Transforming Air Medical Training with Virtual Reality: A Conversation with William Belk

What if you could revolutionize healthcare training with the power of virtual reality? Join us as we sit down with William Belk, the Director of Simulation and Innovation for Air Methods Corporation, to uncover the transformative journey from being a flight paramedic to leading cutting-edge simulation-based education programs. William shares his exhilarating experiences in the air medical field and the pivotal role that simulation plays in enhancing training and performance. Discover how his passion for innovation, coupled with the unique support from Air Methods, has driven significant advancements in the industry.

We also tackle the critical aspects of simulation accreditation and its impact on air medical transport services in the U.S. Learn about the stringent requirements set by the Commission on Accreditation of Medical Transport Systems (CAMES) and how simulation is effectively replacing in-hospital clinicals. William discusses the competitive nature of the industry and the shift towards a culture of learning, moving away from high-stakes, pass/fail scenarios. Additionally, we explore the logistical hurdles of air medical services and the strategic importance of helicopters and fixed-wing aircraft for long-distance medical transport.

Finally, get an inside look at the collaborative efforts to standardize simulation practices and enhance training across the board. Despite industry competitiveness, hear about initiatives like the Air Medical Simulation Alliance (AMSA) that foster knowledge sharing and improve debriefing techniques. We also delve into the challenges of imposter syndrome in high-stress environments, the shifting demographics of flight clinicians, and the game-changing integration of virtual reality in medical training. This episode is a treasure trove of insights for anyone interested in the future of air medical services and healthcare simulation.

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Transcript

Disclaimer/ Sim VS/ 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. Thanks to SimVS for sponsoring this week's episode. Simulation helps develop the mindset of patient safety by allowing learners to practice and fail in a safe environment. SimVS designs tools that contribute to the development of this mindset. We are excited to release our new 4-Pump Simulator Practice primes proficiency. To learn more, visit www. simvscom. 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: 1:24

Welcome to another episode of The Sim Cafe, and today we have William Beck and William, do you want us to call you Will?

William Beck: 1:31

Yeah, will's fine, absolutely.

Deb Tauber: 1:32

Okay, perfect. Will is an educator flight paramedic. He's got a passion for simulation-based education and he's going to share his journey. Welcome, Jerrod today. Thanks for being on.

Jerrod Jeffries: 1:49

Thank you and thanks to Will. Yeah, he's exciting. We were just chatting a little bit before we turned the mic on, and this is a field that's brand new to me, so I definitely want to do it justice here. So, will, why don't we give you an intro about yourself, and then I want to? I think there's a lot of different areas that we're going to dig into just from that.

William Beck: 2:03

Yeah, absolutely so. The first thing I have to do is I owe you both an apology. We have been trying to schedule this for over two years and we are finally here, but we started this conversation at least two IMSHs ago. I don't remember exactly where we were at Deb, but you and I were in an airport at one point and ran into each other and started talking about this as well. So I'm the last in the immediate circle of people I run around with to actually schedule a time and meet with you guys. It's fantastic.

William Beck: 2:28

But, as these guys have said, I'm William B, the Director of Simulation and Innovation for Air Methods Corporation. So we are a very large air medical company based here in the United States. We kind of go back and forth between being the first and second largest program in the world, but here in the US this is where our major footprint is, and I've been with Air Methods for about the last 10 years, I believe Actually, it is 10 years now and so started out as a flight paramedic with another company flew there for a while. That's where I got my start using simulation more formally, and as a ground paramedic. Before that I had used it some for education, but really it was when I started flying that I spent more time with high fidelity simulators, and that just comes along with the financial aspects of air. Medical programs tend to have a little bit more resources than working for a local ambulance service, and so I came over to Air Methods as a flight paramedic.

William Beck: 3:15

I spent three years and change here with the company working in eastern Oklahoma I worked fixed wing helicopter, you name it. In Eastern Oklahoma, I worked fixed wing helicopter, you name it. When that, uh, when that base that I was at actually closed in 2016, I moved over to kind of more central Oklahoma, outside Oklahoma City, in a place called Seminole, and flew in a helicopter there for another six or seven months before I accepted a position and came in as an educator. And so I've been in air with education now for seven years with air methods, uh, and then bounced around, gone through a few minor promotions, and then the major promotion in the director of simulation was about two years ago, and so that this I'm the first person to hold this title.

William Beck: 3:51

I think I'm actually the only director of simulation in the entire HIMSS world that I'm aware of. If there's someone else out there, please email me and correct me on that, but my company, air methods, created this position for me a few years ago based around the work that we were doing with simulation, and you know I was overseeing our sim development. I was working through our sim labs and they came to me at one point and said, hey, we really want to offload the other responsibilities you have and let you focus on this full time. And so air methods has given, given me a lot of leeway and put a lot of faith in me over the last several years as far as our simulation program goes.

