This episode is live from INACSL and Deb interviews Amanda Wilford and she shares her journey into simulation. Graciously sponsored by iRIS Health Solutions.

Amanda talks about her time at METI and how she "walked through the door" of simulation. Meeting great people all over the world. She shares her 20-plus years of experience and how she has learned along the way. 

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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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Thanks to IRIS Health Solutions Limited for sponsoring this week's podcast. IRIS is a scenario design platform, which makes it really easy to design, set up , and run great scenarios in line with recognized best practice. IRIS makes co-design and sharing of scenarios simple and the library and review. Ensure one high quality version is always maintained. You can also join the IRIS Fair share community and access , reuse, or repurpose over 700 scenarios from colleagues around the world. With IP always recognized, the new Iris mini sim wizard allows quick and easy scenario creation for simpler sims, such as in situ two , primary care and paramedic.

Intro: 1:00

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: 1:39

Welcome to another episode of The Sim Cafe, and today we have Amanda Wilford.

Amanda: 1:47

Good afternoon, Deb . Thank You.

Deb: 1:49

Thank you for agreeing to being a guest today. I'm very honored to have you.

Amanda: 1:55

Thank you so much for inviting me, and it's a real privilege to be here in Providence , um, on Rhode Island.

Deb: 2:02

Yes. And for the audience that doesn't know we are recording live at an INASCL and this is my first time meeting Amanda, and I'm truly honored. So Amanda, why don't you tell us a little bit about your story and how you got into simulation.

Amanda: 2:18

Okay. Well, it was a phone call. I was a ward sister on a car jack ward and I answered a phone and someone said, we're looking for a , an educator to come and teach some nurses in the simulation center. And this was about 2000 and I thought, I can do that. I've never knew what a simulation center was. So I, Julie turned up, I delivered a very boring theoretical session on chest drains and then stayed and watched post-graduate nurses interacting with a , an interactive mannequin doing care of a patient with a chest drain . And I was literally blown away. So after that I said to the , um, instructor, I want to be part of this. And then spent the next two years volunteering for them until finally a full-time job came up at the Bristol Simulation Center. And then I began my journey into simulation at the end of 2002. And it was just phenomenal seeing , um, learn in such a way that they could problem solve , thinking about patient care change management. And it was at that really early stage in simulation where we didn't really know the science or the literature. So it was a time of innovation and excitement and experimentation. And that's really how it all began.

Deb: 3:31

Wow. You really are a pioneer. If it was in the two thousands Yeah . Early two thousands cuz it's coming up on 25 years, right?

Amanda: 3:39

Yeah. And it was one of those times when, you know, things open, a door opens and you bravely walk through. And then at Bristol we, we were taking the simulator out to the clinical areas, which we now call in situ point of care simulation and, and seeing the power of simple things, of making changes and then doing interprofessional stimulation. But at that time we just had nurses, doctors, physios together and then suddenly understanding that there was literature behind it , there was research and just really trying to figure out where, how you do it, how you design. So I did lots of dreadful things that now you would , you would look back and think, why did you do that? But now as I look back, I can see how the science has grown and how the literature, the growth of simulation societies and also the simulation community is so friendly and networks and shares. And for me that has really why I've stayed so long is because I've changed jobs within simulation. I moved from the UK health system into industry. I work for a company called Meti , then cae , and now at the University of Staffordshire in the uk . It's really nice. I've , I've had a bit of everything. I've done the public health side, I've done industry and now academia. So it all links up. And again, you can see how those lessons and those experiences really make a difference to patient care and safety.

Deb: 5:02

They absolutely do. I love your accent. Thank you.

Amanda: 5:06

It's the English thing.

Deb: 5:08

<laugh> , I just couldn't have tell you that. Okay. So go ahead and tell me a little bit about your time at Meti and what you did there.

