In this episode, part one, The Legendary Dr. Pamela Jeffries describes her journey into simulation. She describes the "stodgy" teaching methods used in nursing education. In 2003 simulation was very embryonic and having the opportunity to get a grant while working at Indiana University (IU) At IU they developed the idea that it could be a theory. In 2015 it was announced that Dr. Jefferies had created the theoretical foundation. She talks candidly with Deb and her son Jerrod Jeffries about the journey and the vulnerability in believing the theory is correct. Dr. Jeffries is humble and motivating her story captures the essence of "chasing her dream". Thank you Dr. Jeffries for this brilliant episode. Part two will be about AR/VR/AI and her ideas of the future of simulation.
Innovative SimSolutions.
Your turnkey solution provider for medical simulation programs, sim centers & faculty design.
In this episode, part one, The Legendary Dr. Pamela Jeffries describes her journey into simulation. She describes the "stodgy" teaching methods used in nursing education. In 2003 simulation was very embryonic and having the opportunity to get a grant while working at Indiana University (IU) At IU they developed the idea that it could be a theory. In 2015 it was announced that Dr. Jefferies had created the theoretical foundation. She talks candidly with Deb and her son Jerrod Jeffries about the journey and the vulnerability in believing the theory is correct. Dr. Jeffries is humble and motivating her story captures the essence of "chasing her dream". Thank you Dr. Jeffries for this brilliant episode. Part two will be about AR/VR/AI and her ideas of the future of simulation.
Innovative SimSolutions.
Your turnkey solution provider for medical simulation programs, sim centers & faculty design.
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:Welcome to the Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser. Join our host, Deb Tauber and co-host Jerrod Jeffries as they sit 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. I'm your host, Deb Tauber. I'm here with my co-host, Jerrod Jeffries, and today we are truly blessed to have a very, very special guest, Dr. Pam Jeffries. Dr. Jeffries, how would you like me to refer to you during this episode?
Pam:Oh, please, please call me Pam. Fine,
Deb:Thank you. Thank you. Okay. And uh, Jerrod, do you wanna call her Pam or Mom?
Jerrod:<laugh>? That's a good question, but I'll try to go with Pam for the duration of, of the episode.
Deb:Okay. Pam, why don't you share your journey into simulation with our listeners?
Pam:Okay. Thanks Deb, for having me on. This is a pleasure to be on your podcast. I know it's going well and I'm glad to serve as one of your guests. So, describe my special journey and how got involved with the pedagogy for simulation. This goes back to early, early two thousands. When I was at Indiana University School of Nursing, I was teaching students, many undergraduate students, and I was even in lab at times, and I saw the very stodgy ways that we were teaching students back in the early 2000. For instance, in the lab, it was pretty passive. We would tell students what to do, then they might demonstrate, but in the meantime, when we told them what to do, it was just very boring, not engaging. So I was always looking for creative and engaging ways to simulate students and really enhance learning. So early on I read the work of Dr. Howard Barrows, B A R R O W S. He was early 1900's. He was looking at standardized patients, some of the first ones. And it was just interesting work where, you know, he, his team were training actors, training actors and actresses how to be standardized patient. And then you would immerse the students in these encounters and clinical would become alive, right? Students were engaged and yet in a very safe environment, they were engaging in with the standardized patient. So I think that's when I started beginning to think, wow, this is a great new pedagogy. Active learning for our students and really immersing them in experiential learning. So early on at IU they had grants, also small grants within the university, partnering with the hospital and the school of medicine. So back in the early two thousands, I partnered with Dr. Scott Ink. He was a pediatric surgeon, but he trained third year medical students. So it was quite a core. They were correlation. It was great with our senior nursing students or junior nursing students. So Scott and I put in our first grant to get our high fidelity mannequin, which was, uh, the man from Laerdol. I think it was called SimMan at the time. But anyway, that's how simulation was started at Clear back in the day at Indiana University School of Nursing Medicine and with the hospital at that time. So that's how I began my journey. Thank you. How did you decide to come up with a framework? How did they come about? Oh, the framework. So probably the most impactful part of my simulation story was, I think it was 2003 when the National League for Nursing, there was a call to be a program director to conduct