The Sim Cafe~ Interview with Russell Metcalf-Smith

Email: russell.metcalfesmith@cshs.edu
LinkedIn: https://www.linkedin.com/in/russelldmetcalfesmith/
Cedars Sinai: https://www.cedars-sinai.edu/education/simulation/team.html

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Transcript

Intro: 0:10

Welcome to The Sim Cafe, a podcast produced by the team at Innovative Simsolutions,edited by Shelly Houser. Join our host Deb Tauber, as she sits 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: 0:44

Welcome to another episode of The Sim Cafe. Today, we are blessed to have Russell Metcalfe from Cedar Sinai in California, Russell and I have had the privilege of doing an SSA accreditation site review in Hawaii in Honolulu. And it was an, an amazing review that the site was just did such a great job. And we were so pleased and, but we got to know each other. And, uh, so I learned about Cedar Sinai and Russell. Why don't you go ahead and tell our guests a little bit about yourself?

Russell: 1:20

Well, Deborah, thanks very much for the, uh, introduction. And certainly the Hawaii visit was a, was an exceptional visit with an exceptional center. And I'm sure you agree that, you know, we, we all learn so much by sharing experiences and visiting different organizations around the world, but a bit about me, I'm the executive director for simulation and interprofessional education at Cedar Sinai health system, which is in Los Angeles. And we have a facility there which opens up in 2013. We see about 15 to 20,000 users a year, and it's based within a larger sort of hospital based academic medical center. And we serve the physicians, nurses, allied health professionals. In fact, we serve people that paint the walls, clean the floors and do heart transplantation surgery. So really the entire spectrum of activity we provide service for.

Deb: 2:16

Thanks Russ. Can you share how you were selected to come from where you came from to be the director there?

Russell: 2:24

Yeah, no, absolutely. I was actually, um, my real passion and my real background is in, and I was head of resuscitation services for a large university hospital in Southwest London for a decade. So my job really was very much focused on going to people who were in cardiac arrest and going to those emergency calls every day within the hospital, but also teaching staff, having policies in place. And it's interesting, the, at that about four years into that role, we managed and, and when I'm saying me, it, it was a number of us. There was a, a couple of fabulous, uh, nursing executives and medical executives. We all managed to get together and we managed to open up a wonderful simulation center and that simulation center was just extremely successful. We managed to win, uh, a significant amount of grants, a significant amount of awards. And one day I got a, I got a message on LinkedIn saying, would you be interested in applying for a position in Los Angeles? And I've never even thought of leaving London. I mean, London really is a, a fabulous cosmopolitan, fast place city. And I really enjoyed, you know, the job I was doing. I, I loved the, the leadership angle. I loved the education angle. I loved the clinical angle, but I, I for the job. And, um, I think the interview process took about nine months with multiple different video calls with what seemed like hundreds of people. It wasn't, but it just felt that way going through that interview process and then traveling across a meeting, the fabulous team at Cedars and, and nine months later started in the rule. And that was in 2013. And Deb know what was quite funny was I, I was in the job on Friday, uh, in London and I literally ended my Workday at about 5:00 PM. And on Monday morning at 9:00 AM Pacific time, I was starting at Cedar Sinai. So literally it was such a, it was such a rapid move. It really felt like I just didn't stop. And we, you know, we're very blessed with the, uh, community support that we have with Cedar Sinai. It's a, it's an organization which has strong top down leadership support for simulation with a new organization. And you combine that with a community that really values the care and the services, the organization delivered to the public. It's been an incredible experience. I've managed to work with multiple different people. And, you know, when I say, I, if I say I it's often should be we, because there are so many different people who in any object are, are, are really part of that success story. And we opened up the simulation center in June, uh, which is about three months early. So June, 2013, so started in March, opened up in June, and it's just really built from there over the past nine years. We, we went through the accreditation processes with some organized very early and, um, and, and really have ended up being in a position where I think Cedar Sinai is the early organization in California to be accredited by every single simulation entity, which, which there is currently. And I think that really, to me, just ensures that we are delivering quality products, that we are trying to provide the best possible services. And just linking back to your, you know, great introduction about our fabulous time, seeing the great program in Hawaii, you know, it, it really that kind of profession interaction and those types of engagements, I think help the entire simulation community because we, we really try and benchmark what other individuals are doing and make sure that we are really delivering what we should be delivering within our own services. And I think that's what it's, uh, it it's so valuable, the networking, the engagement, and going through these accredited processes, it feels, I think when you're going through them and, and having, having gone through them, a number of times, um, person where people are coming to our facility run the accreditation, it's stressful, but I think you end up with a much better product at the end of it.