Jerrod Jeffries: 4:22

Certainly built up over 10 years of course.

William Beck: 4:29

Do you miss being in the field? Yep, there are things I miss about being a full-time flight paramedic. So, first things first, I don't think there's a better job in the world I really don't. You work two 24-hour shifts a week, so you work two days a week. You're home with your family the other five days, which is amazing. So when my oldest son was a baby, up until he was a toddler about three years old, when I came into education, full-time I was I mean, I was a full-time stay at home dad and working a full-time job, and it wasn't like I wasn't truly a stay at home dad, but I was home all but two days every week. And if that day that I had to work fell on a weekend, then he was with my wife and so we did have day, except for when I would drive across town and spend 24 hours sleeping at the station.

William Beck: 5:08

And I miss that aspect of the job. I miss the flying in and landing on a highway and you know everyone kind of looks at you, and then you land and you throw tubes in people or you cut holes in folks. Like I miss the exciting stuff. To be 100 percent honest, I do not miss getting woke up at three o'clock in the morning to go fly in the dead of winter and freeze to death. I don't miss flying in Eastern Oklahoma and 115 degrees and 95% humidity.

William Beck: 5:35

There are aspects of the job I don't miss, but I do. There are things I remember fondly about it as well and I truly believe that and that's really why I'm still in HIMSS and education is, although I'm not doing that job, I get to help other people have the coolest job in the world. Right, and that's what I'm, what I have to do. And just so you guys know this is a fun fact the air conditioner in a helicopter is considered functional if it can keep the cabin 15 degrees cooler than the outside environment. So if it's one hundred and fifteen degrees outside, it's still one hundred in the cabin and that's considered OK. So there are parts of the world I never want to fly in ever again. But if we're talking Idaho or Wyoming, I might be okay, I might enjoy that wow yeah, and I'm even looking at your the air methods.

Jerrod Jeffries: 6:11

You know your guys's coverage. There is a lot of hot areas of where you cover yeah, we are.

William Beck: 6:17

We are coast to coast. I don't quote me on the exact number, but last I heard we had 160 ish clinical bases. So that's bases where we employ the pilot, the mechanic and the flight crew. But then we have another close to 200 bases where we employ the pilot, the mechanic. The helicopter is ours but we partner with a hospital or another service to provide the clinical crew. We call those alternative delivery models or hospital-based services. So we're somewhere in the neighborhood of over 300 helicopters across the United States. Wow, yeah, okay.

Deb Tauber: 6:46

Now you mentioned the word HIMSS. For those listeners who might not be familiar with that term, what does that mean?

William Beck: 6:52

Yeah, so HIMSS just stands for helicopter, emergency medical services.

Deb Tauber: 6:56

Okay, thanks. Why don't you explain what simulation looks like in the industry, what challenges and kind of what mistakes and what's going well?

William Beck: 7:05

Yeah, absolutely. So. That's a lot of questions in one question, and the broad answer is that simulation and HIMSS encompasses a lot of things. So almost all of us are using some level of simulation, and there's a reason for that. Most programs, especially here in the United States, are accredited by CAMES, so the Commission of Air Medical Transport Services, and there is a requirement through CAMES and it's a lot like our SSH accreditation. Right, there's rules and things that we have to follow, there's standards that are set, and so CAMES requires that people either do in-hospital clinicals, where you go in and you work in the ER, you go work in the operating room, or you work in pediatrics, or you can replace those clinicals with approved simulation cases, and so what that looks like is you write your cases, you pay a small fee, you submit them to CAMES and a group of people looks them over and says, yes, this meets our standard or this does not meet our standard, and so most of us are taking advantage of at least some level of that. Even programs that still have clinicals want to see maybe a competency check or something else, and that's done in the sim lab, and I can't speak for all of us, but I can speak for the programs that I've worked for in the past as well as where we're at with our methods, and so one of the problems with this is because we're in a very competitive market.

William Beck: 8:15

It's, you know, it's capitalism, right, all of us are competitors. We work I hate to say this, but we work against each other. We compete for areas, and we're not always sharing the information. We're not sharing the wins, we're not sharing the losses when it comes to simulation, and so everybody works in a silo. We all have our own SIM programs, we all have our own way of doing things. Yes, there's a few of us that are really well connected and talk a lot, and we do share information as much as we can, but even then, we're held to whatever proprietary information we're allowed to share. So we have to be very careful that we're not just sharing scenarios left and right because we had to pay to get those accredited or we had to go through the process of doing that, and so that's probably the biggest weakness is that we all are using simulation, but there's no set standard of how simulation must be used, and I've worked for flight programs and I've seen this even within our methods at one point in years past where simulation wasn't used for education.

