Dr. Jabeen Fayyaz shares her story into simulation with Deb and Jerrod. She has a keen interest in cultural differences and wants to share this globally. This episode is sponsored by Innovative SimSolutions, the turnkey simulation solution.

Dr. Jabeen Fayyaz, PEM Staff Physician, serves at the Hospital for Sick Children and Assistant Professor at the University of Toronto, since 2018. I graduated from Pakistan and worked as Pediatric Emergency Medicine (PEM) faculty at Aga Khan university hospital (AKUH) for five years. I was among the few leaders in Pakistan with the EM specialty recognized by the College of Physicians and Surgeons of Pakistan in 2011. Later, I worked at Sultan Qaboos University Hospital (SQUH) for three years and led the implementation of the Canadian Triage and Acuity Scale (CTAS), followed by a quality improvement initiative utilizing the LEAN Sigma methodology. 2016 I started my PEM fellowship for sick kids, followed by a one-year Simulation fellowship in 2018. I have a master’s degree in health professional education from Aga Khan University Hospital in 2018; in April 2023, I completed my Ph.D. from MGH IHP, Harvard, with my thesis" Exploring Cultural Sensitivity for Physician and Simulation Educators." 

At sick kids, I am PEM international fellowship program director and Simulation resuscitation lead. I am the IPSS INSPIRE fellowship chair and BOD member for INSPIRE and IPSS. In the last three years working with National and international for community outreach and capacity building in PEM partners Indus Hospital and health network, I have implemented a simulation-based PEM curriculum for EM residents and a one-year PEM certification program with twenty-seven physicians currently enrolled from all over Pakistan using distance simulation.  I am particularly interested in exploring how strong culture plays a role in Facilitator and learner interactions in simulation-based education. 

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Transcript

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Intro: 0:44

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: 1:28

Welcome to another episode of The Sim Cafe, and I'm Deb Tauber, your host with co-host Jerrod Jeffries. And today we're fortunate to have Dr. Jabeen Fayyaz, who is a staff physician and she serves at the Hospital for Sick Children and assistant professor at the University of Toronto. Since 2018, she graduated from Pakistan and has worked as a pediatric emergency physician at AGA Con University Hospital for five years. And without further ado, I'm gonna go ahead and let Dr. Fayyaz speak a little bit about herself and tell our listeners a little bit more. Thank you.

Jabeen: 2:07

Thank you, Deb, for a humble introduction. I really feel , uh, deep sense of gratitude and fulfillment while being with you all here and talking about little bit about my journey. As you have alluded that I'm Pediatric emergency Medicine physician, currently working at the Hospital for Sick Children affiliated with University of Toronto. But my journey didn't start it from Canada. I am originally from Pakistan. I did my basic medical education and pediatric specialization from Pakistan and then start my work as a pediactric emergency medicine physician at Alga Khan University Hospital, where I stayed at a faculty physician for few years. But then I moved to Muskat, Oman at Sultan Cabos University Hospital and stayed there for a couple of years. During this , um, time, the simulation based education was just limited to some life support courses like pediatric advanced life support, basic life support, and then some of the skills , um, skills related simulation that I was doing and heavily involved with. Because of my passion in education, I started my masters in health professional education from Aga Khan University Hospital and completed while I was at , uh, Ultan Cargos University Hospital. Then my journey bring me to Canada Hospital for Sick Children to do a pediatric emergency medicine fellowship. And here I got introduced formally to education and then I completed my fellowship of one year in simulation. And that's kind of a game changer for me. Then I realized that simulation is not only limited to life support courses, it is just a lot more than that and that make me pursue my PhD , uh, in simulation from M G H I H P affiliated with Howard, which I recently finished and focus of my simulation of my thesis in PhD was exploring cultural awareness , um, among the learners and simulation educators. And the reason behind me being from a different culture when I come first arrived to Canada, the whole culture was a shock for me and I have to struggle learning various things. And then I realized it is so important to have cultural perspective embedded into the curriculum. So that's why I thought why not to explore it further where I got the opportunity through my PhD.

Jerrod: 4:40

Wow , thank you. That was a lot to unpack though, <laugh> one. Thank you. Right. And so let's focus on the cultural aspect. I need to simplify it for myself and maybe some of our listeners. So started in Pakistan, then went over to Oman, and then now in Canada, correct?

