The history of the Society for Simulation in Healthcare (SSH) with Dr. Andrew Spain: The rise of SSH. Thankful to our sponsors EMS, Simulation IQ for their financial support to the program.

In this episode of The Sim Cafe, Deb Tauber and Jerrod Jefferies interview Dr. Andrew Spain. Andrew shares his story as he started his career as a paramedic and how he worked his way up and currently is a leader within The Society for Simulation in Healthcare. Andrew shares his contributions to the Code of Ethics, certifications, The Healthcare Simulation Dictionary, and The Diamond Ball. He shares lessons learned and the value of networking.

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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: 0:55

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: 1:37

Welcome to another episode of The Sim Cafe, and today we're here with myself, Deb Tauber and co-host Jerrod Jeffries. And we have Dr. Andrew Spain, who is gonna talk to us about many things. So thank you. And I'm gonna call you Andrew, just cuz I won't be able to keep up with Dr. Spain the entire interview. But congratulations on receiving your doctorate. I know that that was long journey. Maybe you can tell our listeners a little bit about what you just obtained and about yourself.

Andrew: 2:08

Okay. Specific to my doctorate, it's Educational Leadership and Policy Analysis is the official subtitle of, of the PhD. I've been many, many years in the making at the University of Missouri. For those of you who don't know, I used to live in Missouri now in Colorado. It was a fun topic to investigate. I was looking at the decision making process, this is for my dissertation, of course, but looking at the decision making process for how paramedic program directors integrate simulation into their curriculums, because that's actually quite challenging for those of you who have been at that level. It could be nursing, medical schools, things like this. You have to think about where does simulation best fit? And there's a lot of components that go into making that decision, because I expect everybody listening to this is probably involved in simulation somehow. And it's an amazing tool for us. We, we know this, but there's decisions on where it fits best in the curriculum because it also takes, uh, quite a bit of resources. You know, you're, you have to have staff, faculty, operation specialists. There's obviously a lot of design components to meet accreditation criteria or, you know, that you've learned through becoming certified, all these sorts of things like that. Right? And so it takes a lot of work to get a really good simulation activity. And you want to have the best bang for the buck for your learners, because there are better times to insert it. And obviously different purposes for it as well. Are you more in the learning phase? Are you actually assessing some combination thereof? I I mean, ultimately we're always looking at performance, but even when you're in early stages of simulation activities, just with an an IV arm or an airway trainer, simple, simpler task trainers, things like that, you're always looking to improve. So you have to assess performance. But those high level osky level sorts of things that are, are very high stakes, for example. Or, you know, you're, you're working on your end of semester curriculum pieces related to, okay, we've talked all about cardiac patient presentations this semester, now we're gonna give you the full meal deal. You, you know, that kind of thing. And can you actually take what you've learned and put it to practice in these incredible scenarios on up to even things like disaster scenarios where, okay, we're gonna go throw 50, 60, a hundred patients at you at various modalities and, and levels of patient presentations. So it's good fun just to walk through that process and see how the decisions are, are made for those sorts of things. And that, how that can be applied to anyone who's improving their curriculum. Frankly,

Deb: 4:35

Andrew, we've known each other a long time.

Andrew: 4:37

Mm-hmm.<affirmative>, I think first through accreditation. Right? I think that's where we, we had our first major intersect. Uh, we probably met at IMSH before then. But

Deb: 4:45

Yeah, I would say at that first meeting on the, the Healthcare Simulation dictionary meeting mm-hmm.

Andrew: 4:50

<affirmative>. That's true. Yep.

Deb: 4:52

Uh, and then we were on the council together for a long time, and I never have asked you the question, how did you get into simulation? How did you, what was your journey in?