William Beck: 8:58

It was only used for competency checks. So the only time you saw the sim lab was when you were coming in to prove that you were smart enough or that you were talented enough to maintain your job. And if you couldn't pass that competency-based simulation, that high-stakes simulation, you then got put on a performance improvement plan and ultimately, if you couldn't pass it, you got released from the company. But there was not a time throughout the year where you got to come in that was kind of stress-free and run through education-based scenarios. It was only the test. That's the only time you saw the mannequins. That's the only time you saw the sim lab and, depending on how you have that set up, that can be good or bad, right Like it just depends on what is Now.

William Beck: 9:34

I don't have any issue with high-stakes simulation. I think there are times where it's appropriate. In fact, I spoke at IMSH years ago and I defended the practice and said there are times where I want to see this done. However, we learned a lot of things in the industry by doing that, and one of them is that you're very quick to scar your, your employees, or your, your learners, right when. Now, all of a sudden, they're scared of the sim lab. They don't want to come into the sim lab, all right, and every time they come in there, they're extremely stressed out, even if they do very well. The minute you start trying to teach them something in the debriefing or wherever else, or you start to have a conversation, they're locked out. They all they heard is I passed or I failed, and they are done with. They don't hear anything else beyond that, and so over the last several years, we've pushed really hard to change this. So there is no more pass, fail simulation within our methods.

William Beck: 10:15

I can't speak for other programs. I know other people are kind of headed in the same direction. We use other ways to assess our employees, but our sim lab is meant to be a culture of learning, and so when you come into our sim lab, yes, you're going to be scored. Yes, you're going to go through all of the same requirements that are set out by Cames. All of that's accredited. We've gone through that process multiple years. However, there's no hey, if you don't do well here today, your job is on the line. We've completely eliminated that risk and it has made a huge difference.

William Beck: 10:41

Now, unfortunately, we a huge difference. Now, unfortunately, we have long-term employees that remember the old days, right, and so I do run into times where people are like, oh, I'm still, I gotta go to HPS, and that's what we used to call it Human patient simulation lab. We've changed the lab to simulation experience, trying to break from that old and that old, you know, kind of feeling of people coming in. But we still hear it occasionally. And so lesson learned right, you do that kind of damage to your people and you get them scared about something. It takes a long time to overcome that and convince them that, hey, we've learned from this and we're going to move on the other challenges.

William Beck: 11:08

Like I said, we're very spread out, and so when you think about air medical services, they cover long distances very quickly. That's the plan, right, if we were just going across town, a lot of times you just jump in an ambulance and it doesn't take much time to get over there. If we're going to need to go 200 miles, now we're looking at a helicopter or fixed wing asset to move that patient and they can do it very, very quickly. So the problem with that is we tend to be spread out in rural areas all over the country, right. So now, how do you take simulation to 160 bases?

William Beck: 11:34

Well, our choice was that we're not going to do that. We're going to bring him into four centralized simulation centers and we're going to eat the cost of flying them in and out. And so we do that. We put them on commercial airlines, we fly them in, we put them in a hotel and we do our simulation. My old program before I worked for air methods. They rented a big 15 passenger van and they moved their Sims from base to base, but they only had 35 bases. So it worked right. There's no wrong way to do this, but that is a challenge that we have to overcome is what works for you, and we've decided that having designated simulation centers was the answer.

Jerrod Jeffries: 12:04

So those are the big things.

William Beck: 12:07

So right now I've got four. I've got one in Kennesaw, Georgia, so it's about 40 minutes North of the Atlanta international airport. There's one in Syracuse, which is right around the corner from SUNY upstate. So if you guys are familiar with that, that program, up there we've got our flagship center, which is our corporate office in Denver, Colorado, and the Denver tech center, and then the last one is in Mesa, Arizona.

Jerrod Jeffries: 12:26

Okay, good spread too.

William Beck: 12:27

Yes, we're all over the place and you know we we just built that Atlanta facility this year. It was a two-year project. I am extremely proud of the work that was done. I had a really core group of people. One of my clinical education managers from the Southeast is named Orlando Marquez. Him, myself, and then my boss, Enrique, put two years of effort into getting that place designed and built and we just opened it up and it's our first simulation center that has our own cadaver lab, and so we're able to do all of our training in one space without having to rent space around town and bus people around. It's all under one roof.

Jerrod Jeffries: 12:55

Congratulations Will.

William Beck: 12:57

That's great, yeah, extremely excited.

Deb Tauber: 12:59

You rent your space out, don't you? You take learners from other places.

William Beck: 13:02

Yes, in a way, we have what's called our Air Methods Ascend program, and so Ascend allows we do a lot of training internally. As you can imagine, 475,000 contact hours a year are delivered to our Air Methods employees, and that's online, in-person, et cetera. So what we've done in the last two years is we've developed content that's online that is effectively for sale to other businesses, to individuals that want to see the Air Methods training. Anyone can come to Air Methods training under the Ascend banner, and that includes our simulation centers. You can come and join our sim lab or we can build a custom lab for you.