Jabeen: 4:57

Yes, correct.

Jerrod: 4:57

And what's the , what's the timeline in each of those countries?

Jabeen: 5:00

Yeah, I was in Pakistan from 2008 till 2014. 2014 to 2016. I was in Muskat , Oman at Sultan Caboose University Hospital. And since 2016 I am in Canada.

Jerrod: 5:15

Okay, great. And what would be some of the biggest cultural differences between Pakistan and Oman and then perhaps, you know, Oman and Pakistan or just Oman to Canada. I mean, just talk , talk us through some of those pieces.

Jabeen: 5:31

Yeah, you are asking me to summarize ears into just few minutes. I'll try .

Jerrod: 5:37

Certainly , unfortunately, we , we don't have , uh, hours here on , on the pod, you know , do your best

Jabeen: 5:44

For sure. So I would tell you lot of differences, but I would try to , uh, summarize couple here. First of all, the way the learners and the facilitators are viewed are quite different from Pakistan in Oman and then coming to Canada, I would say power distance is the biggest thing, which I noticed. What do you mean power distance? Yeah . Yes, for sure. It is , uh, important concept, which I really learned recently. It's just like what your teachers say is always correct. You do not question your teacher. You do not say them that here you are wrong or you do not engage being as a learner or as a teacher or facilitator in a learning conversation and try to understand the mental frame. Uh , when you are trying to learn a concept, it is just like, for example, a teacher tell you that if a patient come with a shock, you have to give 20 mil per kg, normal Celine bolus, then it is full stop . You have to do that. But what difference I found here that you'll go beyond that, you will ask, the learners will ask you why and why it is important and then what impact it has and then how various practices impact various patient population. And in that manner this comes up, this power distance kind of thing. The other thing which I would tell you is a culture shock. Culture shock is , uh, getting exposed to something which I haven't expected. For example, in Pakistan and Oman age till , which I see pediatric patients were 12 years and 14 years when I was there. Now they see it up till 17 and 18 years, but I'm telling till my time. So during my training also, I'm not exposed to adolescent medicine, some mental health issues, some gynecological problem, which is very, very specific to this age group. So when I come to Canada, nobody prepared me for that. And suddenly my age of practice changes from for 12 to 14 years to 18 years. And then even asking mental health history, there's history pertaining to their sexual practices. It is so difficult for me to even verbalize because it , it is in our Muslim culture, it is not taken as a good thing to talk to child that , uh, do you smoke? Do you drink, do you take drugs? Are you being involved actively in any , any sexual activities? So this is quite completely no-no in our culture, both in Pakistan and Oman. So the the second thing, which was very different in their , in Canada in comparison to those two countries was uh , kind of a cultural shock that I got exposed to.

Deb: 8:41

That's wow. Yeah. Yeah. Fascinating. Fascinating. Now I'm gonna ask you a question and I'm curious about this. So how'd you decide on pediatrics?

Jabeen: 8:50

Oh , that is an interesting question. <laugh> . I would tell you I am the first , uh, physician in my family because , uh, my family is amazing. It's a one , like it's wonderful family, but I'm talking about 2000 and nineties now. The things have changed a lot. But when I started my education, a lot of , uh, girls, I'm talking about female pursue their career as either a teacher because it is , um, uh, or a doctor because it is considered as a very respectful profession , uh, and a safe profession for females in my country. And also , uh, it is considered as a status symbol. Like if you're a physician, you are highly educated, you will get success in your life because you, you get married in a respectful family. So this is a whole cultural perspective. So I'm one of the very few physicians in my family from that era. And really I chose peds because the patient population, I feel safe that I can take care of it. <laugh> , I do not have to get involved with many trauma related adult or elderly patients, pets , kids , very nice to handle parents, very nice to talk to them. So it's kind of a convenience that make me choose this profession or this subspecialty

Deb: 10:16

<laugh> . That's very interesting. I , um, had worked in the emergency department for 25 years and I was always in into peds. I always got pushed in there because they said, Tauber, you got four kids, you're good with kids. Yeah, <laugh> . And I would say I'm good with healthy kids, kids <laugh> . Yeah.

Jabeen: 10:37

Very nice. I love it. <laugh> .

Deb: 10:39

Thank you. Why don't you, so we know how you got into simulation. Do you have a favorite or most impactful simulation story that you'd like to share with our, with our guests today?