Andrew: 5:03

Probably ultimately by becoming a paramedic, I'm one of those fascinating case studies that I didn't even know I was doing simulation when I was doing it. I mean, I became a, a licensed paramedic back in September of 92. So that dates myself a little bit. But as soon as I became a paramedic, I automatically jumped into doing education as well. Oftentimes more through, I'm gonna call'em the, the Alphabet soup courses, things like, you know, A C L S, pals, of course, uh, basic life support, pH tls, uh, you know, the variety of things that are out there. Didn't know I was actually doing simulation. But almost all of those courses, if frankly all of them have some component of simulation, whether it's C P R Annie and practicing, you know, your chest compressions and depth and rate and all those sorts of things like that, up to having standardized patients as part of the scenarios for your trauma courses, doing moulage programming, you know, the various pieces. Although we didn't have the fully programmable, even partially programmable mannequins or anything like that early on. So I didn't even know I was doing simulation and didn't think I was doing simulation because I didn't have those big mannequins that, oh, wouldn't that be great to have? Or something like that. Until Robin Wooten came down. I was running the EMS education program at, uh, the University of Missouri through their healthcare system at the Level one Trauma Center. We're doing some great stuff, just didn't have the mannequins, didn't have access to them or anything like that. Didn't know where you were doing simulation. And Robin course corrected me. So many thanks to her for bringing me, I would call it, into the simulation fold. She, at that time was setting up the simulation lab. They were building a brand new building at the University of Missouri and they brought her on as the simulation program director, 9,000 odd square feet that she was gonna get for a brand new simulation program. And, uh, she came down as part of her onboarding to meet different people who might be engaged in using it. And we formed a great partnership. It was great to be able to work with Robin to help get that spun up. Uh, we were been able to get grant funds to buy a wide range. Uh, I'm trying to remember the exact number, but I think we got three Hals a Noel, a five-year-old, a three-year-old, a one-year-old as part of a disaster grant to go and do disaster training around Missouri. But also it's like, well, you know, that's gonna happen maybe 30 days a year, so what are we gonna do with the other 335 days of the year? Well, let's do it as a joint submission for this and actually use them in the sim center. And that helped them get started with a lot of the equipment they had, other mannequins that they were using. And of course other simulators as well. But that sort of was my main entry into simulation is when Robin crossed my path, actually was one who encouraged me to become a member of SSH. I don't remember the year. It was probably sort of 2006 seven, somewhere in there. So it was still early in the, in the ages. I was not what we would call a good member. I was not very involved. I paid my dues and like to the journal, but that was about it. Probably. I didn't get very involved, but that was sort of my entry into simulation is, is and, and sort of formalizing it. And so it was kind of a fun story, but it also is indicative of how many, in talking to so many people, so many of us didn't even know we were doing simulation or what quality simulation looked like. We were just sort of repeating what we had when we were learners. It's like, well, they set up the IB task trainers that way. I guess I'll do the same thing for my students. We just repeated what we knew. And until you start engaging in that larger community and learning about standards and and methods that from others, do you really start to improve your processes? Of course. That was really kind of a fun entree into all of it for me.

Jerrod: 8:26

And when you joined the society, is that where more the education piece took over? Or did you still have legs in both? Or when did you kind of really embrace the society piece?

Andrew: 8:37

Probably not until I was hired 2010, to be perfectly honest. Because again, I was, I was what I would call the bad member where at least paid my dues but didn't engage. I don't, you know, I didn't submit votes for the board members or, you know, get involved in any committees or things like that. And frankly didn't take advantage of a lot of the, of the resources that were available through s SSH back then. And of course, you know, we've grown those significantly over the years. So it really wasn't until I got, you know, more involved. I, I mean, I was certainly learning, but probably more through the EMS side. The National Association of EMS educators had a number of different courses and things like that, cuz they're certainly promoting high quality simulation for EMS educators. And being, that was my specialty, my focus running EMS programs, that's where I was spending more of my efforts, I would say

Jerrod: 9:23

As some of the groups I've been involved in, in the historically as well as ssh, it's, you only get out what you put in. And so I think that from your bad member lingo, it's, if you want to derive more from the society or from the industry of healthcare simulationist, you put more in and you're gonna receive more back throughout your journey through the past decade and a half, what were some of those bigger ones that you've kind of been involved in that you would wanna highlight to maybe some of the other members?