William Beck: 13:32

But also, yes, we are working on pricing to set up the sim center so that if we travel around, I mentioned we have four simulation centers, so if my team is entirely in St Louis, they're not going to be in Atlanta, so I can have that Atlanta facility available to rent and you can bring your own educators. You use our equipment, use our space. You can even use our cadaver lab and we can set up the actual specimen order for you and then you guys teach it. Or you can say hey, we want you to teach us in your space and same thing, we'll come in and teach the lab for you to your specifications, but we'll use it in our facility.

Jerrod Jeffries: 14:00

So, seeing some of these changes though I mean you were talking about I guess this was size too, but people were busting them around and now you're creating different centers. You know you currently have four. So how do you see this industry expanding, you know, say, in five years? Or how does that development through education and through, you know, simulation?

William Beck: 14:18

evolve? Yeah, I will. I'll tell you my wish list, right? So my goal, what I would love to see happen vision, if you will, probably more vision than goal. I want to see us come together. I want to see the industry come together, at least on the education side.

William Beck: 14:29

There will always be competition in HIMSS and I'm definitely not calling anybody out on the business side of things. That's how it should be, that way or not. That's how it is here in the country and how we operate in healthcare. Uh, if we're looking at other countries where it's not a competitive industry, then it's a little easier to communicate. And so, for me, I think what I want to see is us come together a little bit more, and what I mean by that is, over the last six or seven years I've worked a group of people I won't say a company, a group of people from several companies to run simulation competitions at air medical conferences, whether that's AMTC or CCTMC, and through that I've learned a lot about what other programs are doing that can benefit us, and I know that we've shared a lot of information with other programs about how they can improve their simulation. You know, to see basically wins and losses, what each of us have tried what works, what doesn't work, and so over the last three months we have been coming together as a group not just those folks, but several others and developing basically this aeromedical simulation alliance.

William Beck: 15:25

So think of that as just a group of otherwise competitors coming together to say, okay, guys, how do we standardize simulation across the board to make sure that we're all doing what aligns with standards of best practice that are published by an axle, that what the society considers a standard is the best practice, meaning society for simulation healthcare. How do we do that? But then also provide a space where we can come in and say, look, I'm running into this problem and let's say you work for a sim program or a flight program that has three helicopters right, you don't necessarily have the funds for a three million dollar simulation center. So you can come into this group and say, look, guys, what options do I have within this budget? And you've got 16 other people there from other flight programs ranging in size from two to three helicopters at a university hospital up to air methods or GMR, where we have hundreds of helicopters under our programs and say this is how we overcame that problem. Here's our recommendations.

William Beck: 16:17

Here's some scenarios that you can run using the mannequins you already have, without having to invest a hundred thousand dollars into a high fidelity simulator, and basically learn from people that are full-time in simulation, even if your program doesn't have a full-time simulation position and that's going to be a thing, right. We have educators of a team that are methods of 28 full-time simulation educators. Most flight programs are going to be smaller. They're not going to have that.

William Beck: 16:39

It may be one guy whose job is responsible. He's responsible for all the simulation, or maybe he's responsible for all education, not just SIM, and SIM is something he does maybe one quarter out of the year Now. He has a pool of people he can go and talk to, and so. So AMSA, the Air Medical Simulation Alliance, is in its beginning stages. We've we've written up a mission and vision, we're working on some bylaws, we're getting into that process of recruiting our initial board members and hopefully we will see that take off over the next few years and see it supported by several companies in the industry to make sure that we have the right people to help everyone else.

Jerrod Jeffries: 17:08

I'm just poking into association as well too. I mean, this is, this is great, though. So it's like, right now it's pretty siloed, but you hope to see it more collaborative, but, of of course, you still have to protect business.

William Beck: 17:18

You know absolutely, and that's that's exactly what I want to do. I want to see and here's to sound a bit cliche If any one of us is holding information that has the ability to save lives that needs to be shared. Right, that is something that we should be sharing openly and for me, that is our simulation education approach. So, whether that's improving simulation, debriefing across the board, because I'll tell you this is EMS in general. I've been a paramedic a long time. I'm pushing 20 years, right, uh, and EMS. So 20, almost 20 years since I got my EMT, 18, 17, something like that as a paramedic. Uh, ems simulation has a long way to go, and I'm trying not to say anything. It's going on in nursing and medicine and elsewhere, and simulation and bringing it over to EMS.

William Beck: 18:01

And so, historically, you do EMS simulation, whether it's for HIMSS, whether it's for an ambulance service. You run your scenario and someone walks in the room and says, all right, here's all the ways you screwed up, right, here's everything you did wrong. And they just lecture you. And then the next group comes into the room and they get the exact same lecture as the people before. There's no conversation, there's no sharing, there's no digging into. Hey, what can we learn from this. It's not a debriefing, it's a canned lecture that gets repeated over and over and over and over again. So if this is still taking place in hemp simulation and it absolutely is we can work as a group and say, hey, this is what we found.