Jabeen: 10:51

Yeah, for sure. I think , um, as I told you, I always , uh, because of my exposure I was always very intrigued and fascinated about exploring the cultural perspective, especially in the area of pediatric emergency medicine. So my belief is that by incorporating cultural factors and simulation scenarios, educator and learners can get valuable insight into the intersection of culture and healthcare and therefore promote the cultural competence, which has an effect directly in the patient care improvement. Because the uniqueness of emergency or acute care is that our interaction is very short lived . We just interact with them with a short period of time. And in that time we have to understand what belief or mindset they're coming from. So one of the simulation that we ran in our department, which is pertaining to it was a kind of a simulation where , um, there was a patient who is , um, immigrant from a Muslim society. The mom is , uh, with the child and she is refusing for , um, treatment that is needed for that child. And the assimilation is about how the learners from the culture which they are not aware, will navigate this difficult conversation that I just built to tackle the difficult conversation. But it turns out to be that , uh, difficult conversation. One side, they continue to get lost into this whole cultural realm that how they can navigate, how they can communicate. The mother was not , uh, understanding English very well. They have to utilize the translational services or interpreter services, how to incorporate that. So I think there's a lot that we unpack and during the debriefing a lot of things comes up that how complex it is to navigate through the cultural belief to navigate when you do not know their language, to understand the emotion and how it plays a role , uh, while you are taking care of a child who is acutely ill. And the management is very much time-based and time limited .

Jerrod: 13:11

Yes. I love what you're doing because , so just a bit about me, I've grown up half my life outside the US as, oh , so I was born in the US but then grew up in, you know, some Indonesia and then Norway and Denmark. And so a lot of what you're saying resonates with me very heavily. And so one follow up question then is what do you see the future of simulation becoming, especially with your focus on these cultural differences?

Jabeen: 13:38

Yeah, I think the simulation field is growing exponentially. There is a lot of exciting things are coming up, but if I see my interest and then where this simulation field is going, and that is definitely in the area of equity, diversity, and inclusion. So simulation is being recognized as a , a important tool to address healthcare disparities. The future of simulation is definitely emphasizing on incorporating EDI principles. EDI means equity, diversity, and inclusion. And I really like how uh , the M G H I H P has included a justice and make it Jedi because I really believe that it need to be equitable, diverse and inclusive, but there should be injustice related to that. So I really like this terminology of Jedi that we use and for um , what it mean to us as an educator is to ensure that the scenarios and training material culturally sensitive, inclusive and representative of the diverse patient population that we are living and we are taking care. The world is a global village LA right now I'm in Toronto . And in Toronto you can get like patients from every cultural background and then, you know, need to know how to navigate with them. So this approach will really help healthcare professionals to develop cultural awareness that will reduce their biases leading to more equitable and a patient-centered care. Another area which I started to explore a little bit more now because of one of my colleague who has an interest in this , uh, in area is artificial intelligence. Now artificial intelligence is everywhere. So I have done a project with him where we utilize an artificial intelligence for interpreting a conversation in different languages and that help us understand that there's a huge opportunity lie that how we can utilize the AI powered virtual patient or virtual real reality simulations, which can further assimilate complex medical conditions, rare medical simulation scenarios, allowing healthcare professional to refine their skills and decision-making abilities in a risk-free environment. So these are the two things which I really want to focus and talk about.

Jerrod: 16:08

Yeah, this is , uh, this is deep because I think that there's, there's different avenues to go down here. I don't know which one I wanna explore. The AI piece came outta left field here, so So are you're exploring with it already?

Jabeen: 16:21

Yes .

Jerrod: 16:22

Yeah. And how are you exploring that within simulation? That through translation in different languages?

Jabeen: 16:28

Yes. What we are doing, we have involved our interpreting services and we have created a script where there was an AI assisted device and interpret services are there and we f orce tested whether this u h, script which is written in English is getting translated in its actual meaning and actual context in D U language and a Spanish language. These are the two language which we t e we are right now testing because of t he expertise present locally. And I think one more is the French.

Jerrod: 17:03

And so the setup is, is a simulator itself and then you have an automated scenario that's going on?

Jabeen: 17:09

Yes, correct.

Jerrod: 17:11

Okay , gotcha . And this is in a sim center?

