The Sim Cafe~

The Sim Cafe~ Interview with Andrew Brown

January 23, 2023 Season 3 Episode 16
The Sim Cafe~
The Sim Cafe~ Interview with Andrew Brown
Show Notes Transcript

Andrew Brown was born on 30 March 1976 in Portland, ME. He is married and has 5 children.

 

Andrew Brown enlisted in the US Air Force and became a Medical Service Technician (4N0X1) in 1994.  Mr. Brown spent time all over the world during his service ranging from Anchorage Alaska as a first duty station to Landsthul Germany and ending up in Baltimore MD.  Mr. Brown retired after 20 years in the US Air Force as a Master Sargent and was stationed at R. Adams Cowley Shock Trauma Center located in Baltimore, Maryland as the Noncommissioned Officer in Charge of the Air Forces CSTARS training program.  As an Independent Duty Medical Technician (IDMT) MSgt Brown had multiple deployments with Special Operations Forces as well as with conventional Air Force units.  Mr. Brown hold a Bachelors Degree of Science in Public Health with a homeland security concentration.  In addition, Mr. Brown is near completion (9 credits) from a Masters Degree in Education and 16 credits remaining in a Masters of Science degree in Entomology.  He has served as a nationally registered EMT since 1993 and a nationally registered paramedic since 2012 as well as a certified Remote Medical Practitioner (RMP) since 2010.  Mr. Brown has taught various adult learning topics in medicine since 1996.  Mr. Brown was employed with the U.S. State Department in the Operational Medicine Unit from Dec of 2014 until July of 2019 including teaching at multiple embassies and coverage from Mobile Security Deployment (MSD) activities. Mr. Brown is an active and current National Association of Emergency Medical Technician (NAEMT) affiliate faculty responsible for certifying training sites and instructors in Pre-hospital Trauma Life Support and Tactical Combat Casualty Care (TCCC)/Tactical Emergency Casualty Care (TECC). As the Chief of Operations for the Walter Reed National Military Medical Center Mr. Brown oversees six civilians and four military members as well as the daily operations of a simulation center with multiple accreditations.   

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Intro:

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:

Welcome to another episode of The Sim Cafe. Today we are truly blessed to have the Chief of Operations of Walter Reed National Military Medical Center, Andrew Brown. Andrew Brown is enlisted in the Air Force and became a medical service technician in 1994. He spent time all over the world in his service. And so with that, may I call you Andrew or Andy? What would you like?

Andy:

Uh, Andy's fine.

Deb:

Thank you very much. Thank you for being here. Why don't you tell our our guests a little bit more about yourself, and then we'll get into our, our Sim Cafe questions.

Andy:

All right, Deb, thanks. Yeah, great to be here. I I really enjoy your podcast. I'm quite honored to be on your podcast. Thank you.

Deb:

Thank you.

Andy:

Um, yeah, as said, my name's Andy Brown. I spent about 20 years, uh, just a little over 20 years in the Air Force as a IDMT. So that stands for Independent Duty Medical Technician, which, you know, to be honest, uh, I'm a little biased, but, uh, I think it's the greatest job there is cuz you get to be the jack of all trades, kind of, they say master of none, but also better than the master of, of nothing. Right? So I got to function as, you know, a medical provider, a technician, biomedical, public health, little bit of dental, even vector surveillance. So, you know, it was really helpful and continues to be really helpful knowledge and background moving forward in my career. And it just keeps, every time I turn around that background keeps serving me. So I retired from the Air Force in 2014 out of Baltimore, shock Trauma as a CSTARS instructor. Uh, and then I went on and spent about four and a half years with the US State Department traveling around the world doing high-risk medical coverage, as well as teaching at a lot of embassies. So even more travel there. I got to see a lot of great places doing that. And then finally, as it stands right now, I am the, as you said, the Chief of Operations at Walter Reed. I've been there a little over three years now.

Deb:

Thank you for your service. Thank you for your service. And can you share with us your journey into simulation? We all come, uh, I've taken a different path to get in here.