Amanda: 5:15

Okay, so I joined Meti cause I just wanted a change and sometimes again, you've gotta walk through that door. So I joined Meti really, they were doing something called the program for nursing curriculum integration. And they wanted to internationalize it. So , um, a post was available. So I thought I'll have a go at that. What I did at Meti was I did work in the uk but then I began to go across Europe, work in the Middle East, the far east, and realize that simulation is very cultural specific and you really need to understand people's healthcare systems and what works in one country doesn't necessarily work in the other. So really being very aware of the patient or client group, the healthcare culture and the way the practitioners work with each other. So a lot of my time at Meti and then when I, when Meti was acquired by ca was working internationally, embedding simulation. So looking at curriculum integration , uh, faculty development, really maximizing learning, but always being cognizant of it's about the learner's journey, but also the patients and clients in their care. So I'm very aware that it's not my view, it's here's what you could do based on good research, evidence-based practice, but what do you need and , and how can we make those adaptions? So it was very much around mentoring and development.

Deb: 6:36

And I think simulation is have a way of looking at a situation and recognizing very early on that there's not just one way to do something and are brave enough to respect other people's opinions and ideas and thoughts and then say maybe this idea and thought is better than the one I had.

Amanda: 6:59

Absolutely. And I also think as well, you know, we talk a lot today about equality, diversity, inclusivity, but actually it is about being culturally aware and actually working in partnerships. So I'm very much a community of practice person. What is it? You come together, you share? So I've done a lot of work in India and that tra that transforms some of the ways I've worked with students where maybe English is not their first language. And again, in the UK we have, we welcome nurses and doctors and other professions who've trained elsewhere to work in the UK and be very aware that they bring a wealth of experience, they bring a different way of doing. But it's lovely to see that. And then you think, actually let's embed that into my practice as an educator, as a clinician. So for me, that cultural piece, and I think that's what I learned in my Meti C world was one size does not fit all and you have to really individualize it. And actually it's, it's a co-creation of new knowledge and experiences. And then I was fortunate because I traveled the world, I worked with lots of pioneers and had the opportunity for them to watch my practice. But I learned from some amazing people like Kim Leighton as an example, seeing her do simulation and then saying , you know, can I talk to you about that? And then she watched me do simulation and gave me ideas and a whole host of people. And that's incredibly inspiring and that's what I think the simulation community does is it really, it shares, like again at this conference here today at an axle, people are just sharing, oh, let's try this, what about that? And I've already got a huge list of ideas to take back to Stafford.

Deb: 8:30

Great. Great. Why don't you name one or two of those ideas that you're gonna bring back?

Amanda: 8:35

Well, I went to a great session today with a standardized or stimulated patients where they're asking the, the SPS to actually fill in an evaluation based on a US healthcare evaluation that she used across the country. Well, we have something similar in the uk and I'm like, well, we could do that. And that again, gets our learners, learners in the house and social care to really think about how they're measured in their professional practice. So I thought that was a , a really amazing idea. And again, I went to a really nice session around gender and about how you embed that very early on and how you support not just the students and the facilitators. And that link to some work we've started doing at Stafford. And again, just some top tips on things to think about, you know, do a needs analysis of where we are in the curriculum. So that was something, it seems obvious now, like I should have done that, but suddenly it's like, you know what, yeah, this is what we need to do. So

Deb: 9:28

I think you bring up something, several things that are very important and one is the cultural aspect of wherever you are at medicine is treated differently, populations are treated differently, there's different, even things like frost burn mm-hmm . <affirmative> and hypothermia in Alaska compared to drownings and heat injuries in Hawaii. But all over the world there's different, different cultural and different medical things that people need to be aware of.

Amanda: 10:04

And also I think the terms, you know, a registered nurse, what a registered nurse in the US might be slightly different. The skill set to registered nurse in the UK or in other parts of the world. So just, just because we have the same label that we're not the same. And it's about finding out what is your scope of practice and actually how that changes. And, and again, looking at issues between the professions, there are, you know, communication issues that we still see across the world, but they are slightly different depending on the culture you are. And also I think from the way that you went to school, you know, I trained back in the 1980s as a registered nurse, incredibly different. I wore a hat and an apron. Um, and these days people would laugh, you know , that's what you wore to work, but that's how it was back then.

