In this episode Deb sits down with Dr. Jose Roberto Generoso from Sao Paulo, Brazil. Dr. Generoso is President of The Brazilian Society for Simulation in Healthcare.

Dr. Generoso's email:  Josegeneroso@gmail.com

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Transcript

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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: 0:58

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: 1:40

Welcome to another episode of The Sim Cafe. Thank you for joining us. And today we have Dr . Jose Generoso, and he is going to tell us a little bit about himself and about Brazil in simulation in Brazil. Thank you for being a guest. And why don't you go ahead and tell our listeners a little bit about you.

Jose: 2:02

Okay . Uh , thank you so much, Deb . Thanks for having me here and , uh, giving this great opportunity for me to speak a little bit and , uh, make Brazil more known about simulation and trying to share about our country with your listeners. And , uh, that's my pleasure. So again, thank you so much. So I'm a critical care physician. I have a background in internal medicine. I graduated in 2006 , uh, here in Brazil at the University of Mogi das Cruzes which is a nearby city surrounding, uh, the greater S ao Paulo area where I'm located right now. S ao Paulo i s the, uh, largest city here in Brazil. And I've started my journey in simulation during my, uh, critical care residency at A lbert E instein Israeli Hospital here in S ao Paulo, uh, where a s a, uh, resident in critical care, we had a lot of s im sessions and sim training, how to perform procedures like intubation, central lines, and, uh, how to t rain a nd how to treat a nd septic shock. And, uh, I've started feeling really confident after those trainings. And, uh, I was sure that gave me a spark that maybe simulation would be the right way to teach and, uh, for, uh, medical students and medical staff and also, uh, h ealthcare associated professions could benefit from, uh, simulation-based learning. And, uh, after finishing my critical care residency in 2013, I, for one year, I pursued a formal education in simulation, which I could not find here in Brazil. U h, what we had at the time was pretty much a C L S a nd instructors course, but I was looking for something more, uh, deep into simulation that could actually and potentially, uh, transform the way, uh, I teach, o r that I was, uh, seeking to teach. U h, then I found D r, uh, Richard F iddler and, uh, D r. J an H irsch at the San Francisco VA Medical Center during, during I M S H in 2014, which, uh, by coincidence was held in San Francisco at the Moscow Center. And they took me, they accepted me to, uh, serve as a fellow at the San Francisco VA. And, uh, I spent two years, uh, taking a fellowship in advanced clinical simulation under their mentorship. And, uh, after coming back to Brazil in 2016, I founded my, uh, own company, which is called G enin Simulation. And, uh, I provide simulation services here in Brazil to different companies that w ant t o benefit from this amazing strategy i n, uh, teaching simulation. And, uh, I a lso had a couple books published as a, a co-author. I s erve as a reviewer. I work as a part of a , t he planning team for I M S H, and I am currently the president for the Brazilian Simulation Society, also trying to expand simulation in Brazil a lso. That's a, uh, brief summary of my journey into simulation. And, uh, that's it. And I a m a Gemini.

Deb: 5:32

Thank you. Thank you for sharing all that. And thank you for all your contributions to simulation. That's wonderful. And we are very interested in learning about simulation in Brazil.

Jose: 5:45

For sure.

Deb: 5:46

So do you have a favorite or most impactful simulation story, Dr . Generoso?

