Transforming Healthcare Education Through High-Fidelity Simulation Training at UT Health San Antonio

Step into the cutting-edge world of healthcare education with Jim Cleveland and Braulio Amezaga from UT Health San Antonio, who are transforming patient outcomes through the power of simulation training. This episode promises an enriching journey through the 17,000 square foot simulation center, where the fusion of high-fidelity simulations and team dynamics is reshaping the future of clinical education. Discover how Jim's expertise in trauma and emergency care informs his research, and how Braulio's technical acumen ensures seamless operations, as they both emphasize the essential roles of communication and teamwork in this innovative educational approach.

Gain exclusive insights into the evolution of simulation in healthcare, propelled by groundbreaking studies from the Texas Higher Education Board. The discussion reveals how high-fidelity simulations are revolutionizing the CRNA program and the intertwined efforts with UTSA's health schools, propelling interprofessional education to new heights. As we conclude, you'll marvel at the rigorous process and subsequent triumph of achieving Society for Simulation in Healthcare Accreditation. The dedication of Jim, Braulio, and their team showcases a commitment to educational excellence that not only meets international standards but also guides future growth in this dynamic field.

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Transcript

Disclaimer/ Interact Solutions/ Intro: 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. This episode of The Sim Cafe is brought to you by Interact Solution and cost-effective audiovisual simulation learning management system developed for instructors to record, organize, schedule, annotate and debrief student simulations, delivering timely, evidence-based feedback. 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 Tauber: 1:20

Welcome to another episode of The Sim Cafe. Welcome, j, and thank you, James Cleveland and Braulio, for coming on the show today. James C and Braulio are from UT Sa n n Antonio a. Thanks for coming on the show tod ay. W Why don't you get us started and tell us a little bit about yourselves?

James Cleveland: 1:39

Well, okay, first of all I'll go first.

James Cleveland: 1:42

My name is Jim Cleveland and I've been at the University of Texas Health Science Center about 15 years and I've been the director for the Sim Center for 10 of those 15.

James Cleveland: 1:53

So but going back to that, what brought me into the simulation at the university setting for education is I was trauma and emergency care.

James Cleveland: 2:02

I'm a clinical nurse specialist by training in the military to 28 years and we were teaching trauma back in 2000 in Houston and the civilian sector and for the first time ever using simulation we were showing team behaviors change with simulation, exposure as far as communication, identification of injuries and vital signs collaboratively identification of injuries and vital signs collaboratively and the patient's recovery and sustainment was greatly improved using simulation. That was the beginning of that type of research and of course it has been replicated and enhanced upon since. But that I've been with simulation for about 24, 25 years, military to civilian and of course that's riding the crest as high fidelity just started coming in around that time. So I've been involved heavily with education components and using simulation and nursing and interprofessional education throughout. So at the university with our sim center it's about a 17,000 square foot simulation center that has high fidelity, mid fidelity, low fidelity. We also work with standardized patients as well, which is generated through a group that's within the university setting as well.

Braulio Anastaga: 3:15

Hello, my name is Braulio Anastaga. I work at UT Health San Antonio. I'm the audiovisual manager and education specialist at the university. My background in simulation really started almost eight years ago when I started working downstairs at the simulation center for the School of Nursing. Usually my background before that was in research, so I did a lot of research projects. I've been working for the university since 2005,. So it's been a while since I've been there and basically I've been able to adapt my role, what I've learned from research and adapted to the simulation setting, as well as my backgrounds in adult education. So I'm able to mix those components together and assist faculty and staff in the development of simulations and how to adapt them and how to make sure they gain the objectives that the nursing faculty want out of their simulation. So my main job is to adapt them and how to make sure they gain the objectives that the nursing faculty want out of their simulation. So my main job is to assist them in those objectives.

Jerrod: 4:11

So, Braulio one knowing that you help with the technical and operational side for such a large school and 17,000 square feet, wow, that's something. What is a day in the life of Braulio, oh?