Andy:

Sure. And you know, to be honest, I, I think it's difficult to pinpoint exactly when my journey in simulation started, but I will say that I wish my journey as a beneficiary, if you will, of simulation started earlier. So, you know, when I was in school, I struggled a little bit because I was that hands-on experiential learner. You know, I didn't fail any grades or fail any classes, but I would've done much better if I had, you know, a lot of simulation to really back up the learning. Everybody wants to know why is this important, why is that important? I'm learning math, I'm learning history. It would've been great to have simulation as an option there, but, uh, if I were to pinpointed, I would say that my journey probably started at my first duty assignment, which was Amador Air Force Base in Anchorage, Alaska. I was a brand new technician working in the emergency department and decided that I wanted to try teaching. And so I started teaching, uh, the life support classes, ALS, BIS, PALS, as well as, uh, NRP. And that was my first experience even with that level of sim, right? So we use mannequins, but also, you know, you use the chicken bones for the, for the io or you do the UVC insertions for NRP and stuff like that. And that was probably where it started. And then that's also where I realized that I had a true passion for teaching. And I think, uh, now simulation is, is probably one of the best vehicles for teaching, especially obviously medical education. But I didn't heavily get into SIM until I was at Shock Trauma as a C Stars instructor. My additional duty there was to be the non-commissioned officer in charge of research and simulation. And so, uh, when I first got there, they were just starting up a research study that had to do with debriefing and debriefing styles in trauma. And so, because they wanted to maintain, you know, interated reliability and stuff like that, they sent me to the CMS up at, commonly known the Harvard course. So I went to that in 2011, and that really, really ignited my passion for simulation, even to the point where I, I learned stuff. It was funny, I learned stuff I didn't even know I was learning. So, uh, I continued to draw on that throughout. And then even after I finished that, we did a bunch of research study. I did a tons of simulation at, uh, at C stars. And then when I went to the State Department, we used mannequins when we traveled to the embassies to, to do Stop the Bleed training and medicine training and stuff like that. And so, uh, we did a lot of mannequins at sea stars for the tactical training as well as at State Department. So that's kind of where it is. And then now, as I said at Walter Reed, we have a very large amount of trainers and a large amount of space, big center. So we do even more sim I learn more about simulation literally every day.

Deb:

Yes. It's so much fun to learn about because you just, every day you learn more.

Andy:

Yes, absolutely.

Deb:

I can tell you that when I got into teaching, we were going for, it's called emergency department approved for pediatrics at the Level one Trauma center I was working at. So my boss brings me into her office and I was that clinical educator, and she says, we're gonna go for a pediatric designation. We're gonna do training in peds, we'll got everyone PALS and EMPC emergency Nurse Pediatric Course and the neonatal course. And I said, okay, great, great. And she said, I said, who's gonna do the teaching? And she goes, you can. And I said, me. And then she just laughed and she said, no, you can, university of Chicago Air Medical is gonna come in.

Andy:

So nice play on words there.

Deb:

Right?<Laugh>. Yeah. Yeah. But I always, you know, I utilize that to say, we always need to make sure that we're clear when we're speaking to people that they understand, uh, what the expectations are. Right?

Andy:

Absolutely. That's a good example.

Deb:

I like that. Right. I I thought I was gonna be sick when she said it.<laugh>. Um, why don't you share with us your favorite or most impactful simulation story?

Andy:

Okay. So if, if it's okay, I'd like to share two. I've got a couple there.

Deb:

I'd love that.

Andy:

So, and they're very different in what they are. I would say the, the first one is when I was at cstars, one of the things we used to do is in the first week of training, we would do tactical combat casualty care, and then we would do pre-hospital trauma life support in that first week. And then the last day, the Friday of that week, we would do what they call a care under fire exercise. So we would take all the students out to a paintball course and we would put mannequins out, run them through scenarios, and we had an opposition force that would, you know, provide them some reminders that they might not be behind cover or concealment appropriately. You know, a a paintball zinging at you or, or hitting you in the rear end is a, is a pretty good reminder that you're not, you're not covered

Deb:

<laugh>.