Jose: 5:53

I actually do, I give a lot of thoughts , uh, to that one because , uh, being into simulation, there are so many things that has an impact , uh, in you being from like a debriefing that you did, right ? Or designing a scenario or senior student actually having a better performance. But there was , uh, one moment that really impacted me. Uh , when I was a second year fellow , uh, at the San Francisco VA with Dr. Fiddler , uh, we used to have, every Thursday morning, we used to have an and run an in C2 simulation for the I C U team. So that was our , uh, big event of the week. Cause everyone was involved, the other fellows were there. And , uh, I c u staff was there. We would call for pharmacy and , uh, we had rep response team , uh, for sports . So everybody was there , uh, at the simulation, at the simulation, uh, at the I C U . Uh, but sometimes we would not be able to run simulation because some c old or some e mergency would happen. But in a , for coincidence o n, o n that day, we had our simulation done. And, uh, I think that was something w e, uh, difficult airway management in the I C U . So we just finished our, uh, our scenario, then we went to the debriefing room and, uh, r ep response team was called because a woman had crashed at the curbside at the main entrance of the hospital. And, uh, she was there laying down. And Dr. F iddler, uh, intubated her on the curbside and, uh, s tayed w ith her. She went then back to the I C U , and, uh, I believe she spent like several weeks at the hospital and she went, uh, back home and alive a nd, uh, thanked a lot, uh, to r each and, uh, all the s ing team and also to the, uh, all the attendees that helped her. So that was very impactful to me because I saw that simulation, s ome t hat we had just trained, like maybe five minutes ago, actually happened in the hospital. And we saved the whole team, helped saving her life. And, uh, if that didn't happen, okay, she could have, uh, been saved as well. But, uh, I believe, uh, had just practicing with simulation m ake things go, uh, way more smooth w ay go and everything h ad their mind sharp, they h ad, they know what to do. And, uh, that was a huge success, uh, to everybody. And, uh, that's what we want from simulation. That s ame sessions a nd practicing simulation actually translates into p racticing and actually improves patient safety and quality o f care. And that was something that we really, uh, achieved on that day.

Deb: 8:50

Thank you. That's a wonderful story. And I fully agree that, you know, the deliberate practice for mastery skills on those high risk , but low frequency events, right? How many times is it a difficult airway? Many times it's, if you're trained for an airway , you're trained for an airway. But I like that idea of a difficult airway. Now, Dr . Generoso, so where do you see the future of simulation going?

Jose: 9:17

That's a very , uh, tough question to answer, but , uh, as I see, like, I see technology growing and all the time, like in people , uh, saying that maybe AI and virtual reality and uh, everything , uh, may play a major role over the upcoming years. And , uh, and I agree with that, but I still strongly believe that human beings, like, and the educators and the syntax and people that actually work with simulation will still be the major piece of it. But I see the virtual reality and , uh, augmented reality and , uh, artificial intelligence, especially now with , uh, G B T chat that everybody has been talking about it. Uh , one thing that I, I have been thinking and wondering is the way we, we develop a scenario like , uh, we run something, we talk to , uh, hospital stakeholders and hospital leaderships and try to gather what they think that would be more useful at their area and their expertise and how we can help with simulation. But it's more like a perception, or someone goes there and they sit and check all the data and all the records and make a conscious decision. What do they hospital, what do that , uh, specific area of the hospital needs for training? And then we develop the scenario, measure measurable objectives, and , uh, we run same sessions, but maybe AI could help once that maybe create an automatic process that they would analyze data and put everything together and say, Hey, look, this is what you need. Uh , there are people , uh, having so much side effects due to this or that , uh, mal prep prat , maybe you should train staff on how to do that. But being , uh, already done, like how you , you don't need to go through all the data and read everything and talk to the same thing and talk to everyone, and then create on paper handwritten what you're gonna do. Maybe if that goes already in a , in under an automated process, and then you can just go there and , uh, run simulation and make it more effective, I think that would save time and we would probably have a better understanding and , uh, read our data , uh, in a better way than just having lots and lots of papers or , uh, bios to read and make that conclusion. So that's one thing that I, I have been thinking about , uh, AI that could pretty much help simulation. And of course I see like , uh, mannequins and simulators having a , an increased fidelity and , uh, have multiple resources. And , uh, we expect them not to be super expensive. That makes it prohibitive to buy. But we'll see. I think we should , uh, wait a little more to see , but I , I'm very curious , uh, to see how it goes.

Deb: 12:15

Thank you. That's a very insightful response and a unique one as well. So thank you for that . Now , can you share with , um, with our guests , what were some lessons that were learned during the pandemic and did that change your goals in any way? And obviously we're talking about the pandemic in Brazil and what, you know, your story is from there.