Andrew: 9:48

In terms of some of the s SSH items that are out there now, correct. Or, yeah. Well, fundamentally at the core, I would say all of it begins with networking. Mm-hmm.<affirmative>. And that's for myself, even going to a conference or something like that. For the most part, it's had limited meaning for those formal education sessions without having the human component attached to it and the networking piece of it because just picking on Deb, I've learned a tremendous amount from Deb, but it takes having a conversation with her and hearing about her stories and what she's done and things like that. And that could be extended to anyone that whose path I've crossed because you hear about these great things, but so many times it's hearing then how it actually worked for somebody. And so it's been really interesting after coming on with S S H and looking at the educational resources, the different things that have been developed, how the human component has been so critical to that. And I'm broadly putting that under networking. But we'll pick on the, on the dictionary for example, that, uh, Deb has already mentioned. We put that together and continue to put that together with the later evolutions of it, with a lot of people involved. That particular journey started in the certification world because we discovered it's awfully difficult to write test questions<laugh> when the language is not well described. Because context suddenly matters. And of course, context nonetheless still matters because you can look at debriefing in the different ways, the different definitions of it and things like that. And you still need to provide some context when you're writing questions or writing an article for a journal or things like that. Frankly, even starting with a base level, what simulation is, if you look at Oren's publication, I'm trying to remember the year, but he has over a hundred different definitions of simulation put together. And they're all linked in some ways, but there are definitely nuances and differences. That context becomes important. But nonetheless, you have to have those things documented in some fashion to help promote clarity and ease of communication. And so it, it was really important to us to have so many people, people in the room throughout this process. And the room includes the virtual room now of course, because a lot of that is engaged through the electronic world. And so been really fabulous to be able to actually be involved with organizations and individuals from around the world to put this together. I joked a little bit, uh, Dr. Loredo was the, uh, one who was very involved with helping get that moving cuz he was the chair of the certification committee at that point. Now counsel and I went to him and said, we have a problem. And he's like, right, let's go about fixing it. And so he engaged a lot of the key individuals in s SSH to promote the funding to, to put that thing together. I joke about it as my Pacific Rim tour because he actually engaged the process where I not only went to Europe and things like that to talk to the different organizations and have direct meetings with them, but I think it was Australia, then to Singapore and then to South Korea and then back home. I, I joke about it being my Pacific Rim tour as part of that effort to get the dictionary put together and launched and hearing the different perspectives, especially from different cultures, different languages and things like that, where you're putting together an English language dictionary and how does that work for those who don't speak English or frankly, of course one would joke, well we should have started in the UK cause we speak American here and they, they speak Australian on Australia and so forth. There's no one English version that fits all, of course. But it's that network and engagement of individuals that underpins every single thing that I think that I've done, which has been the best part of all of this. You know, my own personal learning, the, the things that we put together. Devin and I have worked on accreditation as well as she, as she mentioned, it takes a lot of people to build those things and to create standards that are actually accepted around the globe. Because you can't do that with only one or two people. You've got to have so many people involved. And that's where I mentioned that fingerprints concept is like, great. So my fingerprints might be on a lot of things, but guess how many other people have their fingerprints on it? The dwarf mine easily. Cuz there's hundreds and hundreds if sometimes not thousands of fingerprints when you look at all the survey input for certification and things like that. And it's just so really neat to see how that's evolved. And frankly, how I went from being a quote unquote bad member to someone who actually is sort of very involved in simulation or, or even as a professional thing involved in EMS. It takes working with people and reaching out to them and you can read the standards all you want that are posted through the various organizations. If you pull up those or accreditation standards or the certification blueprint, it's sometimes really hard to wrap your brain around that until you start talking to people and hear their stories and how it then relates to your own story so you understand better. And it's just a fascinating process of course.

Deb: 14:29

But I have to say, you're the kind of person who people are not afraid to come up. You're very easily approachable. And that warmth j elly.

Jerrod: 14:38

as he sips the Papa Bear mug.<laugh>, I like that.

Andrew: 14:41

<laugh>, I gotta have my coffee. You know,<laugh>,

Deb: 14:46

The warmth and kindness comes through all the time and it just opens the door for people to wanna be around you and to join you and to, to follow you essentially.

Andrew: 14:57

Even that I would say is a reflection of you all. I've joked with people and I say joked, I probably shouldn't put it that way. I've described to people that I have the best job in the world. Well, I've now had a couple different jobs and titles with SSH but what makes it the best job in the world is ultimately all of our members and all the non-members. I crossed paths in healthcare simulation because until more recently, we haven't even had degrees in healthcare simulation. So everyone found healthcare simulation, but was on a different route. First they became a clinician, later became an educator and suddenly found this really cool thing called healthcare simulation. And the reason that they're here is because of the passion about it and the really, uh, you know, high level interest and desire to do some amazing things. They see the value of it and so forth. And so I have literally thousands of people around the world who have this amazing passion, interest level of, of dedication that I get to work with. And that makes it the best job in the world because there's some really cool things I did as a paramedic, as an EMS educator, all these sorts of things like that. But it's a different world entirely. And a lot of people were there still just in healthcare and things like that because they need a job and just have to earn money. And it's a different type of focus then we all gotta feed our kids, we gotta have a house to live in and some of those things like that. But so much for healthcare simulation is about people who are here because of their passion. That just makes it really cool. And you can see that energy every single I M S H because people just come outta that conference just jazzed and ready to go<laugh>. It's just incredible energy there. Of course.