Andy:

But the reason that this story is, is so impactful to me is it really helped me understand how important buy-in is and where that comes in. And so what ended up happening is they were doing a care under fire exercise, and it just so happens this, one of the students was, you know, we, we'll call'em hair challenge, right? So they were bald and what hap,, they had, you always have to wear the mask. And he was trying to, to move the casualty and take care of the casualty and treat them, but his head was sticking up above cover. And so one of the opposition forces actually shot him in the head with a paintball in the back of the head, and here's where it gets interesting, right? And so the color paintball they were using was red, and so all the conditions were just right. I mean, it was like, you know, one of those times in a movie where everything just kind of stops and you see that picture. And so it hit him in the back of the head and it just kind of splattered out and it, it looked like he had been shot in the head. And I will tell you, another student who was kind of watching him trying to cover or whatever, just immediately broke down. She immediately broke down because it just triggered fact. And so seeing that level of realism, even though at that time it was accidental, right, to, to that point and then seeing the impact. And then when she shared that impact during debrief and all of that came together, it, it was interesting. You could actually see the learning happening and seeing how, how much of an impact that made. So that's that one. The other one I would say, actually relatively recently while at Walter Reed, one of the things that we, in simulation do, I won't say regularly, but get tagged a lot for, is what we call, uh, just in time training. So that's, you know, a lot of times that's a military term where that means we gotta fill a training gap quickly for an event to happen. And so we did it, uh, during covid we did some just in time training, but also when we were closing the base in Afghanistan, just in case we were gonna get casualties or whatever. And so what we ended up doing is developing these scenarios and the scenario was basically a casualty that had been brought in and we had designed it as our first, what we tend to call, uh, a facilitated scenario. So intentionally we present the case and we present the initial simulation, let the simulation start, and then make a very intentional pause no matter how good or bad they're doing, very intentional pause and ask them critical thinking questions about that, that relate back to the objectives. And then once they get all that piece going, then we go back into the simulation and then we stop again and then finish the simulation and debrief. And the reason this was so impactful to me is that that's where I saw how useful that facilitated simulation was. And depending on the learner group, it really, really makes a difference. And it's not fantastic, usually from my experience anyway, with like learners that are basically mastered the whatever it is that are just looking to dust off skills. But if you have either novice or new content to learners, it actually works really well. And so those are kind of the two that kind of my biggest impact,

Deb:

Right? I love just time training. And I think especially when you get into like something that's high risk, low frequency centerline, you're not gonna do that often, let you know, know and you, what's the equipment gonna look like, chest tubes, stuff like that, just to make sure that when you open that equipment that you know what you're looking at and it makes it easier to do.

Andy:

Absolutely. And then, and that scenario I was just telling you about, actually one of the main focuses was management of a chest tube.

Deb:

Uh, where do you see the future of simulation going, Andy, what are your, what are your thoughts?

Andy:

Well, so I think the future of simulation, I hope the future of simulation here in the US goes kind of the direction, uh, that I've heard about it going in some of the other countries where it basically follows the same path that flight simulation and aviation is, right? Where before you do this low frequency high impact event, you do a simulation about it or to basically maintain skills, you must do x number of hours of simulation in X, Y, Z. Maybe it's task oriented, maybe it's event or simulation oriented. Hey, we don't see, uh, like you said, central lines very often. So let's go ahead and do a simulation to determine if they need a central line and then place a central line doing a deliberate practice type event or something like that. So that's kind of, I think from, from the simulation center and from the learner side, what I really hope from the vendor side simulation kind of moves to is seems like most vendors that I've experienced, not all of course, but most of the vendors I've experienced tend to try and develop items that meet a broad range of tasks, right? A lot of your high fidelity mannequins try to try to do everything. And the problem with trying to do everything is that usually means you don't do one thing particularly well, right? Just kind of spreads it out. And so it would be really nice if the focus was doing one or two things really well and less focus on everything. Now, I understand that funding's a challenge a lot of times, and so that's why you want to have that. But it really, to me, it comes down to the right tool for the job. And, and anybody that's listening that knows me, I, I say that phrase probably on a daily basis. It's about the right tool for the job. Stop trying to use, there's super high tech, a hundred thousand dollars mannequins for test training. That doesn't make sense. Those are for full on simulations or whatever it is. Use the right tool for the job. And it could be, even the right tool could be the right training, right? It could be a facilitated sim versus a deliberate practice versus a debrief sim or something like that. And so I think that's real important.

