The Sim Cafe` Interview with Dr. Jared Kutzin

Jared Kutzin, DNP, MS, MPH, RN, FSSH is an Associate Professor of Emergency Medicine and Medical Education at the Icahn School of Medicine at Mount Sinai and Senior Director of Emergency Medicine Simulation at The Mount Sinai Hospital. Jared is a registered nurse with advanced degrees in health policy and management, public health, leadership, and medical education. His advanced training includes completing the Clinical Quality Fellowship Program (CQFP) offered by the Greater New York Hospital Association and the United Hospital Fund and the Comprehensive Patient Safety Leadership Fellowship (CPSLF) offered by the National Patient Safety Foundation and American Hospital Association. Jared is certified in healthcare quality (CPHQ), patient safety (CPPS), simulation operations (CHSOS), and as a Nurse Executive – Advanced (NEA-BC).

In 2017, Dr. Kutzin was inducted as a fellow in the Society for Simulation in Healthcare’s Simulation Academy and in 2018 he served on the Baldrige Board of Examiners and was recognized as a fellow by the New York Academy of Medicine (NYAM). Previously, Jared served as the Chairperson for the Society for Simulation in Healthcare’s (SSH) Certified Healthcare Simulation Educator (CHSE) Committee and as an Accreditation Committee Site Reviewer. Currently, he is a member of the SSH Board of Directors, the NYS Board of Nursing, and the NYS EMS Council. In addition, he is the Associate Editor for simulation for MedEdPORTAL, The Journal of Teaching and Learning Resources and the on the Executive Editorial Board for the Journal of Emergency Nursing. Jared’s research interests include educational methodologies, patient safety and quality, an how the built environment impacts care.

Email: JaredKutzin@MOUNTSinai.org
LinkedIn: https://www.linkedin.com/in/jared-kutzin-29664354/

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LinkedIn: https://www.linkedin.com/company/76504273/admin/

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Transcript

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Intro: 0:51

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: 1:25

Welcome to another episode of The Sim Cafe. Today. We are truly blessed to have Dr. Jared Kutzin as our guest and Dr. Kutzin would you like me to call you Jared or Dr. Kutzin?

Jared: 1:37

Jared's fine.

Deb: 1:39

Okay. Thank you very much. So welcome. And why don't you tell our listeners a little bit about yourself?

Jared: 1:45

Sure. So currently I am an Associate Professor of Emergency Medicine and Medical Education at the Icahn School of Medicine at Mount Sinai and the Senior Director for Simulation at the Mount Sinai Hospital in New York City. In addition to those full-time roles, I am on the board of Directors for the Society for Simulation and Healthcare, and the Deputy Editor for Simulation Curriculums for MedEd portal, which is the, uh, double AMCs, the American Association of Medical Colleges, Journal of Teaching and Learning. In my full-time role, we are responsible for training and education of emergency medicine, clinicians, uh, medical students, residents, faculty, fellows, uh, but we also interface with our critical care departments, our obstetrical departments, pediatrics, EMS, nursing, and many others throughout the health

Deb: 2:37

You, and how you actually got into simulation know on Sims. I'm I'm gonna give a shout out to the SIM Geeks, uh, podcast. Cause I heard you when you were just amazing on there. I learned so much about theories. So go ahead and, uh, talk about your journey.

