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The Sim Cafe~
Discussions on innovative ideas for simulation and reimagining the use of simulation in clinical education. We discuss current trends in simulation with amazing guests from across the globe. Sit back, grab your favorite beverage and tune in to The Sim Cafe~
The Sim Cafe~
Theatrical Roots and Healthcare Simulation: Dr. Lou Clark's Journey and Innovations in SP Education
Discover the fascinating intersection of theater arts and healthcare simulation with our special guest, Dr. Lou Clark. Transitioning from the vibrant world of acting and playwriting to becoming a leading educator in healthcare simulation, Dr. Clark shares her unique journey and insights into the evolving field. Her story unfolds with her move to the University of New Mexico, where her theater background became an invaluable asset in training simulated participants (SPs). Now at the helm of the Association of SP Educators (ASPE), she discusses the critical, yet often overlooked, role of SP educators and the transformative power of performance in healthcare education.
Explore the intricate responsibilities of SP educators, from recruiting standardized patients to crafting scenarios that resonate with authenticity and inclusivity. This episode shines a spotlight on an innovative collaboration with pharmacy faculty to develop a transgender care scenario, highlighting the significance of consulting the trans community for genuine case development. Learn about ASPE's groundbreaking accreditation program, set to debut at the 2025 conference in Montreal, underscoring the organization's dedication to maintaining high standards and inclusivity in SP programs worldwide. Join us for an engaging conversation that celebrates the blend of disciplines like psychology, education, and theater in the realm of SP education.
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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 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:Welcome to The Sim Cafe. Thank you for joining us today. Today we have Jerrod as co-host and we have Dr Lou Clark, so welcome, Dr Clark, and thank you so much for agreeing to being a guest with us today.
Dr. Lou Clark:Thanks for having me, Deb and Jerrod, and just kind of moving forward. Please feel free to call me Lou, I'm very informal.
Jerrod Jeffries:Thank you.
Dr. Lou Clark:Thank you.
Jerrod Jeffries:Thanks for being here, Lou. Absolutely. I think there's a lot to get into, but maybe we want to level set with all our listeners and first, starting off, could you give us a little bit about your background, where you come from, what you're doing now?
Dr. Lou Clark:Yeah, absolutely. I didn't start out to be an educator or in simulation. I think, like a lot of simulationists of my generation, like a lot of simulationists of my generation, I started off life in the theater. I'm a trained actor and singer and did the freelancing and all those kinds of things in a few different cities and got my master's of fine arts in dramatic writing. So I'm also a playwright, and that was at the University of New Mexico.
Dr. Lou Clark:And as I was getting out of school and this was back in 2007, I wanted to stick around and a friend of mine said you know, there's this amazing job. You should go down to the medical school because you would be, you'd be really good at this. They need someone to coach the actors. And that was how I got involved. That was my first position was as an SP educator at the University of New Mexico in Albuquerque.
Dr. Lou Clark:It's a wonderful program and from there I really discovered that this job that I sort of took on as a day job was really meaningful. It was rewarding to use the skills that I have as an artist, as a theater artist, in service of healthcare, training and education. And so I went on from there, got very interested in communication, because that's such a part of performing arts, and got a doctorate in health communication and organizational communication from Arizona State University. So I've been in SIM since 2007. And what keeps me excited to work with SPs is just that connection that I've watched them make on a routine basis and how that really transforms learners.
Jerrod Jeffries:And just to clarify SPs, for some of our listeners might be yeah.
Dr. