The Sim Cafe~ Interview with Dr. Scott Crawford

Scott B. Crawford MD, FACEP, FSSH, CHSOS

 Dr. Crawford is Executive Director of the Training and Educational Center for Healthcare Simulation at Texas Tech University Health Sciences Center El Paso (TTUHSCEP). He is Associate Professor in the Department of Emergency Medicine at the Paul L. Foster School of Medicine at TTUHSCEP. In addition to his faculty position he is also a board member for SimGHOSTS. He has presented both in the US and internationally on topics related to audio/video design, information technology, simulation operations, and medical procedural training. He has served as an author for standards of best practice in simulation and is Editor of the textbook Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice.

 Dr. Crawford completed his emergency medicine residency and served as Chief Resident of research and technology at TTUHSCEP in 2012. Dr. Crawford earned his M.D. from Rush University in Chicago in 2009 and a bachelor’s degree in physics from The Colorado College in 2004. He continues to search for economical and innovative design ideas to enhance the world of healthcare education by bringing a more engaging and educational experience to all learners.

SimGHOSTS- https://simghosts.org/page/Dr_Scott_Crawford

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Transcript

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Intro: 0:39

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: 1:13

Welcome to another episode of The Sim Cafe. Today we're truly blessed to have Dr. Scott Crawford. Dr. Crawford is the executive director of the Training and Education Center for the Healthcare Simulation at Texas Tech University Health Sciences Center in El Paso. He's the associate professor in the Department of Emergency Medicine at the Paul Foster School of Medicine. And welcome and thank you for being with us. Uh, would you like me to call you Dr. Crawford or Scott?

Scott: 1:46

Uh, Scott is fine.

Deb: 1:48

Okay, thanks. So do you wanna tell our listeners anything else about yourself?

Scott: 1:53

So I've been in simulation now for going on a little over 10 years and have had the opportunity to participate as an educator and then, um, a little bit more op actually in the operations role was my original start.

Deb: 2:08

So yeah, go ahead and share your journey into simulation, how you got in here, because we all came into simulation on a different path.

Scott: 2:16

Sure. So I was a resident in emergency medicine here at Texas Tech University Health Sciences Center at El Paso from 2009 to 2012, and was able to stay on as a faculty member upon my completion of that training program and the director for the simulation program. And the residency was Dr. Veronica Greer. And at that time she had invited me to join the simulation program to assist with education for the graduate medical education portion. And in July of 2012, asked, um, since she knew I was relatively tech savvy to get some of the wires and cables and things that we might need to put together a sim center. I did not know at the time what all that would've entailed, but knew that we needed to be able to communicate with learners in the room and then record some information about what was happening for research and review and just general observation. So I worked to put together a small scale AV system that was an entirely homegrown solution. And then, uh, later in that month, she also suggested that I go and check out this group that was meeting in Las Vegas called Sim Ghosts. And that was truly the start of, uh, what would become the next 10 years of my life. After joining that conference in 2012, I learned that there were many other individuals working in the same strange world that I had found myself and lots of just great minds that like to innovate and find solutions. And so continued to be involved with them and the following year was invited to join the board of that organization and that's where I have been ever since.

Deb: 3:58

Yeah, you've done a lot of service for Simos and I think that's fantastic. Not only are you involved with simos, you're also a fellow for the society and you have your CHS os and your center is going up for third accreditation. So you're very involved in simulation on professional levels and uh, that's wonderful. Absolutely wonderful. Why don't you share with our learners your favorite or most impactful story about simulation?

Scott: 4:28

So there's kind of two different stories that I'd like to share, but they're both, uh, very related. It is where a learner has come back and thanked me essentially for putting in the effort for providing educational content for them. The first one is a resident who I've had residents during the years, uh, come and say, you know, that, uh, case you ran last week. Well, you know, this week I had that patient in the emergency department and I felt more prepared for it because of that simulation. And that's always, you know, really nice that they bump into you on shift and let you know about that type of thing. So I really like being able to hear that I've made an, an impact through something that I've done. But I had a resident who didn't just bump into me on shift to let me know about that, but they actually called me up two years after graduation to say that they were in on a, uh, a Dr. Crawford simulation case during their last patient encounter. I had developed a reputation for having fairly complex cases that, uh, occasionally I was accused that they, you know, were too far fetched and then would frequently be told, Oh wait, nope, I just had that one. But, uh, to hear about it a few years after the fact and that they really were able to provide better care because they knew to look out for the rare but, uh, still potential complications of a patient in cardiac arrest. My thought was really nice to hear as an educator. And now more recently at, um, the last conference I went to had somebody come up to me and thanked me for spending the effort to write the textbook on simulation operations. And it was one of those that as I was doing it, I, I knew that there was a lot of information that had never been well described and written down, but I was never sure how large of an impact creating something like that was. I was convinced there would be, you know, six people that would read it and you know, that would be it. But, uh, have somebody come up to me and say that it has truly changed their approach to their professional development and growth in simulation was just really special for me. Yeah,

Deb: 6:29

That's valuable when people seek you out and tell you how your work has impacted them. Thank you. Now, once you share with our learners kind of what lessons you learned during covid.

