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The Sim Cafe~
The Sim Cafe~
Fostering Excellence in Patient Care Through Simulation Technology with David Biffar
Innovative SimSolutions.
Your turnkey solution provider for medical simulation programs, sim centers & faculty design.
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 week's podcast is brought to you by Beaker Health. Beaker Health is a user-generated and peer-reviewed community educational platform designed for healthcare organizations. We let your community connect and engage with one another freely and efficiently. Beaker Health, where dissemination and measuring impact comes easily. Welcome to the Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, edited by Shelley Hauser. Join our host, deb Tauber, and co-host, jared 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:Welcome to another episode of the Sim Cafe, and today I'm here with Jerrod Jeffries and Dave Biffar. Dave is the Director of Operations for Arizona Simulation Technology and Education Center AZTEC , at the University of Arizona, Health Sciences from Tuscan, arizona. So thank you very much, Dave, and welcome to The Sim Cafe. And why don't you tell our listeners a little bit more about yourself?
Dave Biffar:Sure, thanks for having me. Yep, I'm here in Tucson, Arizona, University of Arizona. I've been here since 2007. I am currently the Director of Operations for a Sim Center that has been around since 2004. We started at 800 square feet, moved to 2,600 square feet in 2011, and now we have 35,000 square feet of space. So I often like to call it the one-car garage, two-car garage and now a space that we could fill an entire dealership of cars and where all our hopes and dreams came true At least I like to think so. So, sticking with myself, I am brought up in the simulation technician operations track and have evolved into the director of operations under my executive director that I've been along with. Who's a neurosurgeon that started Aztec? His name is Alan Hamilton, and we have always kind of had an open concept in terms of how we develop simulation technologies and onboard them for our user groups. He's got some of his hands in Hollywood and we've brought on a bit of that into the way we do things, and early on he also worked with Ballistic, ballistic gels and sawbones as a neurosurgeon back in the 90s. So we've always maintained a makerspace that goes along with Aztec. That was something that was important to us.
Dave Biffar:For me, I got into simulation. I kind of stumbled into it. I got out of college and spent about 10 years or so in human services. I worked with at-risk youth populations mostly adolescents, in group homes, in in-homes, some residential facilities, and I actually started on a corporate level working in quality assurance, youth advocacy, and then I slowly made my way into most people work with the clients and then as they evolve, they move away from them into a more corporate structure. I went the opposite direction and moved closer to the clients and over time I moved from a QA training and development for crisis management, incident review and program evaluation person to having a more mental health counseling background, which is what my master's is in cognitive behavioral, using cognitive behavioral therapies and working with youth in their homes and in group homes regularly, whether it was group therapy or one-on-one. And so, like a lot of people, I got a bit burnt out from that and was looking for something new and I stumbled into a position at Aztec and there was only three FTEs at the time and went through a big circular interview process and I ended up getting the job.
Dave Biffar:Part of me looking back in hindsight was even though I think they liked that I had program evaluation in my background. I knew I was good at running a business in terms of, like, the intricacies of a group home and I also had a lot of training and development in my background and that all kind of synced up. And I also don't think there were a lot of candidates, because no one really knew what we were, what we were about back in 2008 when I started. So I got the position and got thrown into it all and 15 or so years later I have never looked back and it was just a great opportunity for me and I've really enjoyed growing in this field with everyone else. So, yeah, that's my. That's other than the fact that I'm a Philadelphia native. I grew up in the Northern suburbs of Philadelphia, I think you know. I made my way out to Tucson back in 2006 and have been here ever since and love this town.
Jerrod Jeffries:That's wonderful. Well, thank you, and I mean I'm still kind of in shock here. Going from 800, was it 2,200? To 35,000 square feet, that is a whole slew of new challenges that you have to keep adapting to and thinking, okay, what are we going to do? But, as you said, having a whole car dealership, I think is a good analogy. So I want to hear, just as within your role like and I loved hearing about you know some of the makerspaces too, but what have been some of your biggest challenges, even with that growth, as well as keeping track of faculty with students, number of student hours, simulation hours and so on, Can you just touch upon that.
