The Sim Cafe~ Interview with Dr. Bob Kerner

Dr. Kerner has an extensive background in emergency care, both as an emergency nurse and paramedic. In his capacity as a registered nurse, he has held positions in busy emergency departments as staff nurse, educator and manager. In 2006, he collaborated with the Patient Safety Institute to develop the first emergency department nurse fellowship while serving as full time faculty at the Adelphi University School of Nursing. He joined PSI’s faculty as a Clinical Education Specialist in 2007 and now serves as Assistant Vice President. Dr. Kerner is particularly interested in simulation as a teaching tool to reduce preventable errors and the use of technology in the classroom. He has produced several educational videos for the Patient Safety Institute, has contributed to simulation texts and published in peer reviewed journals. He holds a Bachelors degree in nursing from Adelphi University, the Juris Doctor degree from New York Law School and the Doctor of Education degree from Teacher’s College, Columbia University. He is an Assistant Professor of Science Education at the Zucker School of Medicine,  an Assistant Professor at the Hofstra Northwell School of Nursing and Physician Assistant Studies, and Adjunct Associate Professor of Nursing Education at Teachers College, Columbia University.

Email: RKerner@northwell.edu
LinkedIn: Robert Kerner

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Transcript

Disclaimer: 0:00

The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of anyone at Innovative Sim Solutions or our sponsors.

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Intro: 1:02

Welcome to The Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, 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: 1:34

Welcome to another episode of The Sim Cafe. Today we are truly blessed to have Dr.Robert Kerner. He is the Assistant Vice President in charge of the Patient Safety Institute at Northwell Health. He completed his undergraduate nursing education at Adelphi University. He holds a Juris doctor from New York Law School and the doctor of Education from Teachers College Columbia University. He has extensive experience as a paramedic, emergency nurse and healthcare educator. Welcome. Would you like me to call you Dr. Kerner, or what would you like me to call you?

Bob: 2:11

Please call me Bob. The only people that refer to me as Dr. Are my children.

Deb: 2:16

Oh, oh,<laugh>. Good to know. All right, thanks. Why don't you go ahead and tell our listeners a little bit more about yourself and about your journey into simulation.

Bob: 2:27

So it's a super pleasure and an honor to be here and be able to speak with you and speak with your audience. So thank you for thinking of me. It means a lot. So, as you said in the interview, a paramedic and many other things, but I began my career in healthcare as a paramedic. I live in a suburb of New York City where all of the pre-hospital care is provided by volunteers. And the typical pathway is you volunteer for a while, you build your pedigree from emergency medical technician to paramedic, and then hopefully you get a job as a paid paramedic with a bigger municipality, say New York City. And that was sort of my career path, and, and that was my first entree into simulation. So in paramedic school, you do, this is back in the eighties, you do a fair amount of lower to medium fidelity simulations. We had one of the prototypes of a layer product called the electronics, which was an ACLS CPR simulator that gave you feedback about the quality of your compressions and ventilations. So I've been doing simulation at guess since 1985. I worked, uh, for a couple of years as a paramedic. And then I was lucky enough to have a mentor who was a year, few years older than I was, who had been on that paramedic career path. He had gone to nursing school and he said to me, you seem to have an aptitude for taking care of patients. Why don't you go to nursing school? Went to nursing school. That same person hired me right out of nursing school as an emergency room nurse. This was right before the law in New York State changed that you couldn't work in an emergency room as a new graduate. Um, so I got in under the bar there and I worked as an emergency room nurse for a number of years at a, uh, tertiary care trauma center that's now part of the health system known as Northwell Health. That same person, the person who said, maybe you should go to nursing school, maybe you should get a job here and I'll be your boss, later popped up in my career and while he was a dean at a nursing school and hired me as a nursing school faculty member. So if there's a takeaway message in the first three minutes of your podcast for people who are listening, it is be nice and kind to as many people as possible because everybody you interact with has the potential to influence your career.

Deb: 4:59

Agree. Agree. Thank you. And would you like to share your favorite or most impactful simulation story with our guests?