Jose: 12:43

Yeah. Uh, I can't say it changed , uh, my goals or goals , uh, nationwide in Brazil, but I , I think it demonstrated that simulation is a crucial part , uh, into teaching and the learning process to every healthcare , uh, professions. And , uh, I think that simulation also helped a lot of our interns and , uh, especially medical students that were off hospital into learning , uh, several procedures, maybe with simulated patients. And , uh, they could , uh, have some sort of a better training than no training at all, that what was happening during lockdown here in Brazil. And , uh, something that also grew , uh, more here , uh, in my country was , uh, telehealth and , uh, maybe training , uh, students on how to perform an assessment over a patient that is not physically in front of you. So several companies had developed softwares and to telemedicine, which is something pretty new in Brazil. And , uh, I can say that it was , uh, regulated by federal legislation and , uh, uh, everyone got more usage to it after the pandemic in 2020 , uh, when it, it really stuck with , struck here in Brazil. And , uh, I also see that some people started to notes in simulation also as a , as an effective tool in , in Brazil because , uh, we were recruiting , uh, physicians , uh, to help at the ICUs at the emergency department. So some people that didn't have an expertise on , for instance, on how to use a mechanical ventilator or how to use , uh, how to perform an intubation , uh, how to manage a difficult airway. So we had that , uh, training for them into simulation. And uh , I had the opportunity to do that at the Universty of Santa Mato, which is one of the simulation standards that I , uh, that I coordinate. So we run several , uh, airway management training for our local physicians there that w ere going to the front l ine and, uh, help those patients in n eed. And, uh, I also gave a thought like maybe that's something, uh, how I see a simulation in the future, maybe using more holograms and, uh, that technology c ause u h, this, t his s till u nknown. I've been going t o I MH like since 2014, like over the past 10 years. And I can say that last year a nd this year there was a lot of new technology regarding holograms. So maybe, uh, that's something that we can use into simulation to perform a remote debriefing into multiple s ites. Like I can run a simulation, I r ead debriefing here in Brazil using my hologram at P AC P alms, uh, per se. So that's just something that I'm n eeding that I'm thinking at this point right now. But I , I d on't k now if that would actually work, but that would be something better than just being into a TV screen and trying to run a debriefing without being there physically, uh, present. So I still don't know how to use it, but that's something that I'm envisioning for the future.

Deb: 16:02

That's very interesting. And I really like that idea. Thank you for sharing that. Now we're gonna switch a little bit here, and we're curious about, do you have something that you can share with our listeners the biggest thing that you'd like them to know? Something that when you learned it changed the way that you practiced a personal aha moment?

Jose: 16:23

I couldn't remember one, but I have them all the time. Like when someone tells me that they press and the next day what they were , uh, with an real patient and they did what they were supposed to do because a simulation or , uh, when something was accepted to publication. Uh , but what , what, I can say that from my perception and my experience into simulation, that simulation really changes perhaps the way you practice . And , uh, it's super fun , uh, to do it it's way , uh, more interactive than just sit and , uh, having a, a lecture, which is totally fine. And it has , uh, its space and it has its , uh, objective just to have a lecture. But I believe simulation is very fun and interactive and effective, and it doesn't compete with actual patient contact with just a theory . So it's something that combines into it to graduate and form , uh, better people and better professionals into their area. And one thing that I , I would say that my aha moment was when I realized that simulation is not investing into super expensive equipment, and the highest, which was something that I had that perception before actually studying simulation, that I thought what makes the difference is having a huge sim center full of virtual reality and high fidelity mannequins. But after being to that area for a while into simulation for a while, I realized that that's not what makes the difference. Of course, that's important to have, but what really makes the difference is having motivated educators, having a good team, having people that believe into simulation, having stakeholders, investing into simulation, and seeing the value of it. It's better to have a , a highly motivated team in very good educators , uh, with low fidelity equipment or do it our self equipments than having the best equipments in the world at the best , uh, infrastructure in the world with people that don't care about simulation or about they don't understand or they don't do it the right way. So I think that was my aha , uh, moment. But , uh, I can't say when it happened. I think it was the , during that journey into simulation.

Deb: 18:47

No, that's very, very true. And I think that when people first see the simulators and they're so attractive, right? People think, oh, you know , we have to use this, we need all this technology. But then when you actually learn globe germ, the , so , you know, putting the , the glow serum on your hands and teaching hand washing , that's simulation, but it's also very simple. And so it's, once again, keep it simple. That's a , um,

Jose: 19:12

Exactly.

Deb: 19:13

Yeah. Thank you for sharing that. So Dr . Generoso so why don't you talk a little bit about being accredited, becoming accredited in Brazil and how that was different and the , the story and what it means to you guys and your team.