Dave Biffar:Yeah, that's kind of multifaceted. I think ultimately it boils down to your learner groups, right, and for us we were always extremely multidisciplinary, and so the easy way to describe it is we provide pretty much for the full range of providers and students, and so it's probably easier to describe who we don't provide services for. It's pre-hospital. We deal with a lot of first responder groups, a lot of EMS organizations, a lot of EMS organizations, and then we move into the hospital. Through the years We've done a lot of in situ training in the hospital, provided for a lot of different specialty needs in the hospital, whether it's tied to root cause analysis based on adverse events, or if it's just regular training on the floor. We've done a lot for the hospital, probably somewhere from 12 or so residencies, and then we have health sciences, pharmacy, medicine, public health, nursing, and now we have vet med as well, which we provide them with some support. Also, we do a lot of outreach and so it's kind of all over the place and that can be very challenging because every group comes with a different sort of personality, level of experience. You know, refining objectives constantly to meet the students and providers where they're at is something that is always a challenge. Anyone can relate to this who's in a large simulation or even small, and just has a lot of user groups. So you know, we went from probably 5,000 learner contact hours a year to 26. Now we're around 26, 27,000 learner contact hours a year. So you can see how the growth for us it has always been controlling the fire, not so much trying to get buy in, and so controlling that fire has been one of the biggest challenges and, I think, one of the biggest takeaways.
Dave Biffar:There's a lot of places I could put my finger on.
Dave Biffar:It is really having a more rigorous onboarding process for new training requests that, no matter whether you're a sim op specialist or a simulation educator in Aztec, or even a research specialist for that matter, no matter what it is that comes our way, you could be the CEO of the training event.
Dave Biffar:And so we use facilitation kind of in a different manner. It's more about the person facilitating the simulation event onto the floor For the instructor and the students, and oftentimes there can be up to 15 instructors and 120 students, right. So we assign one person to a group and they have to enlist all the resources they need, whether that be human resources, meaning more technical support and all the different technologies that are required to make a simulation happen, and so what became quickly challenging for us was trying to triage and negotiate all the requests that would come our way in a streamlined and organized manner, and that has been very successful for us in terms of giving folks working as a tech the opportunity to own their own thing, or multiple things throughout the year. Some of them are recurring. Oftentimes it's a one off, so that has been something that that I think you know everybody has challenges with when they're onboarding new requests.
Jerrod Jeffries:For us, it was all over the place in terms of how they would come our way, and I love that you know you're kind of putting it back on the responsibility to say we can provide some of the resources and the environment, but it's up to you to own it. And I think that shift, or that turnaround, I think is powerful because that allows you that growth in that many number of hours that you're getting through. I mean well over 20,000, closer to 30,000 now in terms of hours, which is yeah, and I think that it's important to note because I know we touched on it.
Dave Biffar:It kind of goes off of how I was brought into this field. Off of how I was brought into this field, I had a mentor and my executive director that trained me up. There was an all-star simulation operations specialist who has now moved on to bigger and better things, who also was a mentor of mine. They gave me the autonomy to learn and soak up everything on my own and they empowered me to take hold of certain things and own them and build them and learn about what everyone else was doing in the field of healthcare simulation and network. Incorporate everything that I could into our simulation center. This is a more structured way of providing that same opportunity for the folks that work in AZTEC.
Deb Tauber:If that makes sense, makes total sense yeah, now David, that is a big center and I do really like your approach of having each discipline be CEO of their training event, especially when you have you mentioned you have veterinary students in there as well.
Dave Biffar:Yes, sometimes it's clear that I need more of a clinical oversight on certain trainings, to the extent that one of my educators may need to be the educator as well, and so those types of requests are kind of a no brainer that I'll go to one of my folks with clinical background right, as opposed to something where maybe there's instructors are taken care of.