Braulio Anastaga: 4:26

it's. It's just making sure we we're all set up right. So it's it's talking to the staff. It's talking to both. Uh, you know, Jim are the manager of the land and working together to make sure that we have the staff to support the simulations, right. So typical day or typical week really goes is review the week. What kind of labs do we need to set up for that week? What, what do we pull for those labs? Then we look at the simulation schedule. All right, so then who is? We always have dedicated people for our simulation, so we have somebody who's dedicated for pediatrics, somebody dedicated for OB and somebody for adult. So then we indicate this is going to be your room, this is going to be your faculty, this is how many students we expect, this is how many times we're going to run the simulation, and so we set everything up prior to either the day before or two days before, so we can prepare a week before we will. And so what we try to do the best is we communicate with everybody, so I make sure we get with staff. Let them know. Hey, this is where you're going to need to be on Thursday. This is the time we're going to start, even though everything's already implemented. We have it in a calendar.

Braulio Anastaga: 5:31

We've realized that once we started implementing more simulations, people sort of tend to get lost in the fog of what's going on. You know, after you run the same sim three or four times, you just kind of forget well, what sim are we running tomorrow? You know, after you run the same sim three or four times, you just kind of forget well, what sim are we running tomorrow? You know, so I make sure to be assessed. Hey, this is what we're new tomorrow. Lay out the plan.

Braulio Anastaga: 5:59

So it's really a lot of running around, a lot of setting up, a lot of communication and all the verification knowing that, hey, this is what we're going to do, correct, yes, this is what we're doing. All right, fine, so I already have you all set up and making sure faculty come down when they are able to come down to review their areas, to review their setups. So it's a lot of checks and balances that I have to do, but luckily I have a team that really helps me and I think one of the things I'm starting to learn that I need to broaden those responsibilities across the team, because once one person sort of takes over everything, if that person's not there, it kind of slows the whole process down. So it's it's something that we're starting to learn, because we're such as we didn't do a lot of simulations in the beginning I think it was only three courses, and now the entire university uh, all the courses have a simulation, so you asked jared, so that's the answer.

Jerrod: 6:41

So but it's also incredible, like when you have the right people in the right places, how well you can see. Okay, there's the efficacy and simulation works and you see that the the benefits across so many different groups. And now you said you know a handful of courses now to the entire university. I mean, it is it? It gives me a chills. It really does, because it's people you know, when you have the right people in the right seats to that are passionate about it and say this is what we need to do. That's when things change.

Braulio Anastaga: 7:10

So that's an excellent point, I think, because they have the trust in us and our team downstairs, with myself, with Luann, with Jim, with Susan, with everybody. That's a team. They all know what's our strengths and that's why we try to put each other in our strengths and so we help each other out, and that way it benefits the students tremendously too, because they know we're there and that we're going to provide a good learning experience for them to take, and that we're going to provide a good learning experience for them to take and the piece that does help with Braulio having the confidence of the faculty.

James Cleveland: 7:40

He has a master's degree, like you said, in adult education, so he's able to do coaching moments, understanding pedagogy, andragogy, learning objectives and even the faculty or subject matter experts. Sometimes they don't understand how that necessarily lands as far as objectives in the learning center and the simulation, so he's able to unobtrusively do coaching moments where it looks a little more overt when I lean in, so it's a lot better.

Braulio Anastaga: 8:07

We have a control room for them to view, but they want to be in the room, so I have to remind them hey you know, come down over here, come sit down with me to remind them.

Braulio Anastaga: 8:15

Hey, you know, come down over here, come sit down with me. You can listen to it in here and you can take your notes here. Because what tends to happen is students always lean towards the faculty. If the faculty's in that room, they're going to look at the faculty and say am I doing it right? And then the faculty will knock their head, check. You know, and that's not what we want. We want that to be sort of like, you know, for them to think on their feet, for them to sort of be immersed in that simulation at the time. And if the faculty's in there.

James Cleveland: 8:38

they kind of take away that and I think that's one thing that's happened really, that suspension of disbelief that's so important for them to believe that the simulation is at least for learning purposes, is happening, for them to be present in it, and I think the conditions of the SimCenter, the reality that we provide, does help Just to understand, though for this team it is a small but mighty team. We have 750 learners that are within the graduate and undergraduate program, school nursing, standing alone, before we even include school of health professions, dentistry and medicine. So it is, it's a small but mighty team, but these guys are on and just the problem is they have so much confidence in us. They don't understand that we make it look seamless, apparently, but I think we're kind of busting at the seams at the same time. So people have to understand that there is it isn't magic, it's just a lot of really good people working together.

Jerrod: 9:33

That's incredible, and one piece is when you said it went to all the university just for to level set with our listeners. It's University of Texas, San Antonio Health. Give me health science, so give me all the differences and where we actually are targeted, versus where you kind of separate between the two.