Scott: 6:40

So Covid had obviously a number of changes as it did for everybody with our center moving very quickly into a virtual simulation environment and then being able to support learner education in that remote environment. We had several of our simulation specialists supporting virtual SP sessions and things like that. But one of the other more recent accolades that we are able to to share is we started a simulation star award this year at our Center for Healthcare Simulation Technology specialist that's kind of gone above and beyond. And this year's award recipient was Donovan bha and he, during covid, and it's actually continued now past that, has been able to design a web-based program that would share multimedia content kind of in a live setting, shared on a second screen. And we were able to script that in so that it was a very standardized format for somebody delivering the case that they'd be able to read through the script, click on a hyperlink, and then immediately on the learner's view it would show a video clip, vital signs, monitor audio clips, x-rays images, and to be able to use that through a virtual platform. But because of how streamlined it was and how easily adaptable that script was, uh, we're now using it for our regular simulation activities even as well to support a kind of a tabletop simulation and virtual discussion. The other big change during Covid was we used our simulation equipment to try and help solve some actual medical problems. I had met with my coworker Dr. Bob Stump in February of 2020, and he had suggested that there might be ventilator shortages predicted, and we started brainstorming what types of solutions might exist for that and had come up with kind of a napkin sketch of a 3D printable device that would squeeze a bag valve mask. I made a very rough attempt at trying to sketch out what this would look like in a online CAD program. And then coincidentally had started meeting with a gentleman at the University of Texas at El Paso's 3D print lab, the KE center, and Luis Ochoa toured our program and our center just looking for collaboration ideas again, early March, right before everything had shut down. And we were able to reach out to him with that napkin sketch and 3D CAD idea. And within a just about a week or so, he had drastically improved the design, created a prototype, and then using simulation equipment designed for respiratory training, able to then test that 3D printed ventilator alternative. So for the next few months, um, my kitchen table became a ventilatory testing lab until my wife got tired of that and then we moved it out to the garage. But having a device squeaking and worrying for days at a time, trying to test longevity and ability to work with different bag valve masks was kind of a fun activity that was able to distract me a little bit from everything that was going on in my clinical life where I really didn't know what to do for a while in terms of how to care for patients and was a, a nice distraction to give me a, an outlet and, and focus. So put some of my background in physics and from a machine shop in college to use to try and find a solution that even started going through the FDA emergency use authorization approval pathway. So we never achieved an official usable device that could be put into place in a hospital, but we did identify that it was a, an achievable option and found that bag valve masks really can hold up under tens of thousands of compressions without fatiguing with fairly consistent volumes. The emergency use authorization process during that time, particularly for ventilators, was a, a changing landscape. And so the requirements actually varied from where we started the project to even mid-June when we were finalizing submissions and our design, as simple as it was, didn't have some of the required safety mechanisms and the alarms that would've been required. And then, so we did not finish the, the design process to pursue that, but was still a nice opportunity to, to show the, the collaboration and the use of simulation to find real world medical problem solutions.

Deb: 11:04

Yeah, sounds like a big project. And I can imagine working on the kitchen table from a napkin<laugh>, that's always, uh, a lot of things happened during the pandemic that changed all of us. Dr. Crawford, can you share with our listeners the biggest thing that you'd like them to know? Something that you learned that changed the way you practice, maybe a personal aha moment from your career?

Scott: 11:27

So the thing that's sort of been impactful for me about understanding how I think that I can, you know, really share my expertise and, and be able to improve the, the world around me and provide a service in healthcare education through simulation is, is understanding that I have a fairly diverse and unique background and finding opportunities to bring all of those life experiences together to share with others. That's kind of the biggest, biggest takeaway that I've had from my, my growth is that all of those experiences that seemed separated and and disparate can actually come together. Um, if you learn how those different pieces of knowledge can be shared and potentially interact with one another in a unique way that because of your unique life experiences may not have been something that's been encountered by others before.

Deb: 12:15

Yeah, I think Matt Eski said something similar in my interview with him. He said, just things that have happened to you and you do systems integration, how do things affect others and how can you learn from one another? And I think simulationist, we have a different perspective on sharing of information, I believe. I think we love to share what we've learned to help move our simulation forward and improve healthcare outcomes for people all over.

Scott: 12:46

One of the phrases that I felt like I heard a lot early on in my career, both in administration and a little bit in education is the phrase, well, we've never done it that way before. And I always viewed that as actually a good thing potentially is it meant that we were trying and testing something new, hopefully for improvement, rather than just continuing to do the same thing that's always been done just because it has been, and obviously you need to test and assess whatever that new thing is to find out if it really is useful and beneficial, but the outside of the box thinking can really have some significant benefits as you explore and try to make things better for, for learners and obviously then for patients.

Deb: 13:26

Absolutely. I very much agree with that. Now, where do you see, since we're talking about outside the box and thinking, where do you see the future of simulation going in healthcare?