Deb: 10:46

No, I wore a hat. Yep . <laugh> , I wore a cap and um, I think they called it a tabor. It was just kind of a , a thing that fit over your front and back with little pockets on it. Yeah. Amanda, do you have a favorite or most impactful simulation story that you'd like to share with our, with our friends?

Amanda: 11:05

I do. And it's , it's right back at the beginning. So the thoracic ward in the hospital I was working out wanted to have C P A P used on the ward earlier on. So we used the simulation center to do loads of training on how to set up a CPAP machine, the type of patients . The final piece was to do a simulation in situ before we went live with real patients. So as we did the simulation on the ward, we realized it was quite an old building that there was no piped air. So we thought, okay, we'll use an air cylinder, but then we calculated how many air cylinders we'd need in a 24 hour period to change over and realize that was a big health and safety issue. And that's when we realized that we couldn't do C P A P , but it wasn't about the experience of the staff, it was about the infrastructure. And that's when I realized that simulation isn't just about education training, it's about ergonomics or human factors, about processes, about change. And from that moment on, I really began to explore in my own practice that yes, let's do simulation for teaching and learning, but let's look at processes, let's look at protocols, piloting new ways, new techniques. And that for me was a , a huge aha because what would've happened is we would've gone live with real patients setting up CPAP and then it would've been a health and safety issue and potentially a patient safety issue. So that's always stuck with me that it's, it's about the, not just about education, it's about processes, it's about what looks great on paper as a process, as a protocol. Does it work in the real world? And you can also use , then use simulation to recreate maybe error and figure out where it is. And it's not always one person's fault. It's , it's often a huge system, infrastructure processes. It's a very complex picture. So that was my big aha moment.

Deb: 12:56

Thank you . Now is there anything, I know that you just recently received your endorsement, your INASCL endorsement. Why don't you share with our listeners a little bit about that , how the journey was and

Amanda: 13:08

So, so , so Staffordshire , um, have invested in a brand new simulation bill . So 5.4 million pounds. And although simulation was being used across the school and we trained nurses, paramedics, operating department practitioners, social workers, biomedical scientists, and sports scientists and psychologists ev there were pockets of amazing simulations. So we really wanted to think , how can we bring the work together? So we went through the Axle four endorsement because it really celebrates teaching and learning based on four standards. And because I think the standards are really useful, we felt we could use it for all the professions in the school. So it was a really lovely way to actually reflect on our practice in regard to the pre-briefing or briefing standard or the professional integrity. And we really were able to benchmark what we did and it just gave us a moment to think of where there maybe were gaps that we wanted to look at. But it did bring the faculty together because we realized as for all of us at work in education, that it's about the learner experience. So just bringing that evidence together. The other way it's been useful is for new staff joining the university to say, you know, this is our standard. We're not saying to people you must use X debriefing model. What we're saying is you need to use a debriefing model that links to your learning outcomes and the level of the learners. So it's really solidified a really lovely foundation across the school that we have a standard that, and when now telling the students, when you have simulation here at Staffordshire University , um, in the school, this is what you're going to have. I'm actually doing a lot of work around the student experience. But it was also a real celebration when we got endorsed. It was a moment of celebration that we're on the right track, but it also gives us a , we're pointing towards where next. So for me, I would encourage anyone, if you're thinking about benchmarking, particularly if you are quite new in your simulation journey, you've got new staff or a new building, I really, we really enjoyed the process, putting the portfolio together, what evidence to include. And we tried to include some of the student voices as well as the faculty. We really enjoyed doing it. So it was a , it is a lot of work, but I think it's, it's work that's incredibly valuable and we can use it for other things. So for other regulatory we can say, look, we've done this piece of work. So yeah, I really enjoyed it.

Deb: 15:31

Where next, where do you think you guys might wanna go next?

