrated and angry, or just found out that they're diagnosed with terminal cancer or whatever it is until we equip them with those communication skills. We are leaving them with only a part of the equation, a portion. And I would say that for me personally, I felt very comfortable with the communication part of it when I went left nursing, but not as comfortable with understanding all of the ins and outs and the responsibility that it was to be a nurse, as far as putting lab works together with the medications and all of that stuff, which is what I worked so hard for to help my students with. But now it's also this communication piece that we've got to help them with. And if we don't, we're gonna continue to see those attrition rates. And also the emotional toll that nursing is in all health professions quite honestly are to people that aren't prepared to emotionally handle it.

Deb: 15:13

Oh, exactly. I couldn't agree more. And I think that the pandemic just created the perfect storm for, you know, people to mass Exodus. Like you don't, don't get the same experiences that you had prior to, um, and even the socialization for the nurses when you're coming into a new hospital or new location during COVID, they, you know how usually you would have, you know, everyone would go out after work and you get to know people and during COVID people, weren't getting those experiences. So those nurses who came into nursing during COVID didn't get the same socialization. As many of us were fortunate enough to get and develop those relationships where you felt comfortable to ask someone a question, you know, Hey Amy, what do you, what do you think I see this? Or, you know, um, and, and developing that sense of confidence to be able to ask a question.

Amy: 16:09

Yeah, I didn't have that, Deb. I wish I did. I, I, I think my workplace for the first seven months was very, um, psychologically unsafe. And, um, I think that I really can identify with these nursing students once I got to the emergency department. Um, that's where I found comfort. You know, I heard residents who had gone to medical school and are now, you know, in their second year of residency asking attending physicians questions that I had. And I thought, well, if they have the question,<laugh> certainly, I am not expected to know everything and I don't have to keep this all inside. And that's when I really started feeling comfortable asking those questions or sitting alongside those attending physicians as they were teaching the residents. But initially I didn't have that. And I think it's very, very important. That is a very psychologically safe environment. And again, that's why I left my ER days to go back to help these students in a safe place with simulation, let them make mistakes and let's talk through it. And the beauty of SPS is they also can talk through it from the patient's perspective, which I think adds a whole nother opportunity for these students to really learn when I said this or did this, how did the patient feel about that? Or what was, what was going on that the patient felt frustrated at this point? Those are these opportunities to unpack all of those emotions, thoughts, and questions that you don't normally have. If it's a mannequin based simulation with a facilitator and the learners.

Deb: 17:38

Now, Amy, when you guys do these simulations with the standardized patients, do the standardized patients participate in the debriefing?

Amy: 17:46

Yes.

Deb: 17:47

Okay, good.

Amy: 17:48

Yes. They actively participate. Yeah.

Deb: 17:50

Because then they can give their experience firsthand to the learners.

Amy: 17:56

Yes, yes. So we use a three phase model or I have traditionally used a three phase model. So that first phase is that reaction, letting the students get everything out. Right. And in that time, the SPS are formulating their feedback on a form that we give them. So it's a very standardized form that they use, but often the, you know, the students might ask a question of, I didn't know what to say, you know, when this happened and we say, oh, well, let's ask the patient, you know, how they felt about it. And it just gives you that opportunity as the facilitator to again, take the spotlight off of you as what you are supposed to say, you know, we're supposed to keep our mouth shut as much as possible, right. But allow that SP to speak for the patient on the patient's behalf, which is a really, really valuable opportunity. And I don't know where this research is, but I know that Susie card Edwin told me and I believe her<laugh>, I believe she read it somewhere. And I reached back to her to ask her, but I, it got lost in translation, but that the students care more about what the SP thinks of them in the simulation experience than what the facilitator does, because they wanna know how they're being perceived by that patient. And if you think about diversity equity inclusion, that adds a whole nother flavor to this, that we can't offer to the students. But when you have SP from diverse backgrounds, they really can offer a whole different perspective that I would never be able to offer to them.

Deb: 19:14

No, I, I believe I heard that or read that same information. Yeah. Yeah. And Susie does listen to these podcasts. So she'll probably reach out to you and let you know where the stores came from.

Amy: 19:25

Perfect. I know she knows where it came from. Yeah,

Deb: 19:28

Yeah. Yeah. She's, she's amazing. Amazing. Can you share where you were and what you were doing during the COVID pandemic and any lessons learned?