Jabeen: 17:14

Yes, this is in the sim center. Okay ,

Jerrod: 17:15

Nice.

Jabeen: 17:16

Yeah, so we have done the pilot testing and our , we involved in a family, for example, for DU language, a family who will be fluent in DU uh, will now then relate to that scenario whether it is communicated in the same language to them, are there a lot of medical terminologies in there that are not able to understand? So this is how it is shaping and our plan is to just then test it at the level of the learner later on. But right now what we are doing is at a pilot testing level where we are just testing the script, whether the context and the communication which is written in English language is translating into the OU or Spanish or other languages in its actual context or not.

Deb: 18:06

Wow, that's fantastic work. That's fantastic work. I'm gonna move into a little bit of a different topic now. I'm curious about lessons that you learned during the pandemic and if your goals changed um, during the pandemic. I think that that's, you know, until some of the stuff is published, which is gonna have to be double peer reviewed, we're not gonna find out what different packets of the world we're doing and learned.

Jabeen: 18:30

Yeah, pandemic is a interesting time period which definitely poses some challenges but then unpack various opportunities as well. Meanwhile, and one of the biggest opportunity that I saw is kind of exponential growth of distance simulation or virtual simulation. There are various terminologies are being utilized in literature, but for me that time period serve as my passion to be fulfilled. I would say I started a lot of distance simulation with learners in Pakistan at Indus Hospital and Health Network where we started a whole simulation based PET emergency medicine module for the emergency medicine resident. And then later on when we see the enthusiasm and then see the results of it, that how well it is working, there was a request come in because P PEM is still not a recognized sub-specialty in Pakistan and there are very few places which are providing pet emergency medicine training in Pakistan. So what we did, we started a one year certification program in pet emergency medicine, which is all distance based . And actually today was the last session that we , uh, have done and we have our graduation in two weeks time for all those learner who have done the first cohort of PEM certification program. Other thing that we started and that I'm very humbled and proud and immensely happy about is did a facul started a faculty development program. Simulation is only considered as in Pakistan, I'm talking about Pakistani context that if you have a Bix sim center or you have loads of resources and a HiFi mannequin, then only you can do simulation. So everybody is tied that we are not doing simulation because it require lots of resources and we do not have that much of resources. So we find that opportunity that we need to convey this message or do a faculty development for the faculty and educators in Pakistan and make them equipped that simulation is not only limited to sim centers or it is not only pedagogy that be utilized by those who have lots of money and resources. So we started this faculty development program, which we called it simulation instructor workshop. And we have done up till now four cohort, like four of such workshops and trained almost um, 80 plus faculty from basic sciences, from clinical sciences, from various sub-specialties on how to utilize the basic principles of simulation based education in their own educational curriculars and in their own setting. So this is kind of opportunity which I feel come to surface during the covid and during that time when acceptability for distance simulation become more and more.

Deb: 21:27

Thank you. Yeah, you've used uh , an opportunity to go ahead and spread more knowledge to the educators. That's wonderful. Now can you share with our listeners maybe the biggest thing that you'd like them to know? Something that when you learned it, it changed the way you practice or a personal aha moment

Jabeen: 21:46

<laugh> ? Yes, for sure. While I was doing my PhD, as I told, I have done three studies and sometime I would love to talk about each one of them in detail. But my first study was adapting the curriculum to the cultural context and in here the cultural context was the Pakistani learner and the second study was uh , a qualitative project where we did an in-depth focus group interviews with the learners and uh, facilitators to understand how they are understanding about cultures change when they are interacting to each other. But the third study actually, which is after lot of discussion with my supervisor who is Susie Ed Ong and she introduced me with one of the cons ways that how we can utilize law she content validity index in finding some validity evidence for the tools. So for my first and second study, we um , used the clinical cultural competency questionnaire. So for my third study we noticed that this tool have never been shown any validity evidence for simulation educator. That made me realize that when we as an educator are not known or are not aware that what is my cultural understanding is or what my perspective cultural is, how can we make our learners go through a curriculum which is culturally sensitive or cult culturally adaptive. So that is kind of an aha moment and that's why I pursue my third study as exploring or finding some validity evidence for this clinical cultural competency questionnaire by utilizing logi content validity index process.

