The Sim Cafe~ Ryan Aga

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Intro 0:43

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 cuple of relaxation, sit back, tune in and learn something new from The Sim Cafe.

Deb 1:18

Welcome to another episode of The Sim Cafe. Today, we're blessed to have Ryan Aga who's going to be our guest and he's going to enlighten us with some of his experiences. Ryan, why don't you tell our guests a little bit about where you are and , um, geographically and about your center.

Ryan 1:38

Thanks Deb . Thanks for having me. I'm , I'm gracious to be a part of this program and your podcast. I just, first of all, wanna tell you're doing a fantastic job in connecting , uh , so many simulationist across the United States. I'm coming from Minnesota, the land of cold, but actually in the summer, we're actually very warm. I am at health partners. Uh , it's a large care system for care delivery , uh , research and education. So we all actually have many residency programs through health partners, and then we're also in insurance organization. So we have three arms as a part of Health Partners. I'm the system wide director for simulation services across the health system. We have eight , uh , healthcare delivery hospitals within Minnesota and Western Wisconsin, and the Western Wisconsin sites serve as rural critical access hospitals. And we also have two in Western Minnesota that are critical hospitals also. And then we have one , uh , major level, one trauma for adult and pediatric trauma center. And that's in St . Paul, Minnesota. We are an accredited center through the society of healthcare simulation. Actually we were the first accredited center in the state of Minnesota and the team is very proud of that. And we were the first healthcare simulation center in the state. So we actually began our journey , uh , with a partnership of Metro state university school of nursing. And that partnership continues. We still do high stake simulation for the school of nursing for Metro state , both of their BSN program and their master's programs. So we, we span a large space. We also, in addition to the eight hospitals, we have our other care delivery systems, which is dental, orthopedic, outpatient and primary care. So we span a large space throughout health partners.

Deb 3:33

Wow . Thanks for sharing that. And thank you for your commitment to the society and accreditation. It's a very, very important journey that you go through and we know that that you believe in simulation and that you have confidence in your organization and that you're doing things well. So thank you for that commitment, Ryan , why don't you go ahead and it's okay if I call you Ryan.

Ryan 3:54

Yes, absolutely. Deb. Okay .

Deb 3:55

Thank you. Um , why don't you go ahead and share with our listeners your story , um , like about how you got into simulation, you and I have similar backgrounds in our emergency medicine , um , backgrounds and our passion for emergency medicine. And , but how did you specifically get into simulation? How did you side step to the field?

Ryan 4:16

Great, thanks for asking. And actually I'm gonna , I'm gonna go back to when I was a child. So , um, simulation actually started as a child in my youth with a Teddy bear on a piano bench in our bathroom. And I was pretending to be a surgeon and a paramedic and or a nurse. My mom was a nurse by background and I actually through through my creative side would use the Atari joysticks as defibrillator paddles <laugh> . So I had a Teddy bear on a piano bench and I was defibrillating the Teddy bear. I also did a thoracotomy. My mom was a little mad at that, but I actually took the scissors, got her sewing kit and , um, started to do some thoracotomy surgery on the piano bench and used her, her sewing kit to put it back together. So it goes way back in that land of pretend and in using and wanting to be a healthcare clinician. Initially, I wanted to be a paramedic out of high school. My mom, as a nurse said, Hey, what do you think about , why don't you think about nursing? I actually listened to my mom, my wise mom, and became a nurse. And , uh , my entire journey , uh , through nursing has been in emergency medicine. So 21 years, actually this year will be my 23rd year and all of it, I did five years at a urban hospital here in the twin cities, Metro area. And then I did 17 years of emergency nursing at our level one trauma center in St . Paul. I ended my nursing emergency nursing career in leadership. So I did collective 10 years of emergency nursing leadership at their level one trauma center, and then went through all of the initial phases of the COVID 19 pandemic. And at that time , um, as I was be in the emergency nursing world, I also was an educator. So I taught all the American Heart Association classes, a CLS pals BLS, and also taught many of the emergency nursing courses through the emergency nursing association. I also at , at the same time was an educator with local fire departments. And that's where I really came up with or was presented with simulation. So we actually started using, you know, LAURDOL , uh , simulators would go out to , uh , local fire agencies , um , and performing simulation education for those. And that's where , where I really, I continued my love , uh , for simulation and education along with being an emergency nurse leader. My next phase, after I thought I was going on a succession planning to be the director of emergency medicine at our level one trauma center. And I didn't get the position that I thought I was being led to. And that really allowed me to take a break to reassess where I was at in my life and in my career. And I'll honestly say to you , Deb , I had a level of once I was able to pause and reflect that I was really burned out. Um, it had been 21 years in emergency nursing intended leadership in the , I would say the pandemic really kind of threw me over the edge. And so at that same time, a, a system-wide director position came open for simulation across health partners. I applied after a fellow colleague and mentor of mine said, I think you should apply for this. And I did. And I now am in the land of simulation. It really brings my creative side and my strategic and leadership side together and all the way going back to the piano bench years of the Teddy bear. And so I am in as many people tell me, Ryan, you found your jam in simulation, and I really am , am honored and privileged to be in this position of leading simulation for health partners.