Amy: 19:39

Well, I was doing a few different things. I still worked full time at the University of Delaware and was the CEO of akin as far as with my academic hat on, we transitioned all of our SP simulations to the virtual options. So we just modified our simulation experiences to make them tele simulation as much as possible and did a lot of data collection and reported out on it. But I think that those programs that had SP felt a little more empowered to be able to make some decisions and make those experiences for the students as best as they possibly could be without having hands on experiences.

Deb: 20:16

That's a good point. That's a good point because if you just have simulators, you're challenged with, you know. Yeah.

Amy: 20:23

And I know a lot of programs that had just simulators, the instructors would go in and the students would talk them through what to do. And I, again, you do what you have to do. I mean, obviously nobody saw this coming, so it's not as if preparation, but our students had a lot of virtual simulation with the avatars and they did not like that. So as much as we could have them doing live simulation experiences the better, and they felt more prepared, they felt as though they, they were getting more out of those experiences. And then for my CEO role, I was trying to hold on and make adaptations and changes. And so we took the amazing learnings that we got from the university of Delaware on how to do simulation with an entire clinical group. And we brought that to akin, to create called it's what we call now a encounters. So those are tele simulation experiences with whole clinical groups. We thought it was gonna be a temporary thing through COVID, but we've gotten such a good response from it that we've, we've actually kept it as part of our offerings, because there are a lot of programs that want to start SP programs, but they don't have the capacity or don't have whatever the resources that they need. So this is a really good opportunity for them to still have live people in simulation, but not necessarily have to create their own SP program.

Deb: 21:36

Excellent. Excellent. Now, can you share with our listeners the biggest thing that you would like them to know, something that you learned and it changed the way that you practice, maybe an aha moment for you?

Amy: 21:49

Let me think about, I, I think the biggest thing that I would say is I remember when I first started doing simulation, I, and I still do love working with the students. Absolutely love working with the students. And then as the healthcare theater program began to grow, as my SP program began to grow, I then had to take more of a supervisory role. And I wasn't in the sim room with the students. And I, I, I can remember being in the office with my Dean and her saying, you're gonna have to pull back and let other people do this. You know? And I started to cry because I love, I like I'm still getting choked up, but I love doing simulation with students. And what she said to me is you have to think about your sphere of influence your sphere of influence when you're a nurse, is you have one patient, right? You're influencing the patients that you're taking care of on a shift. When you became an educator, your sphere of influence then grew because you're now trading the next generation of nurses. Right? And I thought of this as I was moving into my CEO position is my sphere of influence was even wider right now that now that I'm really now being able to impact not just the University of Delaware and the students there, but we're really being able to impact at a much larger level. And I think that a lot of, and I wanna say, especially females, I'm not saying that it's only females, but the, you know, the idea of moving to the next level is a little scary because you love what you do. Ju I just recently left the university, but even before I left, when I was having a bad day, my team would say to me at, at akin, my team would say to me, you need to go back in and do simulation with students because that's really, you, you see the learning happening, right. And that's really what gets you up in the morning and gets you excited. So I would say that when it's a scary moment, you have to be willing if it's increasing your area of influence or your opportunity to impact other people, you have to consider that over, staying comfortable within the position that you're in.

Deb: 23:42

No, I, I think that's, that's a great piece of advice for our listeners. Thank you, Amy. Do you wanna talk about the different products that you guys have just cuz I know you have added some extra one, some new things since I, since I first saw the product and just so that our listeners can know, and once again haptic means that you can feel things and that's one of the questions on the cheese, you know, they'll want, you'll need to know that for some of those testing things. So go ahead and, and tell the listeners about some of the products that you guys have.

Amy: 24:13

Well, our latest and greatest, which is really creating quite, um, the storm is our ABI. So it is a wearable childbirth simulator. And if you think about a reverse backpack, it is 30 pounds. People always ask us, you know, that. And I always say, well, it's 30 pounds, but that's about how much a woman would gain, you know, a healthy, healthy weight gain. But we test all of our products to make sure that they're comfortable for at least three hours. So the way that we create them and design them makes it so that they're not keeping somebody from being able to breathe or something along those lines. It's very important that our patients are alive and stay that way. But the Abbi is a wearable childbirth simulator. It's very easy to use. Again, all of the products that we've created are meant to be worn by a live person. Procedures can be done safely on that live person, but they're also very, very realistic because those vibrations come at the time. So if you think about the, the ABI that comes through what we call an a band, it's a watch and fractions are what actually is triggered. And the way that it's triggered with the ABI is actually an Ave band. So it's a, it looks like a smart watch and that smart watch vibrates so that the SP knows when the contraction is starting and when it's over so that they can react. Realistically. So as the life cast, baby is moving down into the birth canal, they are reacting at the appropriate times. It is also in partnership with I simulate. So it matches up to their fetal heart monitor. So you can actually have all of those things happening in synchrony, but the Aber has multiple complications. You're really able to simulate normal and abnormal. We have multitude of other products. We talked about a tra, which is our very first product out. The other one is a urinary catheterization model. Well that avcalf and the idea, you know, some people say, well, maybe people aren't gonna wanna wear that because it's a really, you know, intimate and personal experience, similar to the at birth. But the idea is, well, yes, but they've got to learn how to talk to people during those intimate and personal experiences. Obviously everything is protected. As far as the person that's wearing its own personal genitalia and you wouldn't want to have an S SP who's been sexually assaulted in the past to have to wear something like that. But by and large, you know, when you think about the idea of these very personal or intimate moments that nurses have to have with their patients, you wanna make sure that you are also providing them opportunities to practice those in a simulated experience and get feedback about it. And what we found is that students don't know what to call genitalia. They don't know how to U what terms to use. I'm gonna touch your I'm gonna touch your and how do we give them those words?