Amanda: 15:34

Um, we are exploring SSH, I w ill say exploring at this stage because I , I don't w ant t o, but we're also, again, I think when you look at things like endorsement or accreditation, it really just makes you look at where the gaps are, a needs analysis for your faculty development, your technical development, but that learner journey. So I think it's a way of bringing it all together and celebrating those successes. But also the team that I work with, we, we do our internal faculty development where the gaps are. So we're not just doing the same thing. We're thinking about this is now where we need to focus on. So currently within the school we're looking at o ur R SP policy to make sure that it's up t o d ate. And I think, I think doing these activities, it just makes you reevaluate what you're doing. And you know, practice changes. You know, 20 years ago we didn't have a briefing, pre-briefing standard. Now we do. So again, the standards keep evolving and I think all the simulation societies practice i s changing as technology and it just keeps us up to date and on that cutting edge.

Deb: 16:34

Excellent. Now what are some of the things, if you wanted to leave our , to talk about what's the one thing that you learned and it changed the way that you practice

Amanda: 16:44

In , in regards to simulation?

Deb: 16:46

In regards to, you know, what it can be in regards to anything Amanda.

Amanda: 16:50

I think it's made me realize, and this sounds really obvious, it's okay to say, I don't know . Oh

Deb: 16:56

Yes.

Amanda: 16:57

Um , so I really like the CU tool from Team steps, but I don't just use it in my professional life, I use it in my home life. You know, I feel concerned about X whatever uncomfortable safety issue. And I found that saying to people, no , or can I just think about that? Can I just clarify? And I think when you are newly qualified as a practitioner, that takes a lot of bravery to say, I'm not sure. Can you just explain that a little bit more? And I think being a simulation facilitator has really encouraged me to teach others to say it's okay to pause, you know, and imagine if this was your family member, you would want that healthcare professional to say, can I just double check ? So I think it's okay to say no. Um, it's far worse to do something that you're not ready for. You feel prepared. So , um, and I've taken that into my home life as well as my professional life.

Deb: 17:51

I love that. And I think that when you think about it, especially for teaching people, setting boundaries within your own family life and you know, someone might, you're trying to teach your kids how to set a boundary, okay, when you say, let's do this, I'm concerned about this and here's, here's why. Can we create a new generation where, help me understand, right? This is about safety. Why do you think this is okay to do? Right? Yeah . So I think I , I really do , uh, appreciate team steps in the , in the cus words. Yeah , yeah .

Amanda: 18:21

Um , I've also taught it to my mum . So when she needs to get help, sometimes when you access healthcare services, you have to go through various firewalls. So I've taught her the cuss tool, which she has used to great effect. Cause it really made her think if you do need to speak to someone , um, and she's taught it to her friends as well. So at the parish council. So really practical tool that can use in many walks of life.

Deb: 18:45

Right now. Amanda, is there anything that you'd like to leave our listeners with today?

Amanda: 18:50

Um, I'm gonna leave on a quote if I may. So I trained at the Nightingale Girls School of Nursing wearing the uniforms that Florence designed <laugh> and Florence said this in notes of nursing, I think it's 1857. And she said the first requirement of a hospital is that it should do the patient's no harm. And I think that's what simulation is. I think if Florence was alive today, she would be a simulation pioneer. I do believe that. And so for me that philosophy is something I think all of us that work in health, in caring professions or where we interface with , um, the public always be safe. And for me that Florence Nightingale quote epitomizes it.

Deb: 19:30

Thank you so very much. And, are you enjoying INASCL this year?

Amanda: 19:36

I am. It's fabulous exhibitors, the sessions, the networking, so yeah, another couple of days. So I've got brimming full of ideas, so yeah, really enjoying it.

Deb: 19:46

Excellent. Thank you so much. And happy simulating. Thank you.

IRIS Tag: 19:51

Thanks again to IRIS Health Solutions Limited for sponsoring this week's podcast. IRIS Health Solutions Limited makes co-designing, sharing, and creating sim scenarios. Quick and easy.

Outro: 20:11

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.