James Cleveland: 9:54

Well, if I can first of all like I just want to kind of walk it back. We used to have a couple of courses that were very simulation heavy and then there were a couple studies that were done. So the Texas Higher Education Board first of all wanted to see can simulation be equally as good as real world exposures? And after that looked like the data showed that again it wasn't about being better but because of the balance where we can guarantee those high risk situations that normally be seen in a clinical setting but everyone can have exposure. It definitely showed that the field was fair, that it was equal exposure. And then we had the other study was done about increasing simulation.

James Cleveland: 10:37

So every one of our courses, undergraduate course, has simulation built into it now. So every student every semester has multiple simulation exposures of that 700. And the graduate program you know they use it for skills, they do task trainers. But now with the CRNA program coming in, starting in August, now we're going to have a very parochial approach to mandatory simulation as built into the CRNA criterium and they will be doing immersive high fidelity simulations as well as all of our students. Now the PC1 that you were asking about is interprofessional, so we have a link group it's called Link and that's about all the different schools coming together to work with different aspects of it and that's kind of a separate issue and we're growing that as we speak, but also the school health professions, physical therapy, occupational therapy, the School of Health Professions, physical therapy, occupational therapy, nutrition science. It is from UTSA. Yeah, they are out of UTSA.

Braulio Anastaga: 11:40

So yeah, you do have UTSA. Yeah, that's from the state.

James Cleveland: 11:44

So we do have that aspect and we have aspects of dentistry. Now that we've worked with recently. We're going to expand our role with dentistry, virtual reality, empathy training and then we also do community and research outreach, you know, with the aspects. So we have a community piece that we do for Alzheimer's and memory empathy training, as well as research components, and we're doing one right now. We're in the middle of using the radar group out of Austin, Texas, right now. So it's a full house and there's a lot going on, but the mission because of our bill payer being the student, they always have priority to everything in the skills center.

Jerrod: 12:28

So how many and thanks? That actually helps me a lot. But when? How many contact hours are you going through annually? Do you guys measure that?

James Cleveland: 12:39

well, we did for the accreditation process, but you know, the hours it's uh, I mean as far as per class that's where it gets a little complicated per class, per curriculum. That that's just. We're on basically. You know, sometimes seven days a week in the beginning of the semesters we don't turn the sheets off, I think for the first month or two. We have something going on there for almost eight weeks straight.

Braulio Anastaga: 13:03

Yeah, the first month is very skill-based, you know very so. Just they're learning those skills. And then after that month our simulation schedule begins, pretty much up until the end of the semester. So we always have at least one or two simulations running with at least a group of 20 to 30 students at a time, so it could be over for each student at least like 80 hours of simulation.

James Cleveland: 13:33

And we also do health assessment. That's actually. They come down to the skill center, they video it using our new AV learning software systems and with that that takes hours and hours and hours and then also grading required and it's all through our learning software system. It's a lot, but I mean the team. The morale is good, the team is focused and the faculty does a really good job of working hand in glove with us. So we couldn't do it without the global approach to doing simulation, people being respectful of our mission. So it's fun.

James Cleveland: 14:12

It's some of the hardest work you'll ever do and I was, like I said, in the military 28 years and some of these days that we do rival some of my days on deployment. So it is, it's a good team and the work again is rewarding, I think, for everyone, especially when you see the students, when you see those lights go on and they have those aha moments. That can only occur sometimes in a simulation area. And also a mistake. There is no legal aspects to it, right, we just flip the switch and start all over again. So it's a safe learning environment and we do our best to make sure it stays safe.

Deb Tauber: 14:46

Perfect Now I know you guys just recently received your SSH accreditation and how was that process and has it helped you guys as far as making things easier for you within the center?

James Cleveland: 14:59

Well, again, it certainly was a big to-do. We were preparing for this about three years ago, doing everything we needed to working with SSH. And then there's this thing I don't know if anyone's heard of it, but COVID happened and then it was a bit of a setback because the CSI it didn't really matter about simulation, we had to be on because clinical sites were haphazard, so we just had to keep rolling students through because we couldn't be set back by, however, whatever the time period was. So it became CSI, became a catch-all for all activities. So our data poll and everything else changed.