Deb: 16:30

No, do you have a favorite thing that you did since you've been there? I believe you were the one who came up with the idea for the diamond ball.

Andrew: 16:38

There's no, that's not me.<laugh>.

Deb: 16:38

Oh, okay. All right. Who's, Who's the.....?

Andrew: 16:40

,That actually belongs more to Jen Manos actually. Okay. Um, the diamond ball probably, I'm hoping I get all the facts straight here. But we ultimately, when we were launching the fellows the first couple of years we just had an induction ceremony was just the fellows. We also had things like an accreditation reception, a certification reception and some other things. President's reception. All of them were great by themselves, but that's a lot of money to spend at a conference. Think about the fact coming up for I M S H 2024. By the way, I hope you enjoy your coffee cuz I think we're paying something like$17 a cup at the convention center that just gives you an idea of how expensive it is to run a conference. Okay. This is, this is just facts again. And so we try to make sure that we're using our money, stewarding it well, and we can actually put on the diamond ball, this is again, Jen's saying, look, why don't we just put these all into one great big thing and turn it into this huge event that's much higher level than each of the individual parts combined.It actually highlights the induction of the fellow in front of a larger group, which is fabulous, of course. Helps us recognize certification and accreditation in front of larger groups. And frankly is a great way to kick off IMSH every year because we get to come and have a really great time. Everybody gets to dress up as they desire, have fun with friends, have a great meal, see a great program. Uh, and if you've been to the diamond ball, you know how much fun it is of course, and things like that. But that was, you know, Jen's idea to sort of bring this together and really have a high profile event that just absolutely, you know, sort of smashes it out of the park every year. And so she's continuously challenged each year to come up with a different set of decorations and stylistic things and everything to keep building on the year before. So she holds it a little bit close to her vest and then springs it all on us because she has a really good time with that. But it's, uh, that's kind of how that one evolves. So I didn't have anything to do with that, but I love the output, of course<laugh>

Jerrod: 18:30

The red carpet for the industry.

Andrew: 18:33

<laugh>. Absolutely. I mean, we wanna see it as that event. Officially it's the President's Diamond Bowl because the president of course is overseeing it and they have certainly some input into to how it's looking, but, uh, a lot of it's just letting Jen kind of do her magic there.

Jerrod: 18:46

And I want to go back and touch upon one thing though, Dr. Spain, you were mentioning all these different options that s SSH and the society provides that you've went through.. And you have your thumbprint on a lot of them. I think, uh, this year's IMSH I was hearing a little bit about some philanthropic efforts. Could you touch on that?