Deb 8:06

Thanks, Ryan. And I think it gets to the point and it sounds like you're a little disappointed when you found out you didn't get the position that , um , man plans and God laughs <laugh>

Ryan 8:17

You got it.

Deb 8:19

Yeah . All right . So great story. Thank you. And thank you for the compliment about The Sim Cafe. It's , um , been , um , amazing to have the opportunity to interview the guests I've had and the guests that are too calm. So why don't you share with us your most impactful story about simulation?

Ryan 8:39

Perfect, Deb, thanks to that question. Um , there's many of them , um, within my short two years of, of being the simulation director, one of 'em , that's probably the most impactful begins with the story. So I was the nurse manager at the time at our level one trauma center. And , uh , I had the opportunity to take a phone call as I was the administrator on call , uh , for the emergency department. And one of the emergency room technicians called me and she was very distraught. Um , I was on my way home on a big freeway in Minnesota and Minneapolis pulled over to the side of the road and I listened to one of my employees. She was faced with two episodes of back to back racism by patients that had come into the emergency department that evening, she felt vulnerable. Uh , she was crying and I was on the side of the road and took the opportunity to just listen and be present. What she told me was , uh , the first patient continued to use very rude crude comments about her ethnicity to may , um , is , uh , Somali that had worked in the department for roughly two years as an emergency room technician. She was going to school at the university of Minnesota and the, the patient continued to use words of, of racism and hatred towards her. She commented that she was able to move past that and said , had happened. And she was faced with it many times , uh , unfortunately in her career and as a student and as a human being in society. But what threw over the edge was the next patient that came in and it was back to back within about a half an hour timeframe and the, the next patient , uh , very similarly used comments that were projected to her that were very racist and very condescending. And in that room at the time was a medical team. It was a physician in the room and a nurse in the room and Sumaya was bringing SU equipment repair equipment into the room. And she, as these comments were being projected to her, the team did not stop the patient. And they looked back at Sumaya and didn't say a word. And what was going through her head was number one, they don't know what to say, or they pretty much disregarded me. And for me to walk out of the room, she took number two as the disregard, and she walked out the room and as she did that, she went down the hallway and she felt completely vulnerable. She was crying, hence her call to me. And as other , uh , coworkers were passing by her, they didn't stop. They didn't stop to say what's going on. And what I told Sumaya , this was very quickly before I transitioned out of emergency medicine leadership. And I , I knew that I was moving to simulation that I would never let her story be bottled up, that I was gonna take it on in the simulation world. And I was gonna use her story to teach clinicians and learners , um , about our organization and as many nooks and crannies. So Sumaya gratefully said, thank you, continued to work with her, brought her up to our simulation team meeting. And she shared her story shortly after I got this position. And what we did is we recreated the scenario, the , the situation that she was faced in , um , she became a part of the building crew of the simulation and we recreated , uh , what Sumaya has gone through with our diversity equity and inclusion team in partnership with them and Sumaya. We started with the new nurses at Methodist Hospital. Uh , one of our satellite hospitals in Minneapolis and new graduate nurses were faced with that same scenario. And the neat thing about it is, is that Sumaya was a part of that. She was one of the embedded actors in the two , um , objectives of the scenario where number one, what do the clinicians say back to the patient? Do they say anything? Do they stop the patient? And then number two, what's probably most important. What do they do to support their colleague who has just gone through this subjected , um , element of racism? And so those are the two , um , objectives of the simulation. Sumaya is a part of it and has since grown that other, other , um , colleagues throughout our health partner system have been able to share their story and be a part of the simulation at the end of the sim and the , in the debriefing that participants that has been subjected to racism either in our health system or in our community, or in academics, is able to share their story. So it links back that empathy element that the learners can hear that this physically happened to this person in this room. And so the comments from the learners are amazing. Thank you for doing the simulation. This is exactly what we need. We were unsure of what to say. They have been phenomenal. And so by far, this is the best simulation that , uh , and one of my most favorite impactful Sims that I've been through.