simulation research. So I was getting engaged with this pedagogy, experiential learning. I already knew a faculty member back then. If you're gonna create change, you have to get the evidence, you have to get the research. It's not good enough to just to say, Deb and Pam believe in this pedagogy, therefore we need to adopt it in our curriculum. So I was after, you know, I was reading the literature and wanted to create a simulation study, but also was really into the simulation. So when the National League for Nursing did a call for a program director, I did put my name in with the support from Indiana University and got the job working with Dr. Maryanne Rizzolo and Dr. Terry Valk. And then they picked eight program coordinators across the United States to work on this project to developed simulation research. So, at the time, again, in 2003, there was, everything was very embryonic. If you went to the literature and looked at simulations, they just said, we did a simulation and students liked it. There wasn't a lot of evidence. We didn't even know how to do simulations. We didn't, it, it was very anecdotal, at the least on the evidence of using simulations. So I felt, as a program director, I had an opportunity to create a recipe, a roadmap, if you will, on how to do simulations, how to implement them and evaluate them cuz we were learning ourselves. So working with the, uh, eight program directors geographically represented across the United States, we developed a framework. It was a simulation framework at the time. It ended up being an NLN Jeffrey Simulation Framework. And eventually in 2015 it became the NLN Jeffrey Simulation Theory. But what we did with the, not just myself, but with eight program directors, we a across, again, geographically represented and representing associate and McElroy programs. There was one diploma program at the time. Uh, we looked at a theoretical model. We wanted to build it on theory cuz if we were gonna get into the science and the evidence we needed, needed theory. Also, we looked at constructs, what it took to build a simulation model and in the literature, and we all dove into the literature and came up with these constructs. If you remember, early on the framework, there was always a teacher involved. There was a student or a learner or participant, whatever you want. Also, in the literature, it talked about the educational practices, meaning active learning, direct feedback, student faculty interaction, collaboration. And then there was that simulation design. How do you design a simulation that suspends disbelief, you know, you wanted the fidelity, the reality. So those things were in the simulation design. And then the whole point of conducting an immersing students and simulation was to get an outcome, right? Whether it was to teach'em more, how to, um, manage pain or care for a diabetic patient with a hypoglycemic event. So there was always an outcome, there was a purpose to that simulation. So we grew to learn all simulations needed to have objectives that were measurable and the simulation that was just part of the essential ingredient of creating a simulation. Anyway, bottom line, myself and the a program coordinators, we created this framework and we developed a book. We created a book, and it came out, I think it was in 2005, I had an article that came out on this framework that was brand new that we were really testing and we encourage people, test it, you know, refute the model, refute, just test it. What are we doing wrong? And ironically, and thankfully, a lot of those concepts struck and it continued to be tested. And many people, I I set the framework of the groundwork for much of, uh, simulation research that embarked thereafter. And then in 2000, probably 12 or 13, NLN partnered with INASCL actually, I think it was INASCL's idea to start looking at these constructs and the relationships and can we determine that that's a, a mid-range theory. And they worked with Beth Rogers, who was a simulation theorist, leading a task group, all kinds of faculty leaders and colleagues across in INASCL and NLN to see if we could really truly label it as a theory, which we did in 2015. And, you know, the article came out, there's all kinds of stimulation articles through the INASCL journal. In addition, the book came out, the monograph in 2015, and it was just updated a year ago through the NLN. So indeed it became, uh, mid-range theory and very, very proud. That's probably one of the most impactful endeavors. And it was not just me, it was a group endeavor with my faculty colleagues and leaders and those original eight program directors when we got into the heavy literature looking at that. But we felt we delivered to the community, not just faculty working in simulations, but graduate students, doctoral students, others across the health profession. An easy framework that's grounded in theory, which was the constructivist learning theory was one. Sociocultural learning theory was another piece of it, because we built it upon a, a theoretical foundation. Thank you.