Deb:

Yeah, I, I completely agree with that. Being mindful of what you're doing and why you're doing it, what is the best tool, right? Even for a cost perspective, how can you, you know, how much money do you wanna spend on this? You wanna do this postpartum hemorrhage where you're using, losing all this flood and it's all the towels and all the cleaning and all the, what's your return on investment for the experience Now, can you share where you were and what you did during covid during the pandemic and any lessons learned?

Andy:

Sure, yeah. Covid actually got pretty interesting for us pretty quickly and, and I would, I think probably different than a lot of civilian facilities, right? And so when Covid first hit, and you know, I'm not, I'm really talking about, you know, the March timeframe when it really got crazy and things started to change. We honestly, we took about two weeks outside the center. We telework, you know, reviewed articles, tried professional development and stuff for two weeks and realized like number one, we all got tired of that really quick. But being simulationist, we're hands-on. That's part of why the job is so great is you get to be hands on all the time, or most of the time I tend to be sitting in an office a fair amount lately. But that's kind of the thing. And so, um, we came back after just a couple of weeks and what we started immediately developing content because as soon as we were back in the office, we realized we were receiving emails to our centralized box that we're requesting training. Hey, we are go, we need to advance the practice of some of our nurses in case we get a surge of patients. And oh, by the way, we're gonna put a big tent outside and we're going to be able to increase our capacity. But we don't know, or a lot of people don't know necessarily how to function in that tent because all the resources that you normally have in the hospital aren't necessarily there. So I'd really like you to develop simulations on how to function in this resources limited environment. And so in our center, we have an education division and we have an operations division as well as an administrative division, education and operations got together, built scenarios and then was able to execute these scenarios to increase the training. And there was buckets of aha moments during that time. You know, there was just, oh, well how do we turn the lights on? I can't, I can't see as well, where's the extra light? Well, there is no light. Put this headlamp on or whatever the case may be. And so you get those looks, those really funny looks like are, I'm not sure if you're kidding

Deb:

<laugh> or,

Andy:

Or is that what I'm supposed to do? No, that's what you're supposed to do. And then you know the process of how to work through it. But then we also in the center worked with different groups on how to do the same task that, that they're familiar with, but do them differently. Some examples would of that would be, um, they started doing, uh, when they did innovations, they would do innovations under a sheet using a video or endoscope or when we run mock codes, we were, we actually had to do training because we did mock codes, but the crash cart was outside the room, so the only thing that went in the room was the suction unit and the defib, and then everything else was passed. So obviously that requires the increase of staff number wise to be able to do that as well as just, you're used to having everything right there at the bedside in the crash crash cart when you're, when you're running an arrest. And so, you know, it was a lot different that way. And, and I think my opinion, of course, maybe a little bias is that simulation is the only way that training could have been accomplished. I don't think reading an article or doing a video or computer-based training would've really cut the mustard there, if you will. And then finally we did develop a trainer that we just used locally where we used like glow germs, some IV tubing innovation head to see are you covered? Are you protected? Are you washing your hands? Did you, did you have your p e in the right location or did it get somewhere it shouldn't have? And so that was actually pretty cool too.

Deb:

That's very cool. Like backed basics, right?

Andy:

Absolutely. Absolutely.

Deb:

Yeah. Very interesting. Thank you for sharing that. My next question is, can you share with our listeners the biggest thing you'd like them to know? Something that's more of an aha moment and it changed the way you practice, like the biggest thing for our listeners?

Andy:

Sure. Again, to be honest, I have two

Deb:

Ok.<laugh>. No, I love surprised. These are gifts. These interviews for me are, are, it's, it's a gift.