William Beck: 18:34

These are the debriefing techniques that we have found work really well with experienced clinicians. And that's something you have to separate him from everyone else. And it's not that other people aren't doing STEM for experienced folks, but hems clinicians are not new. These are experienced people. The minute they step foot on a helicopter they've already got three, five, 10 years of experience in a high, high stakes situation where they're talking 911, ambulance services, critical care, ground transport, n, i, p, whatever it is, they're working ER. These people come with a ton of experience and they're not coming into the room not knowing anything. We should be able to take that information they already have and apply it to the simulation.

William Beck: 19:10

And that's where debriefing techniques come in. That's something that we don't do great as an industry, and you know, that's one example of many. Right, but making sure that we as a group can say look, here's what we've learned. And here are the debriefing techniques that we've seen work best with experienced clinicians of 10, 15 years, you know, versus coming in there and just saying, hey, this is what you did wrong, this is what I want to see better next time. It's more along the lines of hey Jared, how do you feel about what just happened and what we do differently going into the future? I mean, those are standard things for all of us that are working full-time in SEM but, as I already mentioned, a lot of educators that's not. They don't have that privilege. They're not full-time simulation educators. Simulation is something they do a couple of times out of the year.

Deb Tauber: 19:49

And you've got a double-edged sword here, because not only do you get the sickest of the sick patients, you guys are also in an environment that's really high risk. I mean, some of those choppers go down, you know, due to unforeseen complications and there's, you know, there's a lot of risk involved. I'm sure it takes a certain type of personalities attracted to this risk.

William Beck: 20:14

I think that's probably probably the truth and I think that type of personality oftentimes leads to difficulty briefing right. So you know, you look at the industry as a whole and we've got amazing people. Every flight program has amazing people. I remember coming into flight years ago and just being at all every day of the people I worked with and how smart they were and thinking, oh my God, they chose the wrong guy, I don't belong here, right, these people are all so much smarter than I am. And then I moved to a different program and I was like, oh my God, these people are so smart and it's like everywhere you go you get that imposter syndrome and I swear it never goes away. It just it doesn't, because every time you move up or go over and same thing. I came into education I was surrounded by these people I'd been learning from for years and now all of a sudden, I'm supposed to be one of them and I'm like, step of the way, I feel that way. But yeah, no, you're absolutely right, there are definitely some strong personalities and hymns.

William Beck: 21:00

You know one of the biggest challenges, you know everyone thinks about helicopters or airplanes. What they don't think about is the amount of space you have to work in. So you're working with a lot of critical care equipment. You've got ventilators, you've got pumps, you've got everything making noise and you have all these drugs and everything going on and you're working in a space that is is no bigger than the backseat of your car, like there is not a lot of space, it's not a flying ambulance. I mean, in theory it's a flying ambulance, but it doesn't have the space an ambulance has, and so that you're right, that's a very difficult environment to work in.

William Beck: 21:26

I already touched on the weather earlier, so it's very hot, it's very cold, it could be super dark. You've got a four pound set of night vision goggles. It can be miserable. I mean, it can absolutely be miserable. And these guys do amazing work in and out every day, and so, like I said, there are parts of it I miss. There are definitely parts I don't. But yeah, you're absolutely right, you're working with people that are not only extremely intelligent but have some really, really strong personalities at times as well.

Jerrod Jeffries: 21:52

What's the overall culture in terms of simulation? Are they wanting to do it? Do they think it's a waste of time? What's, what's it feel like with it?

William Beck: 21:59

It runs the gamut, I think, if you go back five years ago, when we were doing everything as pass fail, no one wanted to be there, absolutely no one would be there. And it was miserable for the educators too, right, because that was, I mean, we were basically executioners at times, whereas all right, and we're going to run this and if you pass, no-transcript load they had to carry but also for the clinicians that put them in a situation where they hated it, they didn't want to come to sim, they were scared. Right now, it's mixed bag, because we still have the people that were here back in the old days, right, and so they remember that. And I think that we're overcoming those training scars of trying to tear down those walls and get to them and say, look, those days are over. I promise you we'll never do that again. But you also have younger folks that are coming in that are loving every minute of it, right, the stress is gone because they don't remember those days and they know they're not going to fail. There's always going to be a certain level of eustress, or healthy stress, involved in simulation. If there isn't, then we're not making our scenarios real enough, right? We need to make sure that there's some level of stress, but in a healthy way, that I get to go in there and know that. I'm going to answer your question, Jerrod. We are definitely shifted heavily towards the hey, I'm excited, I want to do this, I'm going to enjoy myself.