Jerrod:So looking at that though, one, a couple questions is what were, especially in the early days in say oh five to oh eight, what were some of the biggest challenges you had surrounding this? Or what would you have done differently knowing what you know now?
Pam:Thank you for the question. One of the biggest challenges probably, is it right,<laugh>, is it correct?
Jerrod:Mm-hmm.<affirmative>,
Pam:When you put a a model out, it was a framework at that time. I mean, it's to be tested. I mean, the challenge was you can't test the whole thing. You can test components of it. That's why I even talked to graduate students. You know, many people tested the debriefing component, right? What do we need to debrief? What are those essential ingredients when you debrief? What about the design that fidelity? How do you suspend disbelief? Many went into looking at the participant. Are there certain elements that the learner needs to know? You know, now we now have the whole new concept of pre-briefing and debriefing. Does it make a difference with the demographics, whether they're old, young, male, female, where they come from? No. Also the roles. Can we, can we put four students in a simulation or six or 10? What, what are some of the best practices? So people begin to test that. And I mean, when you put something out there like that, when you say the challenge, you don't know if it's, I mean, you're putting it out there, you're putting yourself out there to, to, for people to test it. We're just saying this is one approach, right? This is the framework we use based on the literature and the findings we had, and this is at the time, but ironically, this grew and stayed pretty true over time, which I go back with the eight program coordinators and myself and working with the NLN I, we, we put our best foot forward and it seemed to work pretty well. That was one of the biggest challenges is, is it gonna be correct or not? And then the other thing, another challenge just, and everybody has dealt with this in the simulation world, how do we know simulations work? Do simulations work? Should we embrace simulations in the curriculum or not? You're always being compared to the standard practice. And that's, you know, real clinical practice within a real clinical setting with real patients.
Jerrod:Were they ever looking at aviation or other industries in terms of that?
Pam:Uh, there, there was research into that and they would quote aviation and all that, but.
Jerrod:mm-hmm.<affirmative>.
Pam:Healthcare is very different than aviation. I mean, there's so many multiple variables where in aviation you can control moments. I mean, you can't control the weather, but there's less variation, I would say, versus a healthcare team. And a healthcare team looks different on Tuesday, on Wednesday, on Thursday.
Jerrod:Mm-hmm.<affirmative>.
Pam:and patients look different, present differently, et cetera.
Jerrod:Yeah,
Deb:No, those are absolutely great points that you bring up. I know that, you know, during all my master's work, I, I referred to your framework for everything. That was always my go-to. So thank you for, for that. Do you have a favorite or most impactful simulation story that you'd like to share with our listeners today?
Pam:Oh, probably the most impactful was when I worked with the eight program directors coordinators through the NLN. And that's how it all kind of launched. When we were all working together, I traveled so much. I went to all their eight sites. We were trying to get buy into simulation and the work that we were doing. So I was visiting their faculty, their schools. I think that year at Christmas, I bought all the Christmas presents at airports,<laugh>,<laugh>, anytime anybody got a present came from the boutique at the airport.
Jerrod:Yeah, we remember that.