Bob: 5:09

Sure. So I'll pick up where I left off. I eventually did get to the academic position at an undergrad baccalaureate degree nursing school. I was one of the rare people working there who didn't have a doctoral degree at the time, but they saw some ability in me. And one thing led to another. They decided that they were gonna set up a sim lab. And so this is, this is late 1990s, early two thousands. We're gonna set up a sim lab. We should start trying to find faculty members who will coordinate the SIM lab. So that was my entree to formal simulation as we know it today was working at that undergrad school. And then after a couple years there, I came back into the healthcare side of things, working for a big hospital system. I've been working for that big hospital system, Northwell in New York since 2007. And my most memorable simulation experience flows from that job. So about, um, 10 years ago, our health system decided to set up a freestanding emergency room in part of New York City. So a full featured emergency room, but no hospital on top of it. And so we were, we were mission tasked with training the entire staff for several months before it opened, which is pretty uncommon in the healthcare industry to hire people months before the facility even opens. And they did a lot of didactic classroom work, and they did a lot of simulation, and they were at our sim lab once, sometimes twice a week. The entire interprofessional team, it was really one of our first successes. And interprofessional education, physicians, nurses, advanced care providers, ed techs, even the unit clerks came to simulation. And the mix of people that were hired were a mix of people early in their career. And there were some people who were further along in their professional career, and let's just say maybe they were a little grumpy about having to do simulation because they were experienced. So the capstone project for this group is we were giving control of their physical facility a week or two before it opened. And we ran the physical facility like a movie set, testing their workflow and their processes. And the most notable thing that I've seen, and it goes to the point that if you put effort into designing a simulation scenario properly, you will engage even the most skeptical person. So one of our cases involved a precipitous delivery. So a young woman walked in off the street and she was pregnant. She was a standardized patient that we employed for this project. We gave her a pregnancy pillow under her dress. Uh, the scenario started with her showing up in triage. She got triaged, she got put into an exam room. When they went in to examine her, they said, give me a minute. I need to get changed. She took out a birthing pelvis, a prompt, uh, which is a pelvis, no legs, a birth canal, and a a baby doll. And we were shooting for something medium fidelity here, just to see how they would organize their team to deal with the labor and delivery. A skeptical physician entered the room and met the patient. The standardized patient was African American. He then lifted up the sheet, did an exam and saw a crowning. I need you to remind you that this was an exercise that everyone knew was an exercise, that they were not open for business yet. That's important to remember. He saw crowning, he reached into his coat pocket, picked up his phone, and called a local hospital and said, hello, I'm at this facility. Please send your neonatal transport unit to take this baby to the other hospital. This was not part of the exercise. This was him reacting to panic and having to deliver a baby in a new facility. The scenario worked out fine. In the debrief, the physician told us that he was so engaged in a simulation. It never occurred to him that, that he didn't need to call for the transport ambulance. We asked him if he noticed the fact that the standardized patient was African American, yet the birthing pelvis and the baby were both Caucasian. And he said, it never occurred to me the mismatch in task trainer would standardize patient. He was so engrossed in the simulation, it was completely real to him. And his final words in the debris force. I was completely skeptical of this as an educational methodology when I came out to the sim lab, but when you did it in my emergency room, it was suddenly real. And I didn't notice a fact that the birthing pelvis was made outta plastic<laugh>. I mean, it, it speaks volumes of, of the ability to really connect with people emotionally and keep them engaged.

Deb: 10:36

Right. No, I, I agree. I agree. And what happened to the, to the team that called, did they end up coming out or

Bob: 10:46

Thankfully that other hospital realized, Hey, there's a competitor facility opening down the block, and they're not open yet. They called back the main switchboard and said, what's with the transfer request? We didn't even think you're open yet. And we were able to divert that transport ambulance.

Deb: 11:04

Good. I can tell you, I was in a simulation one time where, um, we hadn't thought about the phone and the students were supposed to call the doctor and we didn't have a number for'em. So one of the learners called 9 1 1. And you can imagine the ambulance comes to the school and, you know, the, the president of the school walks down to the lab that, you know, sheer shame that that student felt. So, I mean, it's, you know, it's always about thinking through the, the end of what's gonna happen with the simulation. I'm gonna ask my next question, and that is, where were you and what happened with Covid during your experience?