Jerrod: 23:45

I do love that you're taking your experiences from various, you know, all your experiences are be tied up into what you're practicing today and then you're giving back to those as well. What are pieces of advice that you would also want to share with others? I would say, hey, there, there is with these heavily resourced cities, countries, institutions, et cetera , how can they start trying to do more of this and what advice would you give them to help give back?

Jabeen: 24:14

The biggest advice is it was also in my mental model frame that the culture can only be different if I'm from Pakistan and I'm working in Canada or the countries or geography of the culture. But the culture is more than that. It's just not limited to geography. It's how I think, it's what's my beliefs are, what's my stake are. Uh , for example, I really like this iceberg model of culture where they say how you dress up, how you talk, how you walk is only superficial part of it . The more in-depth part, which is the down part of the iceberg, is more and I would say recognize the power of cultural awareness and then apply it in simulation based education, embrace the diversity and the challenge it pos and then foster the inclusive learning environment by integrating cultural perspective. Every one of us as simulation educator can shape healthcare professionals in a way that they can deliver , uh, patient-centered care to diverse population. So this would be my biggest message. Don't be afraid. It's not easy thing to do, but it is very, very fulfilling thing to do.

Jerrod: 25:29

So then that ties it out. Well cuz my next question was if theres one thing that people could remember this conversation by, what message or final words would those be? And maybe you wanna repeat what you just said, but I don't wanna steal your thunder there if that's the case either.

Jabeen: 25:44

No worries. That's all good. It's just like, as I said by uh , like there are a couple of points that always I keep in mind when I am now writing a scenario, talking to a learner , uh, having a conversation that be culturally aware, embrace diversity and challenge your assumption. It might be something else in your mind, which could be something else or something different for other foster uh , inclusive learning environment. And then help the healthcare system to shape empathetic , uh, healthcare professionals. So this would be my message.

Deb: 26:23

Thank you. I really liked how you described the iceberg and about how the way someone looks, talks and walks is just the tip of it and the inside of them being something totally different. So I I thank you for that analogy. That was very, very helpful.

Jabeen: 26:41

Yeah. Yes, thank you. And I literally, if you come , uh, it is just, you cannot cut it . But I'm just talking about it that while going through this process I realized so many terminologies are being used culturally aware, culturally sensitive, cultural humility, cultural competency, and I just make my own framework that you first become culturally aware because you started to know who, what is your cultural identity. Then you develop or start understanding other per people or other person culture. Then you become culturally sensitive and then you continue to explore it further during your journey. While either it's your professional journey, your personal journey, you want to learn more, you want to be more aware that make you , uh, culturally human, that you are okay interacting with people from different cultures. And then it'll continue to take you toward the cultural competency. So I just make my, the circle of culture by myself, which , uh, make more sense to me.

Deb: 27:47

<laugh> , that makes a lot of sense. Is there anything else that you'd like to leave our listeners with as we come to a conclusion here?

Jabeen: 27:56

Yeah, definitely. I think , um, uh, what I really want to say that I might have introduced everyone with various terminologies and various concept. I'm happy if anybody wanted to connect with me and want to explore it further because it took me three years to understand them and I'm still very, very novice and new to the space and happy to learn with anyone who want to get in connection with me. Thank you so much.

Deb: 28:24

Thank you. And where would our listeners get in connection with you? We can put that in the show notes to make sure they can reach out.

Jabeen: 28:30

Yeah. Yes, I am happy to share my email, which is Jabeen like my first name, which is Jabeen, J A B E E n , Fayyaz my last name F A Y Y A Z@gmail.com.

Deb: 28:47

Thank you. Thank you very much. Do you know Matt Charty ?

Jabeen: 28:52

Uh, yes. Yes.

Deb: 28:53

Okay , good. I think he's doing a lot of work around

Jabeen: 28:57

Cultural .

Deb: 28:57

Yeah . Yes .

Jabeen: 28:58

Good . I met him in IMHS and we are doing some kind of work together, <laugh>.

Deb: 29:04

Good, good. You know, I've only lived in the United States, so I have mm-hmm . <affirmative> , you know, a lot of, just can only think of one from one lens. Yeah . So with that, thank you very much and happy simulating.

Jabeen: 29:17

Thank you so much for giving me this opportunity. Uh , it's uh , it's such a pleasure talking to you all. <laugh> ,

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Thanks to innovative sim solutions for sponsoring this week's episode.

Outro: 29:36

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