Jared: 2:56

Sure. Thanks for that. So, you know, I started off in simulation without really recognizing that I was starting out in simulation. Uh, I was actually at a sleepaway camp when I was about 17 years old and I was a soccer coach and a soccer referee. And I had always been on the swim team and that summer, they said to a bunch of us counselors right before the summer is about to start we're short, a few lifeguards, would anybody wanna learn to become a lifeguard? And I was like, well, yeah. I mean, that sounds pretty straightforward. I already been a really good swimmer. And right before camp that summer, I actually had a teacher of mine in high school, a science teacher who encouraged me to take a CPR class. I went to him as a student and I said to him, listen, I, I know you run the EMT club. This is back when like CPR was all these variable numbers. And like it was 32 or 15, two or five to one or all this stuff. And I was like, and there's this new machine called a defibrillator that you'll learn how to use. And it was super intimidating, but I went to him to ask him about this because I was refereeing a soccer game and a kid got hit in the face with a ball. They were bleeding. There was, you know, I didn't know what to do. And I wanted to feel more prepared. And I said, I just wanna learn the basics. And so he taught the basics one day and said, come back tomorrow. Right? We're do the professional rescuer stuff. It's like, you've already done the hard part, just do the, the two person compression and ventilations and this defibrillator and you'll get your professional rescuer certification. So I did that. And lo and behold, that summer I went away sleepaway camp where they needed lifeguards. And I was like, I've already done the quote hard part of CPR, right? Like I I've got that all straight. So like swimming is easy for me. And so I became a lifeguard and I really enjoyed it. And that fall, I went home and I said, well, what's the next step? And I became an EMT and I really enjoyed that as well. And I started riding on the ambulances and I wanted to do more. And so I became a lifeguard instructor and little did I know the American red cross and lifeguarding was my foray into simulation. Right? So as a lifeguard instructor, I had 20 students in my class. I would put two or three of them up on the deck of the pool to, to watch. And I had the other swimming around and before they all jumped into the pool, I said to them, when I touch my head, you are gonna pretend to drown. And if I touch my arm, you are gonna pretend to drown. And we wanna see who will recognize that and respond appropriately. We didn't call it simulation, but that's what it was. And when I went through the EMS academy, it was all hands on practical. That's the way I learned. And so it became second nature to me. Like I started to realize like I'm a kinesthetic learner and I love this hands on piece. And so my foray into simulation as a career really happened after I graduated from university, I went to nursing school and then moved up to Boston to get a Master's degree. And some people have heard me tell this, this quick story before, but, but I was in, uh, at BU getting my Master's in public health and health policy and management. And I had a professor of mine who was telling us that the way we talk changes, the way we work. And I was like a 23 year old wise guy. And I was the only clinician in the room. And I went up to her after class one day, I go, listen, I, I don't get it. You want me a nurse who works in emergency nursing and, and EMS to go back to an office to think about what we said to fix things for next time, I don't have an office. It's get me this, get me that I need this in the emergency department. How does anything that you are telling me in this classroom apply to me? And this very wide individual said to me, that's an interesting statement. Why don't you come see what I do outside the university? We sometimes let grad students come, come see what we do. So write a letter to these four people, Dr. Reer, Dr. Cooper, Dr. Gordon and Dr. Simon and come up to Cambridge. So I wrote this letter, dear Dr. Cooper, Gordon reer, and Simon. My professor, Dr. Rudolph says that I should come up and see what you do at this facility of yours. Can I come? And they said, sure. And I went up there and everyone introduced themselves and they are Harvard anesthesiologist and Harvard surgeons. And they finally got to me, I go, I'm a grad student from BU I don't know what I'm doing. And they dropped us into the middle of a simulation, took us out and started debriefing us. And I realized that that's how I always learned lifeguarding EMS academy. Jenny Rudolph was my professor at BU she's the one who exposed me to the formalized side of this educational methodology that I had experienced previously. And my first job out of grad school was at Brigman Women's Hospital in New York, in Boston. And I was on the code committee. I worked in quality and patient safety with some amazing people, people who have gone on to lead the national patient safety foundation and, and work in these amazing organizations. And I sat around this table and I met this physician who would lead you to believe that we were not doing things as optimally, as we should, especially around cardiac arrest. And we got along really well. And he said, you know something about simulation. You should see what I do. So this physician, Dr. Charles Posner invited me down to the strata center at Brigmans Women's Hospital. And I got to see what they did. And those were my forays into simulation, my high school science teacher, who encouraged me to take a CPR for the professional rescuer class, my interest in teaching and lifeguarding and EMS, and two really forward thinking individuals who I had the great experience of, of just sort of happening across 15 years ago, up in Boston, Jenny Rudolph and Chuck Posner.

Deb: 9:01

Wow. Wow. That's fascinating. You know, and it's so funny because I was a lifeguard too, and I forgot about that. And I forgot about the training until you just brought up something that I had completely forgotten. And my kids were also three of my children were, um, lifeguards too. So yes, we do do a simulation for lifeguarding. Well, this is gonna get us into our next question, which is please share your most favorite or most impactful simulation experience.