Andrew: 19:02

And that's our new development committee. Jenny Kaza has actually been the lead for all that. And this started a few years back pre covid. And as you can imagine, so many things had to be put on hold for all that. Um, I now function as the staff liaison until we get a, a staff member to really take that on and help that grow that. But the s SSH fund is a new initiative we just launched at IMSH this year, which is our, as officially making official our philanthropic arm for the society. As part of what you see with society maturing and becoming larger. Uh, you sometimes they're called foundations, sometimes they're called funds and things like that. And so Jenny and her team with the task force put together a really nice plan to help grow us into that arm because it's nice to be able to finally have this area where people can donate. And of course they're tax deductible cuz we're a 5 0 1 c3 organization, which sadly doesn't necessarily help those who are not in the us uh, to figure out how to engage that perhaps if there's any tax benefits to those outside of the US borders. But nonetheless, they're non-operational funds that designated really for things that are driven by member decisions. And so the money that's gonna be donated by individuals, it helps us grow the Beverly Anderson Scholarship Fund. So people who are challenged with resources both inside the US and outside the US have a chance to get funding to come to IMSH. And so we're trying to grow that, continuing to grow the Chad PPS fund for promoting sharing of great topics at IMSH through that lecture on the Sunday, that keynote that, uh, is named after him, we also have the components of research and technology innovation invention that have been added in that these are kind of some neat things you've probably heard of. It was previously called the Novice Research grants. it's n ow the early researcher grants, uh, t hey're actually awards now. We're trying to also avoid the grant term because that creates some challenges for people who might apply when you have grant attached to it. And that helps those early researchers in healthcare simulation really get started and, and have, uh, s ome funding to support the work they're doing through research. But we're stepping into those much larger awards. We know a lot of individuals can't even apply for awards to do their research in h ealthcare sim unless it's, it r eaches certain thresholds, they're not even allowed by their institution. Ye ah. So we can help grow that and uh, w e recognize th at a unique opportunity to actually help promote technology and innovation as well. And the technology committee is sort of driving some of that one, but what a great way to help promote that part of healthcare simulation as well, because that's intrinsic to so much that we do. It's certainly not the only thing in healthcare simulation, but technology is clearly embedded throughout healthcare simulation in many ways. And it's just really nice that the s ss h f und is now again, so rt o f, it's completely separate from operational funds. It's in i ts own bucket there. The decisions on how the funds are going to be allocated and distributed ar e a ll through the members. The development committee is sort of gonna make that first decision of w hatever we've gathered each year can go to each group and then those groups can make those decisions th at t he technology gi ven t h e, the research committee and things like that, make the call and evaluate the submissions an d, and all th e s orts of things that'll be part of that process. So lots more to come on that, about how that goes. But I hope everyone sees the wisdom of having something like the s SSH fund to support these things and really be a way to grow healthcare simulation and member involvement, member engagement, all these really cool things as part of having the s SSH fund. And so many thanks to Jenny and all of her group. I know there's many more people that I'm not naming, but she's really been the champion for this and had to stay the long haul cu z w e had to put her on pause through Covid and they finally were like, okay, we're coming back and revisiting this. And she's ju st r eally been great for taking that and really pushing it to fruition. So really nice to be able to work with her on that project.

Jerrod: 22:52

Thank you. And it's very fitting for IMSH for 24 being innovate, disseminate, educate, and advocate. So

Andrew: 22:58

We'll be able to announce the first, you know, awards this year at IMSH. So we're really excited about that.

Jerrod: 23:04

Extremely exciting. Well, and to get involved, you just have to visit the website, I assume.

Andrew: 23:09

Yep. Right now it's just very simple website with some of the basic things that I just described. And of course the ability to donate. You can of course reach out to us development@sshfund.org. You can just type in ssh fund.org if you wanna go to the website. We're actually gonna be building out a much nicer website that has a lot more of the robust things that you expect. But we had to start somewhere and now we're continuing to grow and we'll be recognizing all those who have made donations. And it's, it's been really neat to see everyone jump in. We're already halfway to our 2023 goal of$200,000 in terms of funds raised, but we Wow. We would like to blow that out of the water, so to speak. This is probably an American, American euphemism and we, I've got people are who are listening to this from somewhere else going, what does that mean,<laugh>? But we really want to just have a great year. Uh, we selected a challenge goal, what we thought was like, well, you know, this is all new for us and we'll want to continue to grow and build on it and, and 10 years look back and just have this amazing fund that we can show all this, these amazing outcomes. Of course.

Deb: 24:06

Fantastic. Now is there anything that's been your favorite thing? One thing that you can point back to or it's, it's just been like a blur and you've done so much and have had so much fun all along the way? Well,