James Cleveland: 15:37

So post-COVID, we pretty much were focused for the last year and a half two years on revamping our efforts with the Society for Simulation Healthcare Accreditation and we were going to do preliminary initially. But then we went ahead and had a consultant brought in. I don't know if we want to name names, but the consultant was amazing and we also saw that we had enough going forward that we went for the full accreditation right away. Being a large center Once we pulled our data packs and everything together and it was substantial, I'm glad we went for the full pull. It was a lot of work but it really has been very validating. It shows that we're within the industry standards, we're a large center and it allows us to really become a focal point, and I think it gives everyone that little extra lift under their wings to feel that, yes, we are doing a good job, yes, we are providing the standards that are now internationally accredited. So yes, Raleigh.

Braulio Anastaga: 16:37

Yeah, it's definitely helped us just to see the whole scope of what we're doing down at the center. I think you're so much into the woods it takes a while, and I think the accreditation process allowed us to sort of take a step back and review the things that we needed to improve upon. I think that's one of the reasons why we went ahead and got a new audiovisual system. We got a new software system because we were seeing the data pool that we had the students indicating. We can't see what's going on. It's hard for us to hear me talking to the staff about using the system itself. Well, we don't use it. Because why? Because we haven't been trained on it.

Braulio Anastaga: 17:13

So, those little things add up. So we sort of it was allowed us to really review and improve our process processes a lot. You know we started to make little manuals again. I think what happens to with a small team. You sort of fall into this whole shadowing kind of hey, you just see me what I do, like you can learn it.

Braulio Anastaga: 17:31

But now that we're about to grow and we're growing as a university because we're going to start implementing more students, you know the process that the accreditation made us do was to sort of formalize all these things, and so now that everything's formalized, it's easy for me to bring somebody on, tell them this is what you need to learn. This is where you can find this information and this is where it's all at, so it doesn't fall all on one in the person, like myself or or Luann or somebody else, to just show them step by step what you need to do. Here's your information, learn it. Once you have questions, come and see us. Of course we won't let you just fly by yourself at first, but that's the process. I think it's really helped us.

James Cleveland: 18:08

And those processes also help because some faculty that are subject matter experts are a little phobic about working in simulation because they don't necessarily feel they have the skillset. And now with some of the processes we have, they can still be part of the simulation. But the AV techs can bring the technical life to the scenario and they realize now that they're not being exposed. They don't want to look like an imposter down there. So the processes that the accreditation helped us focus on has helped formalize that and we do onboarding, you know, in bringing faculty down. All this has vastly improved just going through the accreditation process.

Deb Tauber: 18:49

Excellent. Thanks for sharing that.

Jerrod: 18:51

Two pieces from my side is one it gives you recognition, which you definitely deserve, but two, it also creates this maturity process that makes you like you were already growing up. Now it's actually just putting labels on things and saying, ok, this is all that we've done in a very short amount of time. We were already doing it, but now we have to check the balances for it.

Braulio Anastaga: 19:12

And that's an excellent point. I think that I didn't realize that we had done a lot of this work already. Even prior to me getting down there, all of this work had already been laid down. It was just putting it all together. Prior to me getting down there, all of this work had already been laid down. It was just putting it all together, and so that's what took the longest because, like, the previous team had already done a lot of that foundational work. It was just us getting it and modernizing it right, just bring it up to speed. But everything was there already and it was just, oh, here it is. And I was like, oh, we already did that. And I was like, well, where is it? Oh, it's here in the share pool. Oh, cool. So then I could just update it, bring it up to speed and bring it up to the new changes that we had, and so it kind of really worked really well the accreditation process and bring all that together.

James Cleveland: 19:52

And it also helps us prioritize what's next, having the accreditation process, areas that we were really sound in, areas that we did fine in but could definitely improve on, sound in areas that we did fine in but could definitely improve on. So it allows us as far as budgeting and focus what's next and what's more important than the next item, since obviously it's a big show, you still have to definitely budget and prioritize and that the accreditation process certainly helped give us those realms and how to move forward. And when you're having discussions with the finance folks that may not be directly involved in the SIM center, you can show them case in point and why we need to move forward in a certain direction Because you're, as a center, so large.

Jerrod: 20:29

it would be interesting to hear someone from a small center who's got it accredited. Obviously, there's benefits on both sides, but I am sure that there's unique findings that differ based off size of center.