Dave Biffar:This is just very heavy on the simulation operation side of things and I can put a SimOps specialist as the owner of a request. You know, and without regular meetings, operations meetings a lot of this would go astray. So we have a method to our madness in terms of how we all come together to organize everything and turning the lab over from one day to the next. You know, I think this is a big thing in simulation. A lot of people don't know exactly what we do to make what we do happen in terms of training. The time between trainings, the work that we put in to break things down, clean things up, reset things and then design other healthcare environments is something I don't think we do a good job accounting for.
Deb Tauber:Yeah, Now, David, to switch tracks just a little bit. Do you have a favorite simulation story that you'd like to share with our listeners?
Dave Biffar:Oh, there's a lot of craziness that has gone on through the years, a lot of favorites. I mean we put mannequins on helicopters, we've taken our whole SimCenter to hotels, but I think the one that resonates the most and I don't even know if favorite is probably not the best way to describe it, but back in 2010 or so, we put together a grant that was to encompass all of our region. It was a border simulation, sort of an in-the-field simulation program that we were designing. The details of that would take another podcast, so I'll just stick to some of the piloting we did to that and what we were doing at the time is we were partnering with Northwest Fire Department and transporting our mannequins into the field near their headquarters. One of the main simulations that we did some practice runs, but the main one that we did was we set up command and control and ran I think it was up to about eight simulators in the field and we were very interested to see how that process would go. So, yes, there was some moulaging effects and things like that.
Dave Biffar:There wasn't very many standardized patients, because we were more interested in what it would take to run a lot of simulators at the same time in a mass casualty event, and the mass casualty event was a multi-car collision. You know it was a lot of work to get it all done. We learned a lot of things, we were able to apply a standardized evaluation to it. We adopted what the after action review that first responders and EMS would use in any given circumstance. So we had it all set up any given circumstance. So we had it all set up, we hit the go button and they had an actual unit that was on shift at the time respond to our multi-car collision mass casualty event, and they did their thing. It went on for about two hours. They incorporated command and control, triage, treatment, all those things, and we did a well-rounded after action review, which also we did a live broadcast of the event, and we used the Arizona telemedicine program under the late Dr Ronald Weinstein to stream everything into the College of Medicine so medical students could also watch and take part in the debriefing to some extent, and so that was also something that was novel and unique to it, which also was part of the grant that we were looking to submit, where we wanted to be able to harness what we were doing in the field, and it was sort of a telesimulation type of modality that we were getting at, more so than telemedicine, but we utilized their resources at the time and so, fast forward, I don't know, a month and a half later, the Gabby Gifford shooting happened and the unit All hell broke loose.
Dave Biffar:And the unit that was the first to respond on the scene to that event was the unit that responded to our simulation at Northwest Fire. And you know we obviously you know we could have added probably another 30 simulators and another 50 standardized patients to help better represent that type of mass casualty. Where that was a mass shooting, ours was a multi-car collision, but there were a lot of lessons learned in hindsight. The unit that arrived on the scene was the unit that trained in our simulation and they did speak to the simulations that they did with us to help them better respond to the Gabby Giffords shooting. Particularly, the time from arrival on the scene to patients in hospital was something that they identified was improved upon based on the simulations they were doing. So there's a lot more to get into in terms of that incident and how it all played out at our at our University medical center, but I think that's probably the one that resonates with me the most.
Deb Tauber:That's a really powerful story. Thanks for sharing that's incredible, Sure.
Jerrod Jeffries:So, and to get, into a little of this, Dave, because of this you know, multi-car match, casualty event, something going for two hours, and of course there's practicality just a little bit later. But hearing all this, especially even with the hotels and the helicopters for other sims, it makes me think of the healthcare simulation design and this modeling aspect. Can you go into how you've actually created something around these diverse events and kind of get into more of the modeling of what you do that and how you do it and kind of get into more of the modeling of what you do that and how you do it?