Deb: 6:33

Yeah, I totally agree. I totally agree. And during my visit, when we were in Hawaii, where we had a way a, of a good time, we, um, I had to go to LA for, for a work conference for my husband. So I had the opportunity to tour Russell's site, and I really appreciated that. And so I actually got to see the site and I can say it is wonderful Russell. How did you get into simulation when you were in London? I don't think we hit that, how you actually stepped into it.

Russell: 7:09

That's an interesting question. So I started off working as a paramedic in London and London is the it's its largest ambulance service in the world. It, it responds to about 1.3 million emergency calls a year. So I, I, I really started off with that clinical passion. It was something I, I really always wanted to do. Just the freedom and the, the different encounters every single day found really quite exciting. Um, and I really developed an interest in resuscitation. I remember working in ambulance service and I was doing multiple different courses, a lot of continuing education and continuing education, which at the time in the nineties was seen as being, not for paramedics. It was much more for hospital staff and people were saying to me, Russell, why are you doing that? I mean, who do you think you are? And I just thought, well, you know, I'm trying to care myself. I love doing this type of thing. And anywhere I, I, I became an instructor in so many different life support and trauma type programs. Uh, and then a course director and a job came up in the ambulance service, which was that of a community resuscitation officer. So I started teaching lots of staff within primary care, um, just emergency care type stuff that, that you might come across in primary care practices. And that job then resulted in me moving into a mental health organization. Um, and it was the largest mental health hospital system in London. I think it had 98 different sites and I was the resuscitation manager. And part of that job was teaching, uh, D different types of life support. So we started using, you know, lots of different, uh, mannequins, and we had sort of sick patient scenarios and different scenarios. You might encounter within a mental health type setting placed ad's defibrillators across 98 different sites and had the business sort of care in for that. And I was there in a contract for about a year and then a job came up in an acute hospital system. And I moved into that acute hospital system. And I think what was interesting about the environment that I worked in for 10 years was that it was in a very deprived part of lung. So it saw some of the sickest patients coming through the doors. People weren't proactive with their health. They were very reactive when stuff had gone wrong. So the higher level of exposure working in London as a paramedic with multiple different types of encounters, then moving into the acute hospital system where you again were, were seeing and very sick people and clinically responding as part of a larger team was, was extremely interesting. So, you know, really, really drilling down to your question simulation and, and whatever you describe as simulation as being, I think there's a whole spectrum of what it means from, from skills based strain, the team to VR to haptic, et cetera. We were using simulation, I think in its most basic form in the community, we were using simulation in a slightly greater form in the mental health setting. And then within the hospital, there were opportunities to use simulation on a much more ad hoc basis on top of the support type training that was being done. And it was really that interest in the impact that, that we were, we were seeing through training, uh, of clinical staff, how we felt that putting more emphasis on that could really make a difference. And we ended up working over an extended period of time to, to get the organization support for a simulation center. And, and it wasn't easy. It really wasn't easy. We were fighting for backing for a good two or three years before the support fiscally came through and, you know, and the fiscal support wasn't huge. It was maybe four or$500,000. Uh, the UK equivalent and the rest of the equipment that we we purchased was all through revenue generation. It was through grants. So for the hospital, I think it was a, it was a very good deal there. They built a relatively basic space and just through engagements and types of conversations. So having now networking, we're very successful in really equipping the venue with every type of technology you would really want for the type of hospital setting that we were in at that time. And it really was just dedication and hard work of multiple different people. And I think we see that across the simulation community, you, you, you have facilities which have everything and you have facilities which really struggle to get any type of support at all. And what I would say is that I've been on both sides of that. I've, I've been on the side where you're really struggling to bring in money, to get grants, to generate revenue, to being in a situation now where, you know, we are very fiscally conscious in what we're doing. We do, and we provide a lot of services, but we often have availability to more resources than, than many other organizations would, would sort of do so. So that's, that's really the story of how I got into it and really how it's progressed and, and, and sort of developed, um, over the past, nearly 20 years.