Deb 14:03

Thanks, Ryan. And I think in addition to that, it's almost it's incivility , right? It's incivility too. And I think that people, once again, don't know how to respond to it, we've had some other podcasts. We had Renee Thompson. We've also had Nicole Szalla, you know, people that wanna bring that education further because not only do you not, you just stand there and just like you said, do you not know? Or do you not care? Right. Right. A lot o f t imes people care, they just don't know what the response should be. I know a friend of ours was mugged on the train a nd the L and, u h, none of the bystanders did anything to help her. R ight. And this p oor young girl went through so much P TSD afterward that she's still recovering from it. And, you know, we need to make this, u h, a movement so that everyone, you know, we look to each other and encourage each other and say the right things a nd the empathetic things a nd t o, to retrain society at this point. So thank you for your story.

Ryan 15:04

yeah, I agree. And I , I think I , I just w anna say, you know, through the debriefing process, many of them do not. And through the simulation, they do not respond to their colleague. The standardized actor actually leaves the r oom. And what they say is that I was so upset at what the patient was saying that I'm focused on only that track, that I'm focused on what I should say or what I should not say to the patient that I forget about what was going on in my periphery. And that likely is way more important b ecause we might sit, need to sit here forever to try to figure out how do we flip this person's mindset with systemic racism. And so it's just been fantastic and agree that people, they just don't have that awareness and perspective until they simulate it.

Deb 15:54

Right. No, absolutely. Now you posted an article , uh , on LinkedIn. It's okay to be exhausting. And why don't you share a little bit about your experience during the pandemic with , um, you know, emergency nursing and, you know, what led up to that article, which I was, you know, it kind of came at the right time for, for dad , because I was like, what is wrong with me? And it's not me. It's every , <laugh> , it's something that it's a collective we're exhausted.

Ryan 16:27

Yes. Yeah. I completely agree. And , um, article posted by Dan Rather from, from CBS, or previous CBS correspondent, I think. Yes, it's. Okay. I think what I liked about the article is that you, you just name and you put presence that what your feelings are , um, if you truly are exhausted, you truly are exhausted and that's okay. And you take time to analyze why that truly is. And I think like you mentioned, Deb , the collective, the collective overwhelm is building. And I think he posted that article in 2021, November of 2021 . And now we have, you know, we have a , we have a global war. We have, we have war going on , um, in our world. And so what I've , uh , took outta the article is that we are in so much of a land of unknown and collective overwhelm that we still, as simulationist as leaders as educators, we need to listen to that. We need to just say that we are exhausted and take the time to, to peel away, peel away from the email, read a book that isn't associated with work, surround yourself with people outside of work. And , and to just take a pause and it's okay to do that . I feel that that's gonna be very important for the years to come in academics and in simulation, cuz people are gonna need us more and more than ever before. One of the statistics that I remember is the association of American medical colleges saying that we will be short 54 to hundred thousand primary care and specialty physicians by 2033 . And if you can think about that collective overwhelm or exhaustion, just thinking about that, that we need to start partnering. We need to build networks. We need to come closer to academics and technology in healthcare . So we can collectively face what is headed with exhaustion. And I think the more that we partner academics and technology and medicine, that for sure we can do it and for sure we can do it if we take the time to recharge and there's been such a stigma, I feel, and healthcare and leadership that we just keep on going and we need to stop that.

Deb 18:49

And you know, Ryan, I think about when I was a , a practicing emergency nurse, we didn't have texting and the ability to contact somebody. So you'd get home. You'd at least have that time when you were driving home from one space to another to decompress. However, nowadays, you know, like you said, you were pulled , somebody called you on your way home. So we never take an unplug for a minute and we have to reprogram that into society that, Hey, it's okay to take a deep breath and to, you know, not take your phone somewhere and, you know, get away from things.

Ryan 19:21

Absolutely. Yeah. I would say the , I mean, in , uh , simulation, we , I think, look at the cognitive overload, what I'm seeing right now in healthcare delivery, across our health system, tremendous cognitive overload. And I , I just, yeah, from mic , you know, you have Microsoft teams that's coming at you , you've got your email, that's coming after you have your co you know, texting that's coming at you. We need to figure out how we can diminish the cognitive overload of educator, simulationist leaders and frontline staff to make our organization safer. So I completely agree. And a part of that toolkit is just a unplug, right. And to find your healthy space where you can, you can allow yourself to regroup , um, and recharge.

Deb 20:07

Right. Right. Thank you so much. So, Ryan, where do you see the future of simulation going?