Jared: 9:31

So we see a, a really diverse group of learners. And the way I look at simulation is that simulation is just one innovative educational modality. What we're really doing is facilitating learning. And our facilitation of learning takes many forms. Sometimes it's classroom based. Sometimes it's small groups, sometimes it's virtual reality or augmented reality or, or the mannequin based simulations. And I think the most impactful, I think there's two cases that I, that come to mind when you ask this question, one is the situations in which I've been fortunate to see learners grow over their careers and over time. And I see them as first year interns, I see them as second year residents, third year residents. I see them as new nurses. I see them as continuing professional development courses. And there's been a multitude of times where a learner has come back and said, you know, that case we ran last time. We had a real clinical scenario. So similar to that, and it went really, really well. And it ranges from the cardiac arrest for the new nurse, to the obstetrical hemorrhage for the team to any clinical condition that you could think of that we've done training around. And I think when I have those conversations with those individuals and say, they say, you know, it was your simulation was so good. It prepared us so well to respond to that emergency. And I say, well, how did the patient do? And they said, it was good. We had a good outcome. And you say, you know, that's the benefit of simulation that you feel like you've done everything you could for the patient. And they had a good outcome. I also though spend my time with my learners and they will do everything perfectly. And our simulated patient won't make it, they will die and we'll have a conversation with them about how they feel afterwards. And they say, you know, it doesn't feel very good, right? I, I would I go and I say to them why they said, because the patient didn't live. And I said, but that's not your benchmark of whether or not you did a good enough job. I want you to leave knowing that you did everything you possibly could for that patient. And yet you still had a, a poor outcome because you'll have a better chance of success next time. And so if you leave that situation feeling good, that you did everything you could for that patient, that translates to me that you had a good high functioning team, and I want you to be good, not lucky. So the most impactful times are when they come back to me and say to me, not only did we have a good outcome, but we functioned well as a team. It was a well run event. It was a well run situation. We did everything we could, regardless of whether or not the patient lived or died. We felt good when we left that real clinical event. And to me, that's one really impactful moment. The second time is cause I, I focus a lot of my time on faculty development now and helping others become better educators. And so when someone comes back to me and says, I've never seen my learners learn this material so well before I've been teaching this content the same way for 5, 6, 7 years. And then we have a bit of a conversation and we restructure it and they go this new methodology. This is amazing. My learners are leaving so much more prepared than they used to leave. So I think both of those situations where our clinicians come back and say that they had a good response and our educators come back and say, they've seen a change in their own teaching styles or their own learners are the really impactful components of simulation based education.

Deb: 13:07

Thanks Jared. That that's great. And I totally agree. And once again, on a gave one more shout out to the Sim Geeks podcast with William Belk and David Shablac, where you talk about learning theories, because if the listeners wanna learn something about that, they can get that there. I was gonna focus on this podcast and talk to you about team steps, because I understand that know a lot about that. And I would like to learn more. So I imagine some of our learners would like to learn more too.

Jared: 13:34

Sure. So team steps, capital STEPPS stands for strategies and tools to enhance performance and patient safety. It's a program that was put out. I don't wanna say a decade ago about, uh, by the AQ, the agency for healthcare research and quality to really focus on how teams and healthcare respond to patient events. And there was a collection of the best evidence from DOD and other what we call high reliability organizations, organizations that are preoccupied with failure, aviation, the military nuclear power industries. And it focuses on four key concepts, leadership, situational monitoring, mutual support and communication. And there's some nice diagrams in there and there's circles and triangles because, you know, in healthcare, we love our triangles, right? Everything has a, the patient safety triangle, the million lives triangle, the Kirk Patrick's theory of, uh, you know, of, of evaluation triangle, right? So we love our triangles. So there's a triangle on circle and arrows, and it really talks about how each of these components interact with our care environment and our care teams to impact patient safety. And we use this all the time when we're talking about what the role of the leader is. And we talk about whether or not you need to be the most experienced, the most knowledgeable person in the room, or really is it just someone who is in that capacity to help direct communication and give structures and role clarity. We use it as our foundation to give names to these terms that we would otherwise, you know, maybe have some nebulous terms for close loop. Communication is a concept. And we relate that back to the aviation industry and pilots taking off. We talk about having a mutually supportive environment where we're watching out for one another and sliding the step stool underneath when the patient's doing compressions. Uh, we use it to talk about awareness of the situation and knowing where equipment is in the room and what, what we use it for is, again, this foundational discussion points so that when our learners are learning these concepts, and we use these terms later on during insight, two simulations during real patient events. And we say, who's the leader. People know what that means when we say let's use closed loop communication. Uh, are we aware of the situation that's going on? There's names to these concepts? And then what team steps does it actually gives you some tools underneath each of those larger concepts. So under communication, it may talk about close loop, communication, check backs, callouts S bar cuss. And for those of you who aren't familiar with cuss, it's, uh, a mechanism that we almost use simulation a little bit about how do you speak up? It stands for concerned. I'm uncomfortable. This is a safety issue. Let's stop. And so an example would be, um, maybe we're running a simulation where we have a standardized participant who's about to do a wrong site surgery. How do we train our staff in the operating room to respectfully speak up to that person? Dr. X, I am concerned that we haven't done our timeout yet. I am uncomfortable proceeding until we do it. This is a safety issue. Let's stop very different than saying Dr. X don't. You know, that we're supposed to be doing a timeout. How come you never do the timeout? What's wrong with you? And so it's the same mindset that we have in simulation being inquisitive, being respectful, trying to understand what the other person's perspective is on the situation. Maybe that doctor had a really good reason for not doing the timeout. Maybe the staff walked in late, but finding that way to communicate about that particular issue. So team STEPPS gives us the general categories and some tools to deploy in various ations.