Deb: 12:18

So it, to me, it sounds like it, it was passion for you. It was a passion.

Russell: 12:22

You know, I, I think it's always been passion. I think when you, when you go into a profession in the health service and you care to social healthcare system, you go into it because you want to be a nurse. You want to be a paramedic. You want to be an allied health professional because the salary ranges are nowhere near as high as they are in the United States. The salaries in the United States for these professional groups can be significantly better. So when you are, when you are going into a, a public like service field in the UK, you're doing it because you really want to make a difference. And I think that that's a case with many healthcare professionals they're going into it because they really want to make a difference to people and, and the real passion behind the I still did out, even though I don't have that clinical contact, which, you know, at times might be frustrating.<affirmative>, um, there certainly is the passion to make a big difference to patient care and to really, um, to really provide the best possible services to hospital staff within the organization. And that's not necessarily delivering all the services, you know, yourself, you know, we're, we're simulating every reading from heart transplants to brain surgery to, to all sorts of complex medical procedures that got well beyond my knowledge field, but we certainly support the professionals who, who have a great clinical idea and, and they come to us and say, look, well, how can you help us transform this clinical problem into an educational event? And I think that's where the expertise comes in. So I think having that clinical background just really understanding enough of what you need to understand, but combining that with a significant amount of, you know, educational, simulation type experience and, and sort of education, I, I think really is a good mix. And I think it's how hospital systems can really maximize the benefits to delivering sort of quality care to patients.

Deb: 14:27

Great. Great. Now I'm gonna ask you my favorite question. Do you have a specific favorite or most impactful simulations story you'd like to share with our listeners?

Russell: 14:38

You know, it's not a story probably of a simulation, but it's a, it's a story of me getting coffee and, um, it, it's really quite bizarre. Maybe isn't the most amazing story you've heard, but you know, often you are, you are doing a lot of, um, work behind the scenes and, you know, just during the pandemic, and I'm sure you've seen this too. We didn't close the simulation center for one day. We were open through the entire two year period providing services to the fabulous clinicians within health care who have gone through, uh, you know, a very difficult time looking at the patients in this sort of pandemic period. But I also saw people within the simulation community and within our own facility who were exceptionally brave. I mean, there really were brave coming into situation, which initially there was very little learn of about, and they were constantly there every single day, supporting, providing education and engaging with, you know, thousands of clinicians. Um, I, I remember the first month of the pandemic. I think we, we saw about 7,000 people come through the simulation center, you know, it was just a huge endeavor. And, and I just really take my hats off to all of those clinicians. And, and again, the staff in the simulation center who were really on the front line supporting essential educational training, but just coming back and just pivoting that to the question, I think you, you feel, uh, at times that, you know, the is a lot going on and that you're trying to meet the demands. And I popped upstairs to, um, to get a Starbucks coffee. And I'm just waiting in, in the line for the coffee to be made available. And this resident came up to me and he said, Hey, Russell, just wanna say, thank you, thank you for helping me make a big difference and saving in someone's life. I said, oh, wow, thank you. What happened? And he said, you know, this simulation, you ran in the sim center. He said it was exactly the same as a patient who I saw within the emergency department. And he said, honestly, I've never seen this situation before. And it presented. And it was just like being in the simulation center. He said, I could remember the stuff he was saying. I could remember the, the reflective experience we had. And he said, and the guy survived. And he said, he survived because of what I did in simulation, because you gave me the confidence to deliver that care. And, you know, I think as educators, we may not always be directly delivering care to patients. And I say this to the clinical staff and the, and the non-clinical staff that we have within facility, we make a difference to thousands and thousands of patients every single day, because the education that we're supporting the delivery of, or delivering personally within the simulation center really impacts a lot of people. And that was just one example that happens, happens to be highlighted simply through standing there getting a cup of coffee. We heard the real impact of what simulation can actually bring to, you know, improving quality within our health system.