William Beck: 23:23

But yeah, we still have some people that are absolutely like oh, they remember the old days, or every now and then you do, you get that one guy that's like I hate this, I'm not learning anything, I have no reason to be here, and I've had that. I've had someone flat out tell me and I won't use a name. But on my first days in education it was one of my first sim labs. I ran in Omaha, nebraska. I had a guy come up to me and he goes I think this is stupid, I don't think I should be here. I don't learn anything Anytime I come in here. It's just a waste of my time. And I swear to you. I responded oh hello, my name is Will. Like we hadn't even met yet, like that was.

William Beck: 23:53

The introduction of interactions have fallen by the wayside. We don't see that anymore because we've taken that like oh, it's pass, fail, and we've moved it more into that fun, engaging learning environment. We still run the same, you know. We still run that through all four patient categories. We still run those games. Improved scenarios, and so those are. They're getting better. Honestly, I can run harder scenarios now because they're not pass fail. So we can get a little bit deeper and we can go a little bit deeper into the medicine. But also we've added other elements. We've added serious gaming, we've added virtual reality. There's some level of engagement for everybody. So, whether you learn in a didactic environment, whether you learn in a hands-on environment, whether that serious gaming is your thing, we have found a way to make sure that that lab has enough of everything in it that we're going to get through to you in one way or another in it that we're going to get through to you in one way or another.

Jerrod Jeffries: 24:41

And speaking of running the gamut, do you see youth coming more into that program? Because it sounds cool to me. It sounds like it has that shiny new toy factor.

William Beck: 24:46

Yeah, there was. I'll never forget the day that I realized I was no longer the youngest guy on my education team, right. So I got hired pretty young into education. I got hired young into flight. I was a paramedic very young, and so I don't want to say that I knew what I wanted to do at a young age, because I still don't know what I want to be when I grow up. But when I'm going through a lot of these things, I remember having a conversation over dinner one night and going oh my God, that guy's younger than I am because I'd always been the baby right and I was always the guy coming up.

William Beck: 25:11

Now I am seeing a significant influx of younger educators, people who are still in their 20s, maybe in their early 30s, coming in, whereas it used to be kind of the old man's game right when you, it was people that were had been flying for a long time before they came into education or had a background in education elsewhere, and so, yes, we are seeing a lot of younger folks come in and then the the actual flight environment and this is across the board at all programs we're seeing flight clinicians get a lot younger as well. So, like when I came in at 24, 25 years as a flight clinician. I was the youngest guy by a long shot at my flight program at the old company that I worked for, and now we're seeing a lot of that. People become a nurse right out of nursing school, right Go to college, or they become a paramedic within a year or two coming out of high school. So they're coming into the workforce younger, as paramedics or, you know, volunteer, whatever that is they're working on or nurses, and then they get their three years or four years of experience that's required. Maybe they work in a high volume system, maybe they work through critical care, but they've got this goal that they want to go into flight.

William Beck: 26:10

And so we're hiring younger and younger flight clinicians. We're not seeing the same 10, 12, 15 year paramedics now applying for a flight clinic. You know flight job. We're seeing a lot of younger folks. And so not only is our education staff becoming younger and being a little bit more open to some of these things, of course our older education staff teams they're coming around to it as well, because it's what the team is doing and they're seeing the benefit and the impact it has on their educators. And then we're also seeing our clinicians are much younger than our new hires are. That's not to say that we don't have experienced people or we don't still hire folks that are coming from other programs, but overall our workforce is much younger than it was 10 years ago.

Jerrod Jeffries: 26:44

That's great. I think that's a tribute and not of the hat to you, obviously, based off our conversation, but it takes a lot of initiative in order to, one, make that appealing, but two, also to say because this is, this is a great little bridge of all the exciting things you can do and you ask a kid, what do you want to do when you grow up? It's like policemen, spacemen, you know whatever it is, firefighter, and you're like OK, now, this is something that maybe a little later in life no one's going to be like oh, I want to go be on HIMSS and I want to be an air medical simulationist, educator, you know.

William Beck: 27:23

But it is great, great that you're pushing this initiative to really make it attractive for younger folks. So tip of the hat to you, will. Well, and there's like I said. I can't possibly give enough credit to our team. I've got 25 educators on our team, right? I can say whatever I want, but without their support and them executing it, there's nothing that's going to change, right? And so this culture shift that we've seen in the last four years at Air Methods falls firmly on every one of them, because they're the ones out there day to day running these labs, communicating with these teammates and employing the new things, no matter how crazy it is or how hard it is.

William Beck: 27:44

Deb actually messaged me earlier and asked if we were SSH accredited. We are going through that right now. In fact, I did my final submission of all of our responses on Friday. They're coming out to see my Atlanta facility on the 13th of June, and so every step of the way, like, yeah, it's great and I want to do these things, but without my team and without them being willing to go, all right, well, it's onto something crazy again. But let's hear him out and let's see if this is going to work for us.