James Cleveland: 20:41

There's unique findings that differ based off size of center. Well, like even with the learning software we put in, because finally and we're still having to learn the software is complex, so we still definitely have to grow into it. The goal is that I can start running budget. Once everything's mature. I'm going to be able to tell you what it costs per contact hours you asked for, per simulation, per student, Because right now we order Luanne Click is our manager and handles our books and ordering. We do it based on bulk items.

James Cleveland: 21:10

But I need to know and up to this point it wasn't possible to know what it costs per student, per event, per semester, and now we're going to be able to get that data as well. So it'll be a much more pragmatic discussion to show exactly if there's a change. We can also predict, if we do make this change, what's the domino effect down the line. So it does, it all works, it works well and, again, you're always afraid to expose yourself for accreditation, but once you allow yourself to be vulnerable and you throw your hat in the ring, it was a great process.

Deb Tauber: 21:43

Great, great. Now, James, I know you have a new. You have a chapter, a book chapter. You want to tell our listeners a little bit about that.

James Cleveland: 21:50

Yes, the title of the book, it just it just came out. I just got released two weeks ago and copies and everything are completely are still getting sent to us right now. But I did chapter 22. It's an adult education learning text and I did simulation learning in adult education and I talk about, of course I use the perspective in the chapter from flight and certainly from my own optics of working in healthcare simulation, but showing now across the spectrum. Simulation can be used in almost all aspects of adult education. So that was the whole reach showing, yes, health care does this. Aviation has successfully done this. But I think it allows remote learners to use audiovisual, they can use case studies, they can still do immersives, even remotely. So, anyway, it just discusses that. And then again back to the data pool. We use the Kirkpatrick model, so I walked through the Kirkpatrick so everyone can track impact of the learning. But it will show you the reason for simulation, how you can use simulation and then how you can, of course, create data and actually measure improvements in learning and cognitive outcomes.

Deb Tauber: 23:08

Thank you. So do you guys have any final words that you want to leave our listeners with?

James Cleveland: 23:14

simulation isn't for sissies and I'll just tell you, you know it definitely you can't go into it uninformed and it does have to mature and it's not standardized. But there's also some proprietary pieces you have to be able to own and you and again, you know the old saying hope isn't a strategy. You have to have a sound format and, again, not to have to overly plug SSH. I like the standards that are provided within the society and it certainly does give you leverage points on how to build your specific world, as you have education needs. So just make sure you constantly keep up to date. It's an evolvement and, uh, always understand change is your only constant, especially in the simulation world yeah, simulations are learning activity.

Braulio Anastaga: 24:06

That's something we remind students all the time. Hey, it's a way for you to learn. It's better than a lecture, it's better than a powerpoint. Here you get to have hands-on user-critical thinking skills and it's and's done right. It could be both impactful, fun and you could learn a lot from it. So I think that's why simulation in the education field I think it's very unique and just it's very different, and that's what I like about it. Every simulation is different. Every experience is a little bit different. So even the monotony of the work, there's always something that surprises you, because you never know what the students are going to do.

Deb Tauber: 24:42

Yeah, you don't.

James Cleveland: 24:46

But it's rare that you guys took time out to talk to us and allow us to kind of speak about the Center for Simulation Innovation. I sure appreciate it.

Jerrod: 24:55

Our pleasure I think that your growth and how you've matured I don't want to say so much so quickly, but over time. I feel that it was in a short amount of time, but how can our listeners get in touch with you if they want to? If you go to the UT Health Science Center webpage.

Braulio Anastaga: 25:10

we're on the splash page you go to the School of Nursing, and then you go there and you title Center for Simulation Innovation. Our webpage will pop up and then Dr Cleveland's contact information is there, as well as Luann. Clicks and myself as well, probably on the saga.

Jerrod: 25:27

OK great.

James Cleveland: 25:28

Perfect, you could put up our email. I mean Cleveland J at Utesca d edu. I mean that's. If you want to put that up, just write to me directly.

Braulio Anastaga: 25:36

I'll send it down to the appropriate person.

James Cleveland: 25:38

I'll say hey, can you guys help with this?

Deb Tauber: 25:41

All right, Okay, well, thank you. Thank you so much and happy simulating.

James Cleveland: 25:47

Thanks much and thank you guys. Thank you Love your podcast. Thanks, Take care.

Disclaimer/ Interact Solutions/ Intro: 25:53

Interact Solution is an ideal complement to your existing curriculum and can be customized for your simulation center. Contact Interact Solution today. 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.