Deb: 17:45

That is a great story. That's a great story. I'm gonna ask you because you guys are the Hollywood, right. Hollywood uses your center at times. And, um, why don't you talk to us a little bit about having movie stars in the center and some of the philanthropic things that you see because of your location?

Russell: 18:07

Yeah, absolutely. I mean, we certainly are based in, um, the Hollywood area. We certainly will be exposed to the filming industry and, you know, other individuals who work within that professional group, I think people sometimes see Cedar Sinai as the Hollywood. Um, but you know, 99.9% of everybody comes through the institution is, is really like you and me, it's your regular, everyday person who, who needs to get healthcare. And that's exactly what, what the health system provides, but, you know, coming to the actual, um, Hollywood side of stuff, you know, we obviously provide a clinical service, but we look at opportunities of where we can bring some income into the organization and actually support the delivery of education, which, which is important. You know, there is a, there is a business element obviously to every single training facility. And we, we do use revenue streams from, uh, filling events. So if we do have a filming opportunity, which comes in, then there's often lots of hospital scenes that we see in movies and different, different TV shows. And certainly we, we have a very careful betting process. I have to say, um, it, it's difficult to get in. They've gotta meet some of the highest standards and they've gotta follow, uh, exactly what we require. But as long as we are limiting that filming to within the simulation center, and it's not impacting any patient care services, we do support when we possibly can. So we've had a number of movies in there which may be visible, and you may see, I can't tell you the names of the movies, but, um, it's a great use of a simulation center when you're not using it to clinically teach somebody. And, you know, people ask me about different suggestions. Um, geographically, we are placed in an area that just makes that business idea ideal, but there's other places in the us as well, outside of Hollywood, which, which could really make use of the local, uh, sort of movie industry, which is really quite huge. And then just really pivoting onto your question about, um, you know, philanthropy again, you know, just, just having a, a really supportive community is something which I think helps every health system. And we have a very active philanthropy departments, which really just guides people to giving, give if switch, they may want to, to the health system. And I think often people want to support their local hospitals and want to support their organizations, but maybe just don't know how to do that. And really are not guided in the process of how can I make a contribution? How can I give some fiscal support to allow the hospitals to provide services, you know, beyond what they may be able to provide just through generating revenue from sort of patient care, which is being delivered. And I have to say, we worked with a fabulous in internal group, um, called the Women's Guild. And the Women's Guild is an organization, which I think is delivered support to the institution for many, many years now. And there are lots of ladies who have been very engaged through various hospital contacts, and they really support multiple different, um, different projects. And the women's Guild supported the simulation center at Cedar Sinai over about a five year period. And we were involved in multiple different efforts to support their philanthropy. I, I jokingly called myself a tour guide because it really felt like that was what 80% of my job was. It was touring different, you know, individuals who, who were interested in what we were doing and who, who may be interested in giving money, um, to support the education. And what I would say, Deb, is that when you engage with the public, when you engage with your local community, and it doesn't have to be<affirmative> in Hollywood, it can be anywhere. You just need to engage them. And I think once they see the magic of simulation, it really, really opens their eyes. And, you know, I, I, I always use the story. You'd never get on an airplane if you thought the pilot was taken off for the very first time, why don't we do this in healthcare? And the public say, well, why don't you do this in healthcare? Because to any rational person, what we do makes a lot of sense, the Cedar one do one, teach one, you know, approach really is something which should be in the past. And I think that simulation is something which is gonna become not a nice thing to have, which I still think it is a places, but it's gonna be a, have to have, it's gonna be something which, you know, you would expect the people have to go through every single day. So I've got lots of different stories about the great support of our local community. I don't think it's a appropriate to share individual cases, but what I would say is that we have a five community and a fabulous group of, uh, many donors who really try to help us provide the best possible quality care to patients.