Dave Biffar:Well, you know, and a lot of people are probably already thinking, will already be thinking this, as you asked the question which is and we all sound like a broken record which is what are your specific objectives? First of all, because we have got to nail those down. Those will lead us right into the design of the healthcare environment, and so some people refer to fidelity all the time when it comes to simulation technologies. I think that's important. We use it to make a distinction between high-tech versus low-tech, which can often be confused, and we've been saying this for years in different forums. It's a little bit more about contextual fidelity, meaning if for this group of students with the stated objective to learn chest compressions, a soccer ball might be just fine to do proper chest compressions and you don't need a $100,000 mannequin to do that. So hopefully that gets to the point a little bit in terms of how we design things. Oftentimes mid-fidelity mannequins they can do 90% of what we do High-fidelity mannequins. Sometimes we only use 60% of the features 80% of the time, kind of thing, right? So the design is sort of built around that in terms of what the available resources are.
Dave Biffar:If you want me to get into mass casualty a little bit. That's kind of comes in a different form. A lot of times we will talk ourselves to being out in the field based on the objectives, or we'll talk ourselves into scaling back the mass casualty to what makes the hone in on, because it makes more sense for being inside. So maybe we're only working on triage right, or maybe we're using the Sim Center to simulate the emergency medicine department that is starting to become overwhelmed with patients from a mass casualty event. They have to figure out how to organize all of that.
Dave Biffar:So the design it comes in a lot of different layers and formats. We use a lot of special effects. We take a hard look at what modalities would be the best. Sometimes standardized patients are the perfect answer to a certain simulation and that can often make things much simpler in terms of the tech involved. And we end up at the end looking back to each other saying why did we, why would we? Always stressing ourselves out using a high fidelity mannequin that you know we had to mobilize and do all these different things to when a standardized patient works just fine. So it's a lot of navigating.
Dave Biffar:It really is like being able to navigate all the modalities and properly onboard them and design them to fit the population and when it all comes down to it, you have your objectives and really you can divide everything we do between scenario-based training and procedural-based training, and whether that's combined that's another discussion. It is another question for our instructors to determine what are the objectives. So, is it procedural competency or is it working effectively as a team to treat a patient?
Deb Tauber:Excellent, thank you, yeah, thank you, hey. Why don't you tell us a little bit about being the editor-in-chief of Storm?
Dave Biffar:Sure, it was something that I was interested in, given how busy I was at the time. It wasn't too far after we moved into our new facility. So I was sort of like, oh sure, maybe I'll throw my hat in the ring to be on this editorial board as a reviewer. And one thing led to another and I ended up in an interview for editor-in-chief, and I guess probably two and a half years later now, since we first assembled the board, we are closing in on our fourth issue and that should come out in the next week or so, and about 30 or so papers total.
Dave Biffar:So STORM is the Simulation Technology and Operations Resource Magazine. It is an electronic journal specifically geared towards simulation operations and that does not mean you need to be a simulation operations specialist by name. It can be anyone in healthcare simulation that has work they've done that's operational heavy and that can mean a lot of different things. And if you go on the website you can see there's different categories that help guide people for submission. We have submission guidelines as well. It is a peer-reviewed journal. We probably have around 20 or so total peer reviewers who are all fantastic, and I like to think that you can see that in the papers that we've published already. We're starting to evolve, hopefully, into what I see as a quarterly journal, and it is published through the Simulation Spotlight, and the four categories are emerging technologies, policy and procedure, training and then career development. And so we'd like to see more in career development, which is a little bit more of an editorial than a technical paper, right, or even a paper that has a bit of research in it.