Scott: 13:38

Uh, so I, I see simulation moving, uh, in a couple of different ways, but the, the way that I really hope that it will move is that we start having less of an emphasis on simulation as a term. That simulation is a technique that we've designed that uses experiential learning, combined with some very specific observational practices with debriefing and feedback. But where we will probably have our largest benefit from it as an educational and patient safety training tool is when we focus less on the term simulation and more on the set of concepts that it embodies. So when we are just performing experiential learning and training because it's routine and not because it's its own separate thing.

Deb: 14:28

Right. So what I'm hearing you say is that we incorporate in essentially bake simulation into all of our activities so that we're using it more universally and not just as a, a thing because it is, it's a vehicle.

Scott: 14:41

Yeah. So the same concepts that we use in simulation can be put into practice, whether it's using a mannequin or a task trainer or a virtual reality experience, but also as part of a review tool for regular healthcare practice. And so when those same concepts just get applied as how you approach a review of any experience that is occurring, I think we'll start having much more impactful outcomes then if somebody thinks, Oh, I have to go over and do simulation for an hour because it's a thing that you do. But if you just start building those experiences as a way to continuously improve your practice and review your own performance and to then provide that type of education as a healthcare practitioner, that that's where we're gonna have our, our biggest benefit is not to do simulation for the sake of simulation, but to use simulation concepts for the benefit of patient care.

Deb: 15:39

Yeah. Deliberate practice for mastery learning. Yeah, I would agree. So I understand that you really like Legos to me a little bit about that.

Scott: 15:49

Sure. It was the project that occurred also during the pandemic for me, although following the ventilator, we had actually ended up moving into a rental house because of a remodeling project that took out, um, our bathrooms and required us to move out for a short while. It was expected to be a month or two, maybe three or four, but that was right before the pandemic. And so we did not expect that we were going to end up celebrating three separate Christmases in a rental house. And so for the first almost year, I told my children that they weren't allowed to get out their Lego sets and play and didn't wanna lose any pieces. And so then shortly after we had celebrated our one year anniversary in the house, I said, You know, we're gonna be here for a while. Just go for it, play with whatever you want and we'll figure out how to get missing pieces if we ever need to. And I thought it would be fun to, you know, just freeform build and have some extra pieces around. And I started looking into ordering some Lego by the pound online and found out that this was a, a much larger project and beast than I had ever considered. And using some online auction platforms, was able to win a box of Legos every night for about a week before the first one showed up. And looking at 25 pounds of completely unsorted Lego is a very daunting task, but uh, allows for sort of a zen-like activity in the evenings as you try to figure out how to separate the pieces into light shapes or colors. So now I have a very large collection of sorted Lego pieces that, um, I'm able to use to build small models and contraptions and try to complete older sets. And it's become a fun, uh, pastime and as my children call it midlife crisis

Deb: 17:39

<laugh>. Excellent, Excellent. You have to send some pictures of that. Is there anything else that you wanna share with our listeners or any questions for me?

Scott: 17:47

Uh, want anybody that's, uh, working in simulation or healthcare education to just keep track of your experiences and figure out ways of sharing things, being able to write down your knowledge, even if you're doing it just for your own benefit later, find that I have enough new and varied experiences that even a few months later I will start to forget the things that I was teaching and, uh, learning myself about, whether it's materials or educational practices or even obviously, you know, healthcare care practices for specific disease processes. If I write the information down in a way that I could try to teach somebody else, even in just a paragraph or two what that is, I'm then able to go back and quickly catch myself back up on what it was I was doing. So almost taking notes for my own use later has allowed me to, to be more adept at picking up and relearning and growing into areas. Like I said, if you have lots of varied experiences and being able to quickly reteach yourself about those, you'll be able to get, uh, further into those explorations faster again in the future.

Deb: 18:54

Yes, this is very true and I think especially now with technology, there's so many different things and I know I find myself going, No, I thought I knew how to do this and then before, you know, and I can redo it from some of the experience I had in the past with different platforms and things like that. Now, if our listeners wanted to get ahold of you for questions or they had anything that they wanted to get ahold of you for, where would they go?

Scott: 19:17

Easiest way to get ahold of me is my institutional email, which is just scott dot crawford ttu hsc.edu. So Texas Tech University Health Sciences Center. Then happy to get an email and, and chat and if anybody's wanting to find anything from me that I've previously tried to put out, I, I'm relatively easy to find through, you know, Google Scholar for some activities and have at least a couple dozen blogs that have gone up through the sim goes website over the years about just about everything honestly, and people can easily try to search for those items as well.

Deb: 19:54

Okay, great. So we will have that in the show notes so that your email address will be there. If someone wants to reach out, they can get it there. And thank you so much for your time and your contributions to healthcare and to simulation.

Scott: 20:08

Well, thank you for having me on.

Deb: 20:10

Thank you and a happy simulating!!

Innovative Simsolitions Tag: 20:15

Thanks to Innovative Sim Solutions for sponsoring this week's episode. 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.