Jose: 19:29

Of course. Yeah, that was a , a huge accomplishment , uh, given that , uh, in Brazil we are the first simulation center to be outside of a hospital and exclusive in a university to be accredited. There are , uh, two , uh, same centers that are accredited here in Brazil. One of them is Albert Einsteins Red Hospital, which was the first one , uh, the first of all. And , uh, we have Pac Palmas , a medical school from AFCAN Group one that I also worked to . And uh , that was an amazing , uh, accomplishment for us. And , uh, I'd like to specially thank Dr. Malva and Dr . Imar Mag . He's the local coordinator. And , uh, we put a huge effort , uh, to be accredited. So that was , uh, and that particular sim center was built from the scratch, so there was a whole new building and uh, and we had it designed , uh, perfectly. And , uh, we chose all the equipments. Uh , we ran , uh, needs assessment. We train , uh, the local team there and we make a simulation based curricula. Uh , that whole process started , uh, maybe two and a half years ago , uh, because we have always been focused in , uh, achieving accreditation from , uh, the Society for Simulation in Healthcare, which I also , uh, would like to thank to their help and their kindness being , uh, uh, visiting us , doing our virtual visit . And , uh, I think , uh, that was a major accomplishment for us and , uh, for Brazil. And , uh, we are looking forward , uh, maybe by the end of 2024 to, to submit for and uh , uh, we are provisional accredited now, so we are looking for , to be permanent, permanent accredited and uh , full accreditation. And we'll do that by the end of 2024. And , uh, over this year we are also planning to submit two more of our medical schools to be accredited, also provisional accreditation. And , uh, but the biggest accomplishment there was to see our medical students and , uh, learners really , uh, having a very good place to learn medicine and a very good place to do simulation with highly motivated people there and , uh, very good equipment. And that , that's our biggest accomplishment, seeing that everything that we actually planned has been putting into, into reality and they are loving it and , uh, we are loving even more. So I think that's , uh, probably my major accomplishment into simulation was helping that amazing thing to hold , uh, their accreditation.

Deb: 22:26

Well, congratulations on that is absolutely music to my ears. Thank you for sharing . And for any of our listeners who are on the fence , it's uh , Dr . Gene , would you say it's well worth the , the effort?

Jose: 22:39

Oh yeah. It's a huge effort, but it's a well worthy effort because one thing that we just at the beginning we decided we just don't want to have the seal. We really want to do things the right way. And having the seal, it's something like they vouched does that we are on the right way of doing simulation here in Brazil. And uh , uh, we are following the best standards of PR that for sure are from the Society for Simulation in Healthcare. So I encourage everyone who are listeners all around the world and also in Brazil that you apply for accreditation. Cause uh , it , it pays off for sure.

Deb: 23:21

It makes a difference. Thank you very much. Now are there any final words that you would like to leave our listeners with to remember this conversation today by ?

Jose: 23:32

Yeah , for sure. I think that , uh, just , uh, the bottom line is that simulation will grow more and more and I think it's , uh, has been growing over the past decades and , uh, for sure it's gonna be among medical students and , uh, everyone who is tune healthcare and simulation will be more known , especially here in Brazil and in different countries that maybe are not still using simulation , uh, the way that they should. And , uh, we welcome you all that if you want to be here in Brazil, visit one of the centers that I run , uh, currently the, the president of the Brazilian Society. So I can be of good help to anyone who wants to visit Brazil and get in touch with , uh, with simulation here with us .

Deb: 24:24

Thank you for sharing that. And thank you for the generous offer. We'll put in the show notes where, how we can get ahold of you. Are there any ways you'd like to share with our listeners if they wanted to get ahold of you, how they could reach out ?

Jose: 24:37

Yeah, sure. They can just send me an email. It's Josegeneroso . md@gmail .com and uh, I'll be more than happy to help anyone.

Deb: 24:48

Thank you so much and happy simulating.

SimGHOSTS tag: 24:52

Thanks to Sim Ghosts USA for sponsoring this week's episode. SimGhosts USA, connecting familiar faces, developing new friendships, and engaging where you will discover, explore, and excel together.

Outro: 25:13

Thanks for joining us here at The Sim Cafe. We hope you enjoyed. Visit us at www.innovativesimsolutions.com and be sure to hit that like and subscribe button so you never miss an episode. Innovative Sim Solutions is your one stop shop for your simulation needs. A turnkey solution.