William Beck: 28:04

And, of course, the occasional pushback of like all right, man, you pushed this a little too far. Maybe we meet in the middle. They're the ones that are driving this culture change without or talking to them or helping them develop stuff, but they are the ones that actually have to do this and they've been. They've been great, they've been very open to it and we've made a ton of change with very little turnover over the last several years. Yes, we've lost some people that weren't willing to, they weren't willing to keep up or they weren't willing to do things the way that we wanted.

Deb Tauber: 28:44

And they've decided on work for us and you guys have transitioned into a lot of virtual reality. Do you want to share a little bit about that journey, because I'm sure it was difficult?

William Beck: 28:50

Yeah, so I can't get to the good part without saying the initial piece of this. So I initially pitched virtual reality to AirMethods back in 2018. And so this was actually before my first trip to IMSH. I didn't go to IMSH for the first time until San Antonio in 2019, which is actually where David Shablok and I met in person for the first time. But when we're talking about VR, the first time I came to air methods, I got told we will never pay people to play video games. This is this. That is a direct quote from my former boss, and that was what he said.

William Beck: 29:19

And so fast forward, you know, a year or so goes by. The Oculus Quest the original Oculus Quest comes out. So this is the first VR headset that has the capability of working without a high dollar VR capable laptop or computer attached to it. And so I get one of these headsets. I get some non-medical content, because we just no one had free medical stuff at the time and VR was still very young, like there wasn't a lot of options out there, especially not for an option that didn't require a big powered computer and I take it to work and I put it on my boss and he goes oh my God, this is so cool, but there's zero application for this here, and so I then went on this you know this crusade, if you will and for the next year and a half, I made every single person I could find in leadership and education even clinicians put this headset on, like I was everybody. If you came to a lab and I was there, that headset was somewhere and it got set up in a classroom or a break room and we made everybody they played video games, you know went through all kinds of cool stuff. They threw paper airplanes, and my goal was to prove to people that, although this isn't clinical content that I have, these are games. You can see the mechanics in VR and how they would apply to us as far as, like, if I can fold up and throw a paper airplane, I can unzip a bag and take out a laryngoscope, and so fast forward another year like, oh, this is cool, you know there's no application for this. Well, we saw some COVID hit right. So in the middle we get this early the pandemic hit.

William Beck: 30:40

At this point I've kind of broken my way in with this and then we saw some turnover amongst my leadership, and so my former director stepped out and went to another program, my former VP of clinical services, senior VP of clinical services. She retired and we then had my supervisor, if you will at the time stepped into the director of education role and we hired an outside person named Stephanie Queen to take over as senior VP of clinical services. And immediately I'm not kidding, immediately I got a phone call from Enrique and he said get that thing ready. We're going to have to figure this out because we're in the midst of a pandemic, right? We're having a hard time getting all this stuff, we're having to cancel labs and we cannot miss training. We have to do these things.

William Beck: 31:22

So I then started going through meeting with every single VR provider that would pick up the telephone and I'm not talking just medical VR, because at the time there was very few options. You know, early 2020, just starting on the pandemic Now there's a ton of them. But I met with everybody and then I started picking up the phone and calling video game developers and custom computer programmers and said this is what I need. And at the end of that entire thing, I'm not. I have a. I still have the notepad. It's got 42 different people that I called, met with and put little like check mark X or question mark right as to whether or not they can meet my needs, and then you know basic ballpark figures.

William Beck: 31:55

I settled on working with SimX and so SimX at the time was a young startup. They'd been around for a few years but they were just kind of breaking out and we partnered with them and developed what has become the well, it's the only air medical specific large-scale VR program in the world. We created simulation scenarios that were specific to us. They were custom developed. It took several years, but we were able to start right away with some of their early scenarios they already had developed and if you guys have seen a SimX booth at IMSH, there's a good chance that you've seen one of these scenarios that we've developed together over the last several years. And so Air Methods and SimX have been working together ever since then.

William Beck: 32:29

Like I said, it was early 2020, late 19. We kind of made that choice and then launched heavily in 2021. So we are using virtual reality internally. We have been for all that time. So every single one of our clinicians goes through a VR component.

William Beck: 32:44

We are currently in the process of going through the IRB for a large scale VR research project.

William Beck: 32:49

So we are looking at comparing virtual reality to mannequin based simulation high fidelity mannequin based simulation for the purpose of training new higher flight nurses and flight paramedics and we're going to track their progress for two years and compare all the data points and say at the end of two years, vr was either worse than, better than or equal to mannequin based simulation based on these metrics and they're going to be everything from clinical quality metrics to how they score on other, on other assessments, and the idea is we're going to do a full two year assessment on that.