Andrew: 24:19

Honestly, I, I mean, of course I've gotta put out the certifications as one of the things that I've really enjoyed being a part of. But I have to put an asterisk behind that because it makes it sound like I didn't enjoy the other pieces. Uh, and that, and that would be incorrect, but that's what I was hired on to do, is to, to get that certification program launched. And as of handing it off to Rachel last year when we hired a new director of certification, she came on in August. Uh, we now have those four certifications and what an amazing thing to see just how many people have become certified. We're over 4,300 individuals from, I I can't remember the number countries, 44, 45 countries now that have become certified. Wow. We had no idea what that was gonna look like back in 2010 when they hired me on. And, and there was concern about whether it's financially viable and, and would it be successful? Would people buy into it? All those sorts of things like that. And again, it goes back to the number of people that have been involved because I've heard some of the really interesting stories over the years. It's like, well how are these test questions written? Do you just, you know, grab a couple of beers and sit at a bar and write them or something like that? And Well, I I, I was characterize that beer drinking has probably been a part of it from time to time. We do it after we've done the writing because we need to de-stress from the hard work of item writing. I should make sure we have Rachel do a presentation on just the item writing and development process. Because every single question that ends up on our exams has probably had somewhere between 20 to 30 people involved in the process just for each item, let alone the collective piece. Because every item starts in, in someone's brain. I've got an idea, I'm putting it down, it's probably gonna almost always rough. Okay. But then you have the item writing group that gets together and there's already a half dozen people that are looking at there and, and mashing it up and editing it and twisting it and, you know, sort of stress testing it in their own brains to improve it because we've gotta make sure that it looks right. But then you have other people that are reviewing the forms that come back and look at it later. And the steps that go through it, again, it's, it's not incorrect. Probably say that every question has 20 to 30 people probably look at it before it, it's up there and running as a scored item on our exams. And so, as you can imagine, we've had easily hundreds of people as part of our item writing and form review process over the years. And while it sounds more fun to just, well it sounds, yeah, let's just go to the bar and write some questions on a napkin or something like that. It's, it's, that's not, not where we are. We, uh, we have to meet all those criteria. We became accredited by the National Commission on certifying agencies back in 2017. So guess what Rachel, our new director gets to do this year. It's time for the reaccreditation process and submitting all that. Oh, by the way, they have new standards so it all needs updated. So we're gonna have a lot of fun with that. Deb, you of course on the crediting side for s s h, you know exactly what programs go through for that. It's a, an industry norm and we've got to demonstrate to our members and those who get certified, this is a valid and reliable process and it has meaning. And of course you'll also see the repeat practice analysis for both CHSE and CHSO-S. Those results coming out this year with the updated examination blueprints and the new forms should be ready for launch in January. Uh, that's sort of our typical process. But every five years we have to go back and do that as well to stay current and, and all those sorts of things. But clearly that's been a really enjoyable process, a really long slog to get these things done. And that's actually one of the challenges with anything that put together because quality does not come quickly and it takes a long time to put these things together. And again, I think everybody listening to this is gonna resonate with that notion of yeah, you're really lucky if something comes out overnight that's high quality. It almost always takes a, a lot of work and a lot of input and there we go.

Jerrod: 28:02

And the amount of collaboration that has to go globally. Yeah. So it's shifting time zones, it's making sure that, you know, holidays for whatever country and I mean to your point of blow it outta the water. Right. Different idioms that need to be adjusted

Andrew: 28:14

And yeah. How many people review the questions so we don't have the americanisms in there. I mean that's an important piece of it. and, and all part of what has to be done for that quality.

Deb: 28:24

And I appreciate the fact that you have allowed me to be an ambassador for helping people with the test and preparing for it. And I love the way that you put that. You know, we all are ambassadors for the society as being members. And I think that's one of the things that you taught me. Thank you.

Andrew: 28:44

You're welcome. And hopefully I've given you some tools to take out as an ambassador and<laugh> have some good talking points and things like that. So.

Deb: 28:51

Oh, you have, you have. And the fact that people can use these podcasts is part of their continuing education. Credit hours is Okay. Just Andrew Spain. Three things I learned, right?

Andrew: 29:05

Mm-hmm.<affirmative>. Yeah, absolutely.

Deb: 29:08

Is there anything that we don't know about you? Something that might surprise our listeners?<laugh>?