Deb: 17:12

Excellent. Thank you so much for reviewing that with us. Can you share with our listeners the biggest thing that changed for you or happened to you during the pandemic?

Jared: 17:24

You know, I think that one of the things that happened to us during the pandemic, like everybody was a shift to the online learning world, but I actually don't think that that was actually that far. We've been doing a lot of tele type simulation and remote simulations and online learning. I think for me, it was this opportunity to engage with various departments, to do research and to find ways for us to become even more valuable to the health system, upskilling staff, retooling equipment. So right before the pandemic started, we, uh, tried to figure out how to split a ventilator. And we did that in the sim center. We worked with our environmental health department to look at COVID particle spread from high flow nasal Cano devices and whether or not we can reverse engineer some equipment to trap the particles that were being spread out. We used blazers and smoke machines and the mannequin that we sort of Jerry-rig to be able to exhale visible particles and see the spread and count the spread and count the, the collection of it. So to me, I think the opportunities to reach out and engage with other parts of our organization that we may not have had the opportunity to engage with was one of the things that we did during the pandemic that was really unique and valuable to us.

Deb: 18:45

Yeah. What I'm hearing you say it was a silver lining of the pandemic was that you were able to essentially work with, you know, more systems integration.

Jared: 18:55

Yeah. Systems integration and, and researchers within the, within the institution that we may not have actually got to engage with previously.

Deb: 19:02

Now is your center accredited by the society for simulation in healthcare?

Jared: 19:07

We are, we're accredited in four areas. We are credited in, uh, education or teaching and learning research systems integration. And our fellowship is also accredited.

Deb: 19:17

Wow. That's excellent. And what was that journey like for you guys?

Jared: 19:21

It was a really valuable experience for us. I think it puts an added credential next horse center's name. It helps us talk to the executives and advocate for simulation. When we are an accredited facility that puts us on par with other facilities in our region and the journey itself was helpful. It, it allows us to put in, uh, structures and processes. It gives me something to fall back upon, right? So when I have a new faculty member, maybe they've been doing simulation for 15 years, but they wanna come down and use our space. I now have to go over our policies and procedure and orient them and they say, but I've been doing it for so long. What do I need to do it for? And I now go, well, that's part of our policy and procedure. And as part of our accreditation program, everyone has to go through it and they really don't argue with it. Then it's not the center director making this up. It's an external party that has put some standards in place that we would like to meet and continue to meet and live up to

Deb: 20:20

An excellent point. The expectations are just out there, it's an alignment of expectations. Mm-hmm<affirmative> and people are unable to circumvent it due to that standard. That's excellent. Jared, I, I love that. I'm gonna ask you another question and I think this is an important question. And with all your experience, I'm sure you're gonna have a wonderful answer. Can you share with our listeners the biggest thing you would like them to know something that you, you learned and it changed the way that you PR kind of a personal aha moment?

Jared: 20:53

The aha moment for me is that the way we use simulation can be deployed to anybody. I think as simulationist, we have to be conscientious that we're not just necessarily dealing with our healthcare providers who work in the hospital setting. There are healthcare providers who work in so many different settings and our nursing schools have scratched the surface of it by implementing home care settings in their SIM centers and stuff like that. But that again is just the surface. We do a lot of trainings with our outpatient cancer Institute. And even though they're on our campus, they have to call 9 1 1. For certain patients, we do trainings for community events. We run a simulation training center, but we also do some aha programs. We do stop the bleed. I have a seven year old, and maybe it's a sad commentary on where we're at in our world, but we have practice tourniquets for our simulation scenarios and our nurses don't know how to apply them. So we train them. So I've taught my seven year how to put on a tourniquet. There are videos on YouTube that show infants kids, probably not able to walk going through the motions of performing CPR because have been around it, they've been exposed to it. And so to me, it's about utilizing our educational modalities outside of what we typically think of as our, as the environment that we need to educate people about. And we can use this to teach kids and EMS providers, as we know, but lifeguarding should be folded into that. And I know we have colleagues who do stuff on a medical transports and, and other environments. And I think we as simulation need to broaden our purview of things as well. The other aha moment is not just about teaching this diverse group of people with, with a bunch of these. Um, but it's, it's about being interconnected with the, a larger system. I sit on the New York state emergency medical services council, where we develop health policy and protocols for EMS providers in New York state. I'm on the auxiliary board for the New York state Board of Nursing and involved with institute healthcare improvement and a bunch of other organizations. And I think the more that we can get simulationist onto these boards and onto these committees and interconnected, I think the more valuable we become as well. And, and the aha moment there is when we have these ideas about who else we need to educate, we can say it, we can think it, we could wanna do it, but until we get the policy to match and support it, like the NCS BN study did with nursing education, like the ASA used to do the, the anesthesia society with their Mo course used to mandate until we've interconnected, what we do in the classroom with what happens out in practice with the policy to help serve as the foundation. To me, that's the aha is that this is all part of a really large system. And that we as simulationist are really this linchpin that hold education, practice policy, all of these things together. Um, and we sit in the middle of all of that.