Bob: 11:43

My answer here is going to likely be different than some of the answers that your previous guests have given. We really didn't change anything. We were tasked by our senior leadership to keep doing simulation. So my sim center serves a medical school, a nursing school, a PA school, about 35 different residency programs and tons of other programs with individual units and hospitals and the individual units. And hospitals, of course, quickly got overwhelmed by patients. So they weren't coming to the sim center. My sim center is a standalone building separate from a hospital campus. You could walk to the hospital campus. It's about a quarter of a mile away, but it's not on the campus. So that took away a majority of our customers who would normally come here for SIM because they were taking care of patients. But the directive came from senior leadership for those academic programs, the schools, those people are, they're competing for grades. They have to stay on their curriculum. So I think we de operationalized for a few days to figure out how to manage social distancing, uh, health screening, masking, we, you know, like everybody else in the world, are we wearing a mask? Are we not wearing mask suit be cloth? Should it be a 3m? Do we need to wear, put on a hazmat suit, et cetera, et cetera. But we pretty quickly got right back to servicing our customers. We did take a hit in terms of our utilization data. It basically took out 50% of our customers. And so if we weren't doing simulation for the schools, we were redeployed. So all of the people on my team are either nurses or EMTs. And so in New York state, the EMTs could go off and draw blood for antibody testing. We did fit testing, we did swabbing, we did other clinical responsibilities just short of going into the hospitals. My response might be a little different than some of your other guests. And so during covid, we maintained almost normal operations. So the directive came down from our senior leadership that they wanted us to stay open. Um, so my sim center is part of a big healthcare system called Northwell Health, and we service a medical school, a nursing school, a PA school, uh, a whole bunch of residency programs, and then dozens and dozens of individual, uh, programs at hospitals and different facilities. Um, so the people in the hospital, obviously were not leaving their campus to come to the SIM lab. My sim lab is off campus from all the hospitals. And on the days that we were not doing simulation for one of those school programs, um, my team was redeployed into clinical environment. So everybody on my team is either a nurse or an emergency medical technician. So they were swabbing, they were doing fit testing. Uh, later in the pandemic we were doing antibody testing. Um, and then finally our last mission in redeployment was actually giving vaccination. So we, we kind of lived in the clinical world, and then when it was time to do SIM with the academic programs, we went back to doing sim, but using social distancing. Um, I know a lot of programs, in fact some of your previous guests talked about using AI and VR and, and different methods. We talked about that among leadership. And the answer was they didn't believe it was a suitable replacement for the services that we were offering. And they weren't willing to just throw money at a new technology when they already knew what we could accomplish.

Deb: 15:49

It's good to hear, because people didn't really get to practice. If there's gonna be kind of a gap in between the learning curve of them getting into the, the environment of healthcare,

Bob: 15:59

It could be, and maybe that gap will be different on a purely academic campus, meaning at a university or college. So at at Northwell, our schools and the hospital system are completely interwoven. In fact, many of the people who are students in the schools are current or former employees from the health system. And so there's an expectation that yeah, there's a pandemic, but you still have to come to work. Yes, there's a pandemic, you have to go to school. Whereas there are other schools within bicycling distance of where I am, where the students refuse to come to class. I know of a nursing school not far from here, where the students said, I'm not coming back like it, it's not safe. I'm not coming back to do simulation. And they were in a jam because they weren't doing clinical, they weren't doing simulation. They were not gonna have enough credit to gradually,

Deb: 17:01

Yeah, it's, it's been interesting to say the least some of the things that have happened during the pandemic. You know, it's almost like if you don't wanna do something, you just say, you know what? I was exposed to Covid. Right,

Bob: 17:12

Right. So we took a line, and I think it it's a Winston Churchill quote who said something to the effect of never let a good crisis go to waste. Uh, so when we were trying to figure out social distancing during the pandemic, we also saw the opportunity to restructure some of our existing programs to maybe make them a little less populated or densely populated and thin out the workflow a little bit. Some of our programs were coming in with like 17, 20 learners at a time and only one faculty member. And with Covid we had room restrictions. For example, our sim rooms, we weren't letting any more than four people in the sim room or no more than six in a debrief room. And so when we instituted that rule, it also had the effect of kind of thinning out some of the programs, a program that would try to cram 50 people through in a two hour period. We told them, your session now has to be the better part of the entire day. And we've left those restrictions in place. And because of Covid, those faculty were able to say, you know what? My learners have a better quality experience if I don't try to blast through 50 people in two hours. So we made lemonade outta lemons.

Deb: 18:40

Good to know. That's a great response. Uh, one of the other silver linings of the pandemic. Now you know, you're an accreditor. I'm an accreditor. You come from an accredited center. So why don't you talk a little bit about the process of accreditation from your perspective and being an accreditor?