Deb: 26:52

That's excellent. That's uh, I know when I used to teach peds, I used to ask the learners, you know, what do you guys call a pacifier in your family, right? Yeah, because it's the same kind of thing. Okay. We call it a boom. Oh, we call it a pass. We call it a plug. It's the same kind of thing on a smaller scale, but you're a hundred percent. Right. I, I really haven't thought about that, but you, um, brought up some really great points. Thank you. Yeah.

Amy: 27:18

Yeah. And there's a total of eight other products that we offer. I mean, again, we're, we're now offering educational services, so there's a lot out there. We've gotten to the point where we almost have that complete, we call it a mannequin replacement package because you can purchase all these products and pretty much replace what a mannequin would do in simulation. We've, we're really getting to that kind of complete solution and all the training and education that they would need as well.

Deb: 27:40

Excellent. Excellent. Now, do you have any questions that you wanna ask me?

Amy: 27:44

What is the value that you see in incorporating SP's and wearable simulators into a simulation program?

Deb: 27:50

I think that using standardized patients and these products really helps to enhance the communication between the patients and helps people to understand that words matter what you say to a patient in the end, at the end of the day, stays with them. Yes. And I can remember different situations in my career, in the emergency department and seeing patients at a later date and having them come up to me and say, you know, the things that you said to me really had an impact, I was glad that you were there for me. And, you know, I don't think that we know that we're saying the right thing when we say it. But when you hear years later, that the impact and the things that you said, and I think a lot of times it has to do with the empathy and compassion that you exhibit during those times that you, you know, lean in towards that individual and you have eye contact with them and you let them know that, you know, we're all vulnerable mm-hmm<affirmative>. And I think that having these products can help with the vulnerability of patients and family members.

Amy: 28:55

Yeah. And I would say the confidence as well, right? If, if, as these nursing students, when they come up and their hands are shaking, or if they're not confident in what they're doing, it throws the patients off. So being able to get those willies out in the simulation experiences and really talk through how to, to do those procedures confidently, I think is also super important and something that my students at the university of Delaware come back and tell me all the time, you know, that those learning experiences simulation made them confident for the, for that experience that they had in a clinical setting. And that's, that's what it's all about at the end of the day. That's what it's all about.

Deb: 29:29

Amy. If our learners or listeners wanna get ahold of you or somebody from the company, where is the best place to do that. And I know you're pretty busy. So I think you're delegating at this point is kind of what I heard you say.<laugh>,

Amy: 29:41

I'm still pretty approachable. I, I mean, I love, again, just like I love talking to students. I love talking to people about what we're doing. So Amyc@ avkin.com, or if you wanna go to the website and check out the products it's avkin.com. AVKIN.com.

Deb: 29:58

All right. Thank you. And I was able to see the birth at NASCIL. I was, I think it was the last birth and, uh, Adam reached over and grabbed me and I got to see it. And it was pretty amazing. Is that, uh, is there a video on the, on your website?

Amy: 30:13

Yes. There's video on the website and there's video all over YouTube as well, but yes, there's a video where you can kind of see that the, a birth and all the other products in action.

Deb: 30:23

Great, great, great. Well, I thank you for your contributions to healthcare and I appreciate what you're doing and I appreciate your time today. Thank you so much for spending this time with innovative some solutions and we will keep in touch.

Amy: 30:37

All right. Thanks so much, Deb. Appreciate it. Okay.

Deb: 30:39

Happy simulating

Sim GHOSTS tag: 30:42

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Outro: 31:13

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