Deb: 24:37

Yeah. Excellent. Excellent. If our listeners wanna get ahold of you, is there a best way to get ahold of you?

Jared: 24:46

Email is always the best first name dot last name, MountSinai.org.. JARED KUTZIN@MOUNTSinai.org. Um, and I am always happy to have folks reach out, uh, and talk about simulation, educational modalities, uh, the policy aspect of things, or even how to sort of navigate a career in simulation. Uh, I was just talking to somebody a little while ago and they were saying, you know, I'm a nurse, but I don't wanna get my education degree from a nursing school. And how do I navigate this world? What do you think is the best way of going about it? And you know what, I think my background's a bit unique, but I think it's served me really well being a nurse, but not having a degree from a nursing school in education, I think is really valuable. Um, and I know some of my nursing colleagues are gonna be, you know, hearing nails on a chalkboard, but nursing has insulated themselves, right, to be faculty in a nursing school. You need to have a Master's degree from a nursing school. And my purview was I wanna learn education from educators. And so my master's is in medical education from a group of clinician educators with an interprofessional lens, not the singular lens from, from, from nursing. And I think, again, this is part of the policy piece that we need to talk about is why is that part of the requirement to be faculty in a nursing school that you have a Master's in nursing education, we are keeping ourselves too insular. And so figuring out how to navigate this world of simulation, where you want it to take you is the, there are so many opportunities which you have to sort of figure out how to navigate those waters. It could be challenging.

Deb: 26:33

Thanks. Is there anything else that you'd like to leave our guests with?

Jared: 26:38

What, well, so the question for you that I have is what's been the most insightful piece of information that you've taken away from doing all these podcasts.

Deb: 26:48

I have to say it has just been such an honor to speak with the simulationist across the board. I have learned so much, this is honestly one of my favorite things to do, just because I just walk away with an a half from everyone. And it's been phenomenal. The generosity of simulationist

Jared: 27:11

That's the biggest takeaway. And I would agree with that. The simulation community is one of the nicest, open, generous communities of people. It's one of the things that I enjoy so much about I'm, I'm sitting here at SIMOPS right now in Northern Kentucky, in the greater Cincinnati area. And I'm watching a close friend and colleague Jennifer McCarthy walk around, uh, this beautiful facility at St. Elizabeth training and education center. And they're giving her a private tour and she's taking pictures and learning about the organization. And, and I, you know, how many organizations could you say, Hey, I I've got something coming up. Can you take me on a tour? And somebody drops everything and let you take pictures and, and look through windows and see what's going on. I think, I think, you know, one of the really nice things about our simulation community is that, uh, no matter where you go, you can find somebody that you know, and who will open their doors to you. And, and I would, I would agree. I would just echo what you said. It, it really is such a welcoming, generous community.

Deb: 28:12

Yes, yes. Make sure you give Jenny McCarthy a big hug for me,

Jared: 28:16

And we should give her a plug. She was on one of your first interviewees on the SIM cafe. So I, you know, she she's standing, she was waving before.

Deb: 28:23

It's been fascinating to know her.

Jared: 28:25

You know, it's also interest a, it's a small world. It's a small community, Jennifer and I actually grew up and lived in the same neighborhood, both from New Jersey. Originally, we actually worked in the same hospital one period of time without knowing it. And so the simulation community really makes the world a whole lot smaller.

Deb: 28:44

Yes, it absolutely does. Well, thank you so much for your time and happy simulating.

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Outro: 29:00

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.