Bob: 19:00

Sure. As a person who runs a center to steal an or or corrupt another quote from somewhere else, it's not the destination, it's the journey. So it's worthwhile to engage in an accreditation process so that you build policies and processes that will help your business run properly. And I think you should do that if you're a sim center, if you operate a pizza poll or you should do it, if you run a bike shop, you should do it because it will make your business healthier. Uh, going through that process of we should have some policies, we should write them down, we should make sure everybody is on the same page. So as a general principal, it's definitely worth doing. As a person who goes into other facilities on accreditation visits, I would say it's worth doing. It's worth reading the standards, reading the companion guidebook and just answer the question posed by the standard. If the standard says you need to have a policy manual, you should have a policy manual. If it says you need to have these seven policies, write seven policies, right? The last thing you wanna do is have an accreditor like you or I come on site and be wondering, do you have a policy manual? All that should be in your application. And when Deb and Bob come on site, you wanna have a few hours of time to just, and have a conversation about how do you do sim. And our job is to verify that what they wrote in that 5,000 page application is what they're actually doing in real life. And then the accreditor can have like a coaching experience. And I think of it as a two way coaching experience in the systems integration standard. There's language about bidirectional communication. That's what an accreditation visit should be like. It should be How do you orient people? Huh? Now that's interesting. It meets the standard. Have you ever thought about doing this? Like here's how I do it. Like could that help you? And can your answer help me? It should be about building community, but the applicant has to put the, the time and effort into writing a good application to get started.

Deb: 21:21

Right. I agree. I agree. Thank you. Thank you for sharing that. And I do hope we get to go on an accreditation site visit together one day.

Bob: 21:29

<laugh>, I think I was one of the first teams to go back to visiting in real life last week, if not the first. One of the first. And I was off in a state that I probably am not really allowed to talk about, but it was fantastic to go on site and meet face to face with real people. There are things that you just cannot, uh, cannot accomplish on a zoom call you. It's tough to read people's body languages and demeanor over a zoom call. It's tough to make a personal connection with people. I think one of the most powerful things that people can do to one another is just shake their hands. Right? And I know that might be sensitive for people with like covid concerns, but man, I like shaking somebody's hand and, and making that connection and then walking around their facility and looking at things. The place I was at last week has a truly magnificent physical plant, and I left there just feeling so ashamed to be an arrogant New Yorker because I, you know, in New York, everything's perfect. We're New York. And then you go somewhere else in the country that you've never heard of and you're like, wow, they're doing a terrific, terrific job. It makes you feel good for the work we're in. Cause we're helping people put knowledge into action. And I don't think there's a higher level of, of calling and the education world than that.

Deb: 22:59

Yeah, I agree. That is, there's just some kind of a feeling when you, when you leave a place that's doing really good simulation and they know that, you know, that they can feel that they're doing good simulation and it's, it's rewarding. Very rewarding. So any potential people that wanna become accreditors, if you're from an accredited center, we, we have open physicians<laugh>

Bob: 23:21

Yeah, for sure. Reach out to the, the gang at SSH because they're always looking for help. Every year there's more and more centers applying for accreditation, and that work alone would be a lot of work. But then you have to factor in all the centers applying for re-accreditation or centers that originally applied for two standards. Now they wanna wanna upgrade to four or they wanna add fellowship or what have you. They they always need help.

Deb: 23:50

Thank you. Thank you. Now, two more questions. One of'em is, can you share with our listeners the biggest thing you would like them to know? And when you learned it, it changed the way you practice a personal moment.

Bob: 24:04

I'm not sure how I learned it. It's possible that somebody actually told me this, but, uh, failure is a good thing. Failure means that you're trying new stuff, that you are taking chances. Hopefully you only fail at the thing once and you learn from it and correct. But as a paramedic and emergency room nurse, you know, the first x number of years of my career were based on the notion that failure is not an option. That you can't let the per person deteriorate. You can't let the patient die. Everything has to be tip top, uh, and, and up, you know, ship shape. And then when you become a little bit more mature, you realize that it's, you're really learning from your failures. And if you're not making, if you're not creating situations for yourself to fail, you're also not creating situations for yourself to learn. And so that's been a gift for me to realize that. And it's a gift now that I try to impart on everybody on my team earlier in their career, so they're not holding back. Like, if you have an idea, unless it involves hurting someone or breaking something terribly expensive, my answer is almost always gonna be let's give it a shot. Uh, well, it might not work, of course it might not work, but we should give it a shot. It could work. And, and the second part of that is our learners in the simulation space are in their own heads. They are doing the simulation in, they're trying to apply knowledge and make it become real. They don't even realize that you're having a failure behind the scenes. Right? Uh, right. You know, if you go to watch like Cir dule, you gotta believe that some of those people are a foot or two off location once or twice during the week that somebody released from the trapeze a second or two early, yet they know how to recover from it because they're professionals. And that's what I try to instill to people who are my staff and the faculty member, is that everything is recoverable in education. Uh, but you have to push the envelope and be willing to try new stuff.

Deb: 26:30

Right. I agree. So in circle, I think it sounds like you, you teach your team as a leader to go ahead and if everything goes great, you're gonna give'em all the credit. If that, if things go south, you'll take the the blame.