Andrew: 29:14

I don't know. I know there's always something, right? I mean little, little tidbits of information and things like that. I would share, you had one question as sort of a Yeah. Possible thing we would cover, you know, sort of when did I realize the value of simulation type of notion? And it was towards part of when we had pulled together, uh, the, the simulation program at mu. And again, Robin had had built that platform and by then she was with S SSH as the executive director. And so I was working with different people, but we'd actually created a whole litany of forces specific to O B G Y N care, notably the high acuity low frequency type cases and things like that. And so we were going around and doing some very formal case work that was with Dina Higbee, perhaps many of you would know her name, but she's still the director there at uh, the University of Missouri. They now have multiple sites all over Missouri. Also been very heavily involved with ASPI as well. And so it's been really great to work with her. Uh, but we were going around and not only teaching physicians a very structured core switch by the way. They were getting a discount on their malpractice insurance after going through that. And that was a really big deal because it was a heck of a fight for her to get that work done. And I believe it was 10% off for two years, which doesn't sound like much until you realize their malpractice insurance premiums. And that was probably saving them somewhere between 15 to$20,000 over those two years. If I remember the figures correctly. She probably had, is shaking her head if she's listening to this going, no, you got it all wrong. It's more than that, or whatever. But the point was that nonetheless was a very valuable course and they could demonstrate through that construct that, uh, the value of simulation. And we had an e m s specific outreach piece of it as well, where of course I was going out to various ambulance education settings for EMS and sharing a lot of that OB training as well. And some of it was actually quite straightforward. We were talking about a breach delivery maneuver that is not typically in the paramedic curriculum and I'm gonna probably pronounce their names incorrectly, but it was, uh, three physicians, MarSos, uh, Snelling and Veet I believe. Uh, I always remember that it goes by the unfortunate smelly feet maneuver because of the<laugh>. It was for breach deliveries. And so you're seeing the feet presenting and that's how they try and get people to remember these things. It uh, weird in education sometimes that we come up with this, but it's a different maneuver in terms of how you address the breach delivery for those high-risk types of situations and something that was not in the paramedic, the standard paramedic curriculum. And so we got permission to extend that to those paramedics through our medical control and, and talk about when you might be able to use this. And of course we had a lot of flight paramedics, ground paramedics, uh, flight nurses, others who were involved in EMS and we were going through this. And again, I wouldn't des describe that it was a lot of these were just more focused on the task training piece of it, especially for this particular maneuver. But it really became impactful to me about the power of simulation when there was literally within one week after two different courses, two different flight crews actually use the maneuver to deliver BRE babies in the field. Would they have had success without that? We certainly don't have that statistical, you know, let's look at that and say, well if I didn't have it, would the baby have done okay or something like that. But they were actually able to take the training within a week and utilize it. And that's one of those wow moments for me. It's like, oh my gosh, this works. And every one of us has those sorts of stories. I've had lots of other stories. We started to joke a little bit about maybe we should stop doing education. Cause every time we go and do education about something cardiac or something trauma or something like that, we never believe were getting these stories back that within a week or two people were using what we just taught. And I'm like, are we part of the problem by creating<laugh>? It's, it's a big joke of course. But um, just being able to see how people can grasp those activities, those simulation activities, and actually apply them oftentimes far more quickly than we would've ever expected. It just rammed home the power of simulation and how it could be so valuable. And in those two cases may literally have saved life. We, again, we don't have the, if it wasn't there by comparison, but it certainly helped.

Deb: 33:28

That's a great story. And so that would be your favorite story.

Andrew: 33:32

That's one of my favorite stories about SIM I suppose. I mean, again, I've probably got lots of other stories, don't do as much simulation now of course I'm very busy with SSH is h more on the standard side of things and so forth. One of my more recent interesting stories, I've been working with Jennifer McCarthy out of New Jersey and she's actually been doing some amazing work with EMS programs out of there and helping them to implement simulation really heavily into their curriculums. And having gone out there, they were struggling with their pass rates. It's a lot of times why they're, why you bring in external experts. We're struggling with something with our written pass rates, our actual performance of our students and things like that. And so she and her crew, which I was lucky to be a part of, were going in there and really going with a heavy simulation curriculum to course correct for a lot of these programs and things like that. And we were seeing, frankly, we've been able to see major outcome differentials, not just things like the pass rates on the national registry exam for the paramedics. I mean they were going from hardly the antibody was able to pass kind of notion to almost everybody passing now the, the learners themselves talking about how they get it and we're struggling before and now it's like, now this makes sense. I think there's feedback from the various ambulance services about how people are coming out and performing much better. But the single biggest impact for me because we had a very engaged process with all the learners was to see the growth of confidence in them. We were talking about people who were really unsure had the imposter syndrome. I mean they talked actively about imposter syndrome. I was like, I just don't think I can do this. I just, I'm not smart enough. I'm not fill in the blank. I mean imposter syndrome. And to be able to engage with them and build that confidence through simulation is just it. She set up a really neat program that had a lot of those affective elements around it as well. So it wasn't just, can you do the skills well and do the patient assessment and the, and the decision making, but really build the healthcare provider holistically as well. So they had that confidence and had the ability to go out and be a functioning member of the healthcare team as a whole with that confidence knowing that they could really do it. And it's just really, really cool to hear that as well.