Andy:

The first one I would say is that, like I had told you, as I started to learn about my passion for teaching, I absolutely love teaching. And part of it is that a little bit selfish, right? Because I get to learn from the learners and that's why I love teaching. But I always, I pretty regularly honestly get asked, well, how did you get to be good at teaching? That's one of those things, like we talked about before, not everybody can teach. Just because you're certified to do something doesn't mean you can teach it. So I frequently get asked like, okay, how did you learn to teach? Can you help me? And my answer always had been, well, you know, I don't know, I just do, it was kind of funny actually, the, the place where I realized it is I was sitting at an embassy listening to good friend of mine who was at the embassy with me, and we were both there to do the same thing, teach this group of local nationals, some basic stop the bleed type medicine. And I was listening to him and I, I like to do that because I like to learn things from the other instructors too. But I was listening and I, I had that aha moment. I said, he teaches the same way I do. And what he's doing right now is three things. And I think these three things is what makes essentially a good instructor. And they are, number one, you have to read your audience. And it's surprising to me the number of people that actually don't end up reading their audience. Because a lot of people expect a teaching to go exactly the same way every time at the 15 minute mark, you should be talking about X, Y, and Z, and that's just not how it works. Not if you want it to be good education. And so I realized that he is reading the audience and I said, you know what? I do that too. That is how it is because I change every time. And that's why I can't deliver a presentation where at the 15 minute market's always the same. So I think that's extremely important. Number two is that you gotta have passion for your subject, right? And so if you ask me to teach about how to make bread, I'm not gonna be good at it. That's just not something that, uh, have a ton of passion about<laugh>. But if it's about medicine or it's, and, and you gotta, you know, obviously understand and and stuff like that. But if you gotta have some level of passion or find the passion in whatever you're asked to teach, you know, you gotta be able to relate it back. And then third, and, and finally the other really important thing is that you only can teach to 60% of your depth. And I know that's not a new concept anybody, everybody talks about that when they talk about instructing. But when I hear people that are teaching outside of their depth, well, somebody had told me X, Y, Z, and so I'm gonna repeat it in my lecture. It almost always gets you in trouble, right? Because you got students who ask about, oh well whatever it is that they had that 60% or outside their death, I'm sorry, or whatever that is. And then you can't answer. And you know, you always have that get outta jail free card of, oh well, you know, I'll get back to you on that. But you tend to lose some credibility and you only have so much, you kinda look at it as stock. You only have so much stock credibility with your students and once it's lost, they're off and they're not paying attention and it's over, you've lost them. And so I've realized through that, that those three things are extremely important. And so the funny thing is now I pay even more attention to them before I was doing'em before, but I didn't know I was doing'em. And now I pay attention to them.

Deb:

I love that.

Andy:

Thank you. Thank you.

Deb:

I, I love that I wrote'em down. Read your audience be passionate and 60% of depth.

Andy:

Absolutely. Yep, yep. Absolutely. The one other thing I'd like to mention about that, which was, I don't know, it's an aha moment, but it really changed when I came into the center at Walter Reed, it changed how we practiced is our chief educator had found an article out of Boston Children's called Sim Zones. Are you familiar with that article at all? No. The title of the article is Sim Zones an Organizational Innovation for Simulation Programs and Centers. And so as we read the article, it was really kind of funny cuz we both, obviously the article is in concrete, but we both gleaned something differently from it. And what we found is it helped us create a common language for the center. It helped us define simulations. And so in the article, it's broken down into basically five types of simulations. The first one is a simulation that doesn't have an instructor or faculty. So kind of like a VR that's autocorrecting that you just repeat. And so that's a zone zero. Zone one is actually a deliberate practice event. And so we really kind of focus on how do we do the deliberate practice and make'em do it exactly right. And then if they don't stop, reset and start over the whole thing so that you develop that muscle memory that maintains zone two is actually when you start thinking about what we call simulations. And so it's really broken down into that facilitated simulation I was talking about before and then a debrief. But the focus of a zone two simulation is the clinical content. That's the focus is. So it could be just a team of nurses, a team of medics, a team of doctors, or a combination of all of them. And so that's a zone two and you can do either way. And then a zone three is similar, but it requires it to be the inherent team. So the team that would normally work together an ICU team or whatever, and the focus is different. The clinical piece is there, but the focus is actually on a process. So for like ALS closed loop communication or massive transfusion protocol or something like that. And then finally the last one instantly enough is not a simulation at all. It's actually a clinical event that happened, a cardiac arrest or whatever that you use simulation debriefing techniques to improve the process and make better. So this article actually, we kind of framed our center around it. So the center had already been there a long time. We came in, hired a bunch of staff and actually framed it around this sim zone.

Deb:

I would love for you to send that to me.

Andy:

Oh, absolutely. I'll do that. Yeah.

Deb:

Thank you. Thank you. Sure thing. So I know that you're an accredited center from the Society for Simulation and Healthcare. Com, can you talk a little bit about that and the process and what it means to you?

Andy:

Sure. So we're a dual accredited center. We're accredited from both S SH and ACS uh, American College o f Surgeons from SSH. We're accredited i n the core standards, the teaching a nd education assessment research and systems integration from ACS. We're actually accredited as both an education institute fellowship program and a comprehensive education institute. So we're dual a ccredited through them as well. And so, you know, that really k inda allows us to do, we run a FLS fundamentals, a laparoscopic surgery program, as well a s FES Fundamentals of endoscopic surgery program. And I think in my opinion, that the reason t hat the accreditation is just so important, is i t because it gives you a backbone and a standard to uphold to, right. And so I've actually had a lot of people ask and we've had leadership at some point even ask, well, why, why d o w e, why is it important for us to maintain this accreditation? And I think the answer there is, well, for one, it creates a framework and requires us to uphold t he standard. And so when we have that educator that comes in that's not doing a great job, then the accreditation is what allows us and helps us approach t hat educator and just say, Hey look, this is not meeting t he standard and a s an accredited center, we have to meet the standard. We have to be able to make sure that we're delivering the best content for the learner and then ultimately for their patients. Because a lot of people forget about that. The impact is not just to the learner, it's to the end result that patient and how well or how solid the care is to that patient. So if we create training scars and we teach them wrong, and sometimes it's even simple stuff, when you have a novice learner and you're accidentally teaching them something incorrectly, it's now imprinted on them. And so back a long time ago when I learned to instruct t hat we talk about the law of recency and all of that stuff, and it's just t hat it i s what it i s. If you teach them wrong the first time, it's really, really hard to correct it, in my opinion.

Deb:

Very much agree. If you don't get it right the first time, then they have anxiety for the next time.

Andy:

Yeah, absolutely.

Deb:

Yeah. Now, is there anything that you wanna ask me?

Andy:

I, I'd love to actually, with all the people that you've interviewed and all the time that you've spent in simulation, um, as I was talking about before, you know, we all notice that not everybody can teach. It doesn't matter what your necessarily certification level is or, or you know, our doctor or nurse or whatever. Not everybody can teach, but it does appear or it does, I mean, obviously it makes sense that you're interviewing people that have kind of risen to the top that are making the impact. And so I'm curious if you've noticed kind of a common trait amongst simulation educators that make them really good at what they do.

Deb:

So I'd say a couple things. One, they're generous with their time and knowledge. They're humble. They have the ability to laugh at themselves,<laugh>, they can be, they can demonstrate vulnerability because if you demonstrate vulnerability to a learner, they feel in-kind the ability to be vulnerable and recognize that you're going to continue to treat them with respect and appreciation and trust, right? Yeah. So I think that the trust factor is, um, you know, really a really big factor in being a good teacher that you trust whoever's teaching you isn't gonna harshly criticize you for something because, because I don't know, I'm not a mind reader, so I don't know why you did what you did and giving them an opportunity to explain it.

Andy:

Oh, that's awesome. Yeah, I really like that, that making it a safe space to learn so that they're not judged and really being able to just, your primary responsibility right now is to learn and let's be comfortable. Let's have a good time because you learn better when you're having a good time. I think. I like that. That's, that's great. Thank you.

Deb:

Oh, my pleasure. My pleasure. Is there anything else you wanna leave our listeners with? I'm so excited to get to meet you next week in person,<laugh>.

Andy:

Yes, thank you. I, I don't think so. I think we've covered some pretty broad topics.

Deb:

Thank you so much. And with that, happy simulating

Andy:

Thank you.

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Outro:

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