Dave Biffar:We're trying to push the field to share their stories, share the networking that they've gone through, share how they've evolved and some of the lessons learned along the way. We'd like to see more of those submissions. I looked back at the stats a couple of days ago and we were very even keel between three categories outside of career development, which is really great to see, and we're trying to push folks to really round out what they're doing to provide subject matter expert reviews, provide more evaluative processes, to onboarding new technologies, to implementing new policy and procedure and to developing novel training ideas, policy and procedure into developing novel training ideas and so we want to see the full circle in terms of needs assessment, how you developed it. We really want them to be transparent about their methods so that it can be easily replicated in other sim centers. So we'll push them for that.
Dave Biffar:We'll push folks for more supplementary documentation, whether it's a video on how they did things or a checklist on how they did things. If it's a procedure, share what the procedure is as an appendix and then you know as part of the results or in leading into the discussion of things. We want to see more about what your process was, to evaluate its effectiveness, not only as you onboarded, as you've used it over time, so applying it to some kind of quality improvement process that's recognized, or just simply a more formalized subject matter expert review, because one thing we can all get better at is determining more formally that what we have designed or developed is actually helping to teach what we intended for it to teach with our students, and so obviously, student feedback is a big part of that assessment process as well.
Deb Tauber:Thank you. Thank you for your contributions and for the. You know coming up with the being the editor of the storm. The other thing I wanted to ask you know and our listeners can't see this, but I've got a 15 page CV on you, and so I'm going to ask you a question Out of these 15 pages, Dave, what are you most proud of? What do you? What do you want to be remembered for you? Did you do in that 15 pages? That meant something.
Dave Biffar:Well, I just recently became a fellow and that is something I'm very proud of, really getting myself. A lot of it was the application process and getting my arms around, everything that you see there on the CV. So that's something I am very proud of because it forced me to go back and take a hard look at everything that I've been involved in and how that has evolved and sort of like what were the most important milestones throughout the last 15 years or so it pivots, depending on the week in terms of what I'm most proud of. I guess being the editor-in-chief of Storm is something I'm extremely proud of. I would not have guessed that I would have been in this role 10 years ago, let alone 15.
Dave Biffar:So any novel technology that I have developed that has been tied to patient care is something I'm always extremely proud of, and I used one of the most well-rounded examples of that for my exemplar when I became a CHOSOS A, because it checked all the boxes that were out there in terms of process improvement in the hospital grant submission, presentation, publication, and it was a novel model that we made, geared towards a very specific objectives, which was simulating the disaster protocol for conversion for robotic surgery.
Dave Biffar:Those were the jobs that I have had in the past that have been tied direct. That you can clearly see the impact on patient care is probably, you know, when you're down into the day to day, that's probably where I'm the most proud. I've always had a thing for human factors. It's because I have a sort of a psychology background. I'm more on the organizational psychology side of things and the engineering side of things. But with all this stuff that we do in simulation, education, everything, no matter how far it is from the hospital, whether it be eighth graders in an elementary school doing a tour, it all leads back to patient care, patient safety. That's always in the center. So whenever there's something I've done that you can clearly see the impact, I'm super proud of that.
Deb Tauber:Excellent, excellent. Thank you so much. Is there anything you'd like to leave our listeners with as we kind of wrap up The Sim Cafe today?
Dave Biffar:No, I just I look forward to seeing everyone at the next conference that we have. That's always a good refresh in terms of what everyone's up to. The most important thing about health care simulation is really the networking that goes on about healthcare simulation is really the networking that goes on and the sharing of ideas, because, as much as we're an accredited simulation center in all four or five areas, we're looking to get fellowship as well. But we have more standards to guide us than we used to back in the day. But I'll tell you, the networking that goes on in between the lines. There's nothing more valuable than that.
Deb Tauber:Yeah, I would totally agree. Thank you so much for being with us. Thank you for your time and happy simulating.
Disclaimer/ Beacker Health AD/Intro:Thanks to Beaker Health for sponsoring this week's podcast. Beaker Health, where dissemination and measuring impact comes easy. 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.