Pam:You know, whatever. I was just traveling so much. But the most impactful part, probably, and that could have been in 2006 when we held our first conference at the University of Maryland to roll out the framework and to roll out, really, it was kind of announcing what we saw. The simulation pedagogy was within nursing. So we had people come from all over the United States, I think it was co-sponsored, uh, of course by the n l N at the time. And we, we delivered, we performed the simulation from live audience and just getting people, it was kind of the first foray, if you will, of seeing what a simulation is,<laugh> and the immersion. And we actually had real students from the University of Maryland and put'em in. And we were, myself and the eight program coordinators, we were all very nervous about that. Is it gonna work? Are people gonna embrace it? What are they gonna think about that pedagogy? But anyway, the rest is history. You know, it was embraced and other people started trying adopting. And you always had the naysayers out there saying, oh, I don't know if students can really learn from simulation, or is it a good way to substitute hours with clinical or not? So that's did happen. And then the rest is history. We went forward. The other, I would just be remissed up, I didn't mention, um, I was also a consultant on the National Council State Board of Nursing big study that was a nationwide big national landmark study. And that was in 2014 when we came out with results from 10 schools of nursing across the us. And we were addressing the question, do simulations work? Can we substitute them for real clinical time or not? Or is, does it make a difference in a detrimental way if we substitute so many hours? And at the time, if you remember, we had three arms of the study across 10 schools nationally. One arm was the control, another was 25% of simulations were substituted for real clinical time. And the other arm was 50% of simulations were substituted. And when I say 25-50%, that was all across seven clinical courses. And when I say 50%, if you had a hundred hours in pediatric clinicals, then 50 hours were in sim. It was a one-to-one ratio and 50 hours on the pediatric unit. So that was a big large two-year study that was conducted. And I felt very honored to be part of the National Council, state Board of Nursing Consultant on that study, working with Susie Kardong-Egrin, and Jennifer, who actually led the study. Honestly, that data came out and there was, uh, that was very impactful because there's an article that really helped shape policy and nursing education for board regulators. And this study was for board regulators, because the boards were saying, Nope, you can't do simulations to substitute, oh, you can use up to 25%. But a lot of these policy decisions at the state level, because we know our state board and nursing first state, they were being made without the evidence, without any research. So this large landmark study provided the evidence for board regulators. And today you can see the language. They, they looked at the study. I'm very proud of that. State of Arizona, I think was the first one that came out with some of the guidelines. And like a guideline, they said, you need to use INASCL best practices or the standards which are defined. You need to, you know, make sure faculty are developed. You need to use a framework, you need to use debriefing. So it was all, they were using the study to dictate their policies, which is exactly what we want'em. So that's a very proud moment to see those policy changes across the state level.
Deb:Thank you. And it had to be a very proud moment that, uh, study is referenced on a daily basis in conversations. Also, you have to be very, very proud of your son, Jared. I have, I had the honor of knowing him for about, since I'd say September, October. And I absolutely love working with him. thank you. And, uh, hey, having him as my co-host, and I wanna ask you for a minute, how do you like being a grandmother?
Pam:Oh, thank you. Yes. I had an amazing opportunity in November to have my first grandchild, Ella Tyson Jeffries, or she's adorable. Beautiful. Most beautiful baby. In addition to my four kids,<laugh>, thanks if I ever seen, she's great. She's here in Nashville with me now, and it's wonderful seeing her. And she's of course, smart, clever, animated, and adorable.
Jerrod:Very curious.
Deb:Yes. All right. Do you have anything that you wanna share with us? Like any aha moments? Something that, uh, you'd like to leave our listeners with?
Pam:Well, thanks for that question and yes, as you know, through the NLN and this, uh, through the National League for Nursing and the work I've done with them, but we've done several books to disseminate the work and disseminate the evidence. And the most recent one, just, I think it was launched at NLN, it was the second edition for the advanced clinical simulations in nursing ed education, advanced concepts, trends, and opportunity. So to me, that's really important, work to make sure we continue to get the most current updated evidence and get it disseminated out there. The evolution of simulations is continually changing. It's not static. We're in a dynamic environment. In fact, what we knew five years ago is almost stagnant now. We just have to keep up. So I'm very pleased to continue to do that. And that's probably what I'm very passionate about now, to keep up with the research and the trends and daily, weekly, I'm monitoring watching that. Even though I'm a dean at the Vanderbilt School of Nursing, I still have my passion and my research scholarship focused in the area of simulations. The other thing, I'll just let you know, it's on the horizon. We actually have a new book coming out. We're working with Walters Claron and I'm working with Dr. Pam Slavin Lee. She's a nurse practitioner. But this book will launch, I think it's January in a year, December, January. Don't quote me on that. But it's a book and it's really about implementing new AAC and essentials, the practical guide for nurse practitioners using simulations for competency based education. And I think in this day and age with nursing, as we have shifted with through our essentials with competency based outcomes, simulation is very, very key. It, it will not go away. We just need to keep advancing our work and simulations and looking at the models and how we're measuring, uh, getting the metrics and the outcomes using simulation. So that book is written by very many colleagues that are nurse practitioners and have gotten into the evidence and the science and the practicality. So I wanted to put a plug into that, that will be forthcoming. And we're probably hearing it first here and kudos to all my colleagues who have put a lot of effort into that book. So we're poised and waiting, but it's looked Walter's clear at this time. Thank you. Jared, do you have anything you wanna
Jerrod:Ask? Yeah, one last question for you. Cause I know we have to get off here, but as you see it today, based off one foot in, I don't think one foot out, but you know, straddling between different, different hats, uh, within your professional life, what to the best, your best guess is the most difficult thing holding the healthcare simulation industry back?