Jerrod: 35:41

And it is so satisfying when you get that communication back, closing that feedback loop of hey, we did help. And sometimes I think that some, you know, to your piece of when you push out education, they wanna make sure that they know, Hey D r. Spain, hey ssh, you guys are the ones that helped us happen. And it's so rewarding to have that. put that good out into the world and h elp save lives as you mentioned.

Andrew: 36:01

Yeah. Yeah. And I think the last thing I might point out is one of the things that I've been really happy with how it's turned out is that healthcare simulation is code of ethics. I don't know if you've had a chance to really engage in that, but that's something that the idea originally came from John Rice, cuz part of having a valid profession is having a code of ethics.. And he came to me and said, we really need to have this. And thankfully our then current president Christine Park agreed and helped us launch all of that. So it was really, really cool to be able to be a part of that process and have a summit type approach. At IMSH. I think we had 45 individuals from different countries in the room. I'm trying to remember. It was really kind of fun. We set it up a little bit like a un round table and they all had their names with a flag out in front of it and things like that. You have a little bit of fun as well, but you go onto our, our website now, of course you've seen so many organizations and institutions adopted and, uh, what a tremendous piece of work that was to be able to get that to, to publish and get consensus on it and in a framework that makes sense because it's tied to a lot of United Nations type format. Cuz it was intended for global use and that that was, that was what we really wanted to do. But, uh, just getting through all that, under Christine's leadership for that was really cool. And to be able to see that. Now again, I have, I have a little fingerprint on that and it's really neat to be able to be a part of that process, but what an amazing resource for everybody that now you can say, you know, we've even got printable posters. And so it just sort of embeds that shared mental model that we all want to create in healthcare simulation where it's safe, useful, outcomes oriented, all these sorts of things like that. So really, really good stuff there too.

Deb: 37:41

Yeah, I agree. How many languages is it in to date?

Andrew: 37:45

I've lost track, but I think we're at 14.

Deb: 37:48

I would, I would think that sounds about right.

Andrew: 37:50

It's about right. Again, it's<laugh>

Deb: 37:52

No credit. It's, it's amazing work. And it's, I always enjoy when I'm on, um, a site doing a review and they point to the, the code of ethics from the society and it's important. It's very, very important.

Andrew: 38:08

And it, and it had to be adaptable to be coupled with the existing codes of ethics that are out there. It's, there's ones in EMS nursing, the physicians, they have a whole book with all the different professions or specialties, excuse me, listed throughout because there are nuances in each of those specialties that need to be addressed from an ethical perspective that, you know, emergency medicine has different things from anesthesia and so forth. And so it's just trying to create something that could be coupled with that and have that simulation overlay that becomes mutually supportive was a bit of a challenge, but really a fun process to go through.

Deb: 38:42

Is there anything that you'd like to leave our listeners with? Any words that you'd like them to remember? This specific episode, bye.

Andrew: 38:51

Get to know your other healthcare simulationist because there's so much you can learn from them. Just be willing to recognize where you can grow and that growth comes through taking all the input in from everybody you run into because they have amazing things to tell you. Just listen to their stories because that's gonna make your story so much stronger by appearing theirs.

Deb: 39:10

Thank you. Jared, anything you wanna add or

Jerrod: 39:14

Ask? No, I love that, just those words, I mean, collaboration and engagement with other members because sometimes it feels very siloed a nd, and lonely. I mean, there could be one position at a certain institution that's this, I'm, I'm all alone here. A nd then you connect with someone in society or other g roups and you're like, well I r ealize we're hundreds but we're scattered across the country the world, th e continent.

Andrew: 39:35

And the, and the willingness of the community to engage the a trap that I see so often is, well, I just don't wanna bother someone. The answer's always no unless you ask.

Jerrod: 39:45

Yeah.

Andrew: 39:45

Ultimately. And so I just encourage you to ask, reach out, be it through our sim connect groups. There's lots of great sim connect groups out there, our sig sections, if any groups and so forth. Uh, reach out to your other colleagues that are not in those groups, whatever it might be, because that's how it's gonna be so much better for you.

Deb: 40:01

All right. Well with that, thank you very much and happy simulating!

Andrew: 40:06

Indeed.

Education Management Solutions tag: 40:08

Thanks to this week's sponsor, Education Management Solutions, adapting technologies to elevate the discipline of healthcare between education, training, and active provider care. Check them out at SimulationiQ.com.

Outro: 40:29

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.