Ryan 20:14

Yeah, boy, I, I foresee us getting super busy and think that is needed for our healthcare system right now. I foresee and , and kudos to the society of healthcare simulation, the advocacy that is occurring to really match what other high stake industries have done, amazing work that is happening there. I foresee that we get closer and closer and have advocacy at that governmental level that is hopefully will lead us into a non-negotiable. I think like the, like Paul Phrampus says, we embed simulation into the inner circuitry of our health systems, just like the fire alarm, just like the oxygen. So I foresee that happening with the advocacy that is occurring across healthcare simulation, which will continue to feed and accelerate our busyness by simulationist. And so that's why, again , uh , take that moment of overwhelm and , uh , to take your time out and to recharge. Cause I think it's gonna get busy. The other thing that I feel that is gonna be a movement is the , of course you've mentioned this on previous podcast, but the, the element of the virtual space and accelerating that across , um , our health systems and with our learners. So that for sure, will, will become more and more and how to keep us up to speed. Um, as this accelerates rapidly will be very important also. So I, I feel those two things , um, that the future of healthcare simulation is gonna get busier. If it doesn't, we will be in really bad shape with our patients, with our patient care and our clinician care because they see that, especially in our centers, our clinicians, our learners, they love simulation the, the team here at health partners before me as embedded a great culture. And they're just wanting more and more because they feel they need that to, to deliver safe care, both within their scope as clinicians and practitioners and for our patients. And so I think it's gonna be very busy in the next decade , which is very exciting, but it'll be important that we continue to network and build firm networks across our discipline and our specialty to keep us on that fast highway.

Deb 22:34

Brian , you guys also did some stuff with palliative care end of life simulations, is that correct?

Ryan 22:40

Yes, that is correct.

Deb 22:41

Yeah. That's another area that I am very passionate about only because I truly feel like many people go into healthcare thinking they're gonna save lives and stamp out disease. Like that's, what's gonna happen. But at the end of the day, we need to be more mindful and deliberate and help patients, families, and caregivers to have these crucial conversations around these tough subjects. So why don't you talk a little bit , uh , about that? And I think, I, I didn't say that I was gonna talk about that, so I hope I didn't throw you off too much on

Ryan 23:14

It . Yeah, no worries. Um , that one's , uh , it's hard not to forget that simulation , uh , that was created out of our emergency department at a level one trauma center, you know, as newer clinicians from nursing, you know, many, I would say those that have been seasoned in emergency medicine have left leaving the culture and the emergency medicine department in nursing , uh , for a lot of novice nurses that are in high state conversations, such as delivering the news of death to family members. And so it became , um , apparent that the emergency medicine department wanted to provide simulation for those charge nurses that were faced with these very high stake, very crucial conversations. So what we did is we formatted and created a simulation, put standardized patients or actors in rooms, and they were faced of delivering a bad news of death. We did that in partnership with our spiritual care department at our level one trauma center and just amazing debriefing elements that came out of that conversation of how to approach, how to display empathy. And we did it off of , uh , several frameworks of how to deliver bad news. And so just fantastic simulations. We did a series of four of them for all of the charge nurses. And the other element that was added in on that was the element of self care for those new charge nurses, the scenario, they went through two cycles of delivering bad news and death. And the question that was posed in the debriefing, add three more of those on top of your 12 hour shift, how do you decompress yourself and how do you, how do you use peer-to-peer support to get through these, these really difficult, heavy conversations that you were you're faced with in your, your shift? So fantastic feedback. They loved it. They were love that we were able to go through through that scenario in simulation.

Deb 25:20

Excellent. Excellent. Is there anything else that you'd like to leave our listeners with or any questions for me, Ryan ?

Ryan 25:28

Yeah. I think what I would love to leave is , um, and is continue your, your fierce advocacy for healthcare simulation . You know, just listening to our daily safety calls throughout our organization. It's just so, so apparent that people need us more than ever health systems need us more than ever. So whatever you can do to recharge yourself, to keep up your fierce advocacy for healthcare simulation, keep on going. We need all of us collectively to come together and, and know that you're not alone. You are feeling overwhelmed or exhaust. There's so many great people that I've met through the society and people like you , Deb , we're able, just able to talk and get what what's off, off , off our minds as we're faced with this ongoing pandemic and this ongoing overwhelm in our , in our world. So I would just like to leave listeners with, keep on going, keep yourself healthy mind, body , and soul, because I think it's gonna be a very exciting future, but it's gonna be Tyran. And so , uh , take care of yourselves.

Deb 26:32

Thank you for this interview and to our listeners. Happy simulating.

Ryan 26:38

Thank you, Deb.

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Outro 26:55

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.