Deb: 23:21

Excellent. Thanks. Thanks. Now, where do you see simulation going in the future?

Russell: 23:27

That's interesting. It's a great question. I hope we're gonna be able to and make use of, uh, evolving technology. I would like to see a greater use of, uh, mobile technology in other words, technology, which we can use from the comfort of our homes. I, I don't think personally, we will ever be able to move away from hands on training of some kind of team based training of some kind, but I would like to see a greater use of technology such as VR or AR or any other iterations of that that may be developed. What I do to see that though, is that so many people try to sell products to us. That really, from my perspective, are just not ready for use. In other words, they may be useful in certain subgroups, but when you're focusing on a postgraduate workforce experience, nurses, experience physicians and surgeons, the quality of products that they're providing and the type of products they're providing really have got to meet that standard. So some of their products might work in undergraduate programs where people are learning right at the very beginning. But I think that once you get to your postgraduate workforce, I think we are still in phase of development. And I still think there's widespread adoption of that technology. There will need to be further development of products which are available. I'd like to see even hospitals moving more towards actually using simulation fully. We see, and, and I'm sure you've seen going through many different hospitals that, you know, and places have amazing facilities. Some places have nothing. So when we look at where are we going in the future, I think some hospitals haven't even started that journey. And when you think about that, it's really quite concerning that we we're talking about moving beyond current simulation type centers and team based simulations, mannequins, and skills journey to something else. But in many cases, hospitals haven't even got to that first stage. And I think there's really gotta be a change in the thought process of organizations in how they make sure that their staff are prepared and are continuously prepared and trained for new and evolving techniques and PR procedures. You know, you, you can be in nursing university or, or you can be in medical university or any other university. And you're taught things 10, 20, 30 years ago, but the medical literatures evolving so much every single day, how do we keep our staff up today? Many of the surgeries people would've been taught 20 or 30, there are so many new surgeries. So they think about robotics. Think about all of these different procedures, which are now available. So I think we need to be responsive to the growing needs of healthcare. I think as healthcare revolves, we need to evolve the greater use. I've heard on your other podcasts, talking about them and talking about, you know, using that technology to integrate with healthcare providers. I think it's great. If I wanna speak to my nurse practitioner or a physician I can log on and I can speak to them straight away from where I'm sitting now, I don't need to necessarily go in to see somebody, because I think we've evolved past that. And we're using technology to, you know, really help us evolve. And I think staff need to be trained to use that technology. They need to be trained how to communicate, how to become personally more engaged with their clinical provider in, in how they're interacting

Deb: 27:03

Russell. This has been a great interview. Now, if our listeners are interested in getting a whole of you, do you have a best place that they can reach you?

Russell: 27:10

Yeah, absolutely. I think the best way to contact me is, uh, probably through email. And, uh, if you want to, we can put that email into the, uh, chat box, uh, and or into the recording at the base of it,

Deb: 27:23

Put it into the show notes. There's notes. Yeah. And I'm also gonna put in that there was a video that you shared with me, um, about Christmas time when it was, it was very, very cool. So we'll put that in the notes

Russell: 27:34

Too. No, that'll be great. But if people want it, um, the email address is Russell.MecalfSmith@csmc.edu. russell.metcalfesmith@cshs.edu

Deb: 27:47

How about any social media, LinkedIn, Twitter,

Russell: 27:50

You know, I'm on LinkedIn. I'm very active on LinkedIn.

Deb: 27:54

Okay, perfect. Perfect. Thank you so much.

Russell: 27:57

Is no thank you, Deborah, for the invitation much detailed.

Deb: 27:59

Oh my pleasure. And with that listeners, happy simulating!

Outro: 28:11

Thanks for joining us here at The Sim Cafe, we hope you enjoyed connect with us at wwwi.nnovativesimsolutions.com and be sure to hit that like and subscribe by. So you never miss an episode of the SIM Cafe.