Bob: 26:43

Yeah. So I learned that from the person who recruited me from the academic doldrums at a university and brought me back into health system at the time was our chief human Resources officer. Then she became the chief learning officer. She had a phrase to that she would use to, they should reduce to describe those initial employees. She hired in seven, eight, and then, and we were all handpicked. And she said, uh, I, I'm like, I'm running a race track. I get the best horses, I get the best jockeys, I lead them to the starting gate, and then I get the hell outta the way. I only put thoroughbreds on the field. Now the advantage is those horses are gonna run really fast. Sometimes they bang into things, sometimes they run off the track and run into the parking lot because they're just running in a straight line. And she would say, my job is to make sure you stay on the track most of the time and you don't hurt anybody. But my job is to let you run free and be creative and be productive. And I've just thought that's such a, a great description. And that's what I've tried to model my own leadership after. The other thing, I'll, I'm gonna throw this in there. A second thing I've learned is I, I always knew this as an emergency room nurse, you're always working for someone. So as a staff nurse, you're working for a manager, supervisor and so forth. As you become more mature and move up the leadership change that structure flips. I'm now working for my team. My job is to make sure that they have the right resources and training and I give them the authority to go out and be productive. You know, servant leadership type stuff.

Deb: 28:29

Now, um, Bob, I'm gonna ask you one more question and where do you see the future of simulation going?

Bob: 28:36

I think healthcare in general is going to involve more interaction between care providers, patients and technology. We already see that now with telehealth. Uh, honestly, I'd much rather, uh, engage with my care providers on telehealth, right? I i, by the time I reach the point that I need to call a doctor, I usually have narrowed it down to what the problem is and I need to talk to somebody about what the next steps are. Um, so we have to prepare learners to be able to have that interface with technology. And so what I see right now, and I hope it will change sooner rather than later, is there a lot of emphasis on VR and AI and machine learning as an adjunct to education? Like how do I replace the mannequin with a pair of goggles? I don't know if that's the right question. Shouldn't the question be how do I prepare the learners to better take care of the patients? I don't know that having them play a simulation through goggles necessarily helps them do better patient care. It it could just be that I haven't seen the right vr ai product yet, but I don't know if we're actually teaching them to inter make that connection between technology and patient care. Um, so I think we have to figure that out in the future. And I think as a healthcare simulation industry, we need to figure out AI and r Many of the products that I've looked at are just modifications of games still. Years ago I went to a sim center where they hired their own programmer to make a VR game, and it was a medication administration experience aimed at registered nurses. And in the game, there's a avatar, if you will, of a registered nurse. It's a female, she's wearing the stereotypical white dress with the white cap and she's going to go give an injection to the simulated patient. And the nurse is carrying a comically large syringe, and she's carrying it like she's carrying a rifle. And I said to the Simpson director, I don't understand this game. Why is the nurse carrying a syringe the size of a rifle<laugh>? And the director said to me, that's because the program we hired used to make video games for the military. And so his concept of what a syringe looks like and how you would carry it is a little off, I think in my own neck of the woods. Our next step in that arena is we will probably go find our own developer and make our own content because the stuff we see from the commercial organizations is not tailored to our needs. And we're not gonna spend a million dollars on VR headsets of us. It perfectly matches what we wanna get done.

Deb: 31:48

Right. No, good, good points, good points. Uh, is there anything else that you wanna leave our listeners with or any questions for me?

Bob: 31:56

No, I think this has been delightful. I can't thank you enough for connecting with me. For the listeners, I would just say that sit and listen to your learners. I think you'll find that even small efforts on our part result in giant positive experiences for the learners. Uh, the things that we might think are cheap or kooky, those learners get a lot out. Um, so it's worthwhile every now and then to take off your educator or administrator hat and go back to being a student. I do that. I go try to be a, learn a new thing every year so that I, I can push myself back into learner mode and makes me think differently about my job. And then just remember that we're blessed to work in a field where every day you get to see the light bulb come on over somebody's head. They do a simulation, they engage in a debriefing, and they walk out and they're like, aha, now I understand this better. You're not going to get that anywhere else.

Deb: 33:03

Thank you. Thank you. And I, I agree. Um, if our listeners wanna get ahold of you, where is the best place to reach out to you?

Bob: 33:10

So RKerner@northwell.edu. I'm on LinkedIn as Robert Kerner. I don't think there are any other Robert Kerners<laugh>. Um, uh, but you can connect by email or LinkedIn. I don't do the Facebook thing. And those are my only footprints.

Deb: 33:33

All right. Thank you so much and happy simulating

Inclusive Consulting Tag: 33:38

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Outro: 33:56

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