William Beck: 33:19

That coming up here pretty quickly. And so Air Methods is doing a lot with virtual reality internally and we just entered into a strategic partnership with SimX that goes beyond us training our own employees, where now we have the opportunity to train external people. So if your program isn't really willing to commit a hundred thousand dollars or $40,000 or whatever it is to get you guys kicked off the ground with your own VR program, they can come to us and we can train them in VR by providing them with headsets and providing them with educators and running them through scenarios, whether that's for an ICU, whether that's for, you know, a medical school, a nursing school, paramedic school, or whether it's for another flight program or an ambulance service. All of that's available to us through Cimex and Cimex has been a great partner to work through all of that stuff with.

Deb Tauber: 33:57

Excellent, excellent. We're gonna kind of close up here. I'm gonna ask you one more question what would you say you're most proud of that you've accomplished in simulation?

William Beck: 34:07

Oh man. So we just talked a lot about that VR program. That was a huge win, right. But again, I can't take 100% credit for this. But it took several years to get us and a little bit of a leadership change right, to get air methods to make that transition from high stakes pass fail simulation into that culture of learning and support and making sure that our teammates got what they needed from us and not just got told what it was that they needed to correct about themselves. Right.

William Beck: 34:33

And so, although the VR thing is big, when the work that we've done more recently, talking a lot about serious gaming, you know we've used a lot of serious games and escape rooms.

William Beck: 34:40

I've been doing some work with role-playing games and I've spoken about that at several conferences for professional development, not necessarily for clinical training, but for improving your team. All of that serious gaming work is kind of my. Those are the things that I care the most about. But at the end of the day, us working through and again this was a team effort but us switching away from pass fail high stakes competency assessments into actually fostering learning and creating an environment where people want to come into the sim lab and they want to learn from us and they're willing to pick up the phone and call us and say look, I need some help with this, you know, without having the risk of going through an actual pass fail assessment. I think there's there's. There's no bigger win at all in what we've done at Air Methods or anywhere in the industry than seeing that transition through over the last four years.

Jerrod Jeffries: 35:25

Do you think there was a correlation between those that you shifted to that from that pass fail about five years ago and there's more acceptance now to justify a new center?

William Beck: 35:33

Sure. So to be fair, the Atlanta facility was replacing a previous facility, so we had an Atlanta training center for several years. That was right by the airport, and when I say right by the airport I mean you could walk to it. It was super close. And so that facility was out. We outgrew it very quickly. It was very small. It had four sim rooms but each one of them was about the size of a small car. There wasn't a lot of space to move around in there and they all shared one big control room into all four sim rooms. You can imagine it got pretty loud. We all had to wear headphones.

William Beck: 36:00

So the Atlanta transition for us was saying what is it that we want in a simulation center and where do we see ourselves over the next several years? And let's build that. What is our wishlist? And let's build it. And so that included the cadaver lab, designated VR space. We finally have our own debriefing room. So that was the other problem with our old center is we debriefed in the sim room?

William Beck: 36:17

I'm not saying you can't do that, but we all know that getting people out of that environment and getting them sat down somewhere else gives them a chance to kind of decompress a little bit and be a bit more open and honest.

William Beck: 36:26

Where they're not still thinking about the scenario right there in front of them and all the things that they could have done differently, we get them somewhere else and we have that conversation in a more comfortable setting. And so really, it was just us building what is hopefully going to become the footprint for us to copy and paste into other facilities. So as we rebuild you know, Phoenix, or we look to start building another center in the U? S we'll take that floor plan and just copy it somewhere else. So, yes and no, I think that, from a financial standpoint, the changes we made in simulation over the last several years helped us justify why we needed to see those things right, why we needed to do that. But at the end of the day, if we're we're being completely honest I had to replace Atlanta because we outgrew it, and so our team got together and said what is it that we wish for here? And then we spent two years finding the right location, going through the process, going through all the contracts and then ultimately building that center.

Jerrod Jeffries: 37:12

Okay, Thank you Will. This has been so enlightening.

Deb Tauber: 37:15

Yeah, we really appreciate your time and all your contributions to healthcare and HIMSS.

William Beck: 37:20

Yeah, you know, guys, and we appreciate everything that we've heard from you guys over the last several years. You know the podcast. You guys been on this and then, of course, with David and I doing ours, that it feels like we have a little bit of a partnership with you guys and then with Phil over at SEMOperative and so the last we not done that IMSH press box together.

Jerrod Jeffries: 37:41

Definitely, and we always appreciate the support from you and David. You guys always rock it.

Deb Tauber: 37:45

Yeah Well, thank you very much and happy simulating. Thanks guys.

Disclaimer/ Sim VS/ Intro: 37:54

Thank you. Thanks again to SimVS for sponsoring this week's episode. Check out SimVScom to learn more about their new four-pump simulator. 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.