Pam:What is holding the simulation industry back? Probably knowledge and resources and support. I'll go with knowledge first. Folks out there that wanna embark on simulation or they do embark on simulation or deans or leaders want or faculty to embark on simulation. But if you don't have the full scope of knowledge and you give them the mannequin, but not faculty development, that's not the full package, right? You can't just give a man mannequin or a room and think somebody knows the simulation pedagogy. Also the simulation directors, they need to be valued, respected, make sure their workload aligns with what they're doing, cuz it is a lot of work, uh, creating those and working with faculty on this experiential learning. So that's about the knowledge and more faculty development is needed all the time. All the time to ensure that we're using best practices and the latest evidence within this pedagogy. The other thing is just support and resources. Takes money, takes time. You know, whether you're hiring a simulation team, you're substituting simulations for real clinical time. Uh, continue to demonstrate the value of that. When I say other resources, whether that's high fidelity mannequin, whether that's virtual simulations, you know, you're purchasing the software for the students equipment, suspend disbelief. You need to have real equipment that, or simulator equipment that looks real to ensure, you know, high quality simulations. So those are some of the things I think we're past Jared, you know, do simulations work. I think people do know they work, but there's still people hesitant on how much can be substituted, including state board of nursings, including, I'll say, professional organizations when not, when you say they can't count simulations unless it's over 750 clinical hours. So those are still challenges that we deal with when, where's the evidence on that. But a lot of these rules and regulations and standards are made without the evidence.
Jerrod:Yeah. And your thought with the knowledge piece, you know, as we all know the, you know, give a man a fish, feed'em for day and teach man a fish, feed him. But it's, it's more of, you know, that man still needs a fishing pole. And so if you don't have the right resources or the actual tool in order to complete the activity, you're still at that square one. So yeah, completely
Pam:Great resources are needed. Development but people forget about that., the faculty development i s a huge issue. It was 10 years ago. It still is. Yeah.. And a ctually you gotta have leaders that believe in the pedagogy. I think that's what I can do in my leadership role a nd any chance I get it, i t's really to foster the understanding w ithin not only nursing leadership, but across the health professions, the importance of faculty being developed in this pedagogy. It's not like just put a mannequin and put i t in a room and hey, you know, create t his simulation. I t, there's a lot of knowledge and skills needed. That's t he w ay that framework slash theory, t hat mid-range t heory i s important. You can look at that. It's a very simplistic follow t hrough, but those components are needed. Thank you so very much. And we know that, uh, w e both have a lot of things going on today. So I'm going to just thank you for being here with us today and sharing everything that you do. And if our listeners wanna get a h old of you with a question or support you in any way, where would you like them to go? O h, they can just email me if they want. That's fine. Pamela.Jeffries@Vanderbelt.edu. O kay. O kay. Thank y ou. S o thank you so much D eb and Jared. I appreciate i t.
Jerrod:Thank you. Appreciate the time.
Pam:Bye-bye.
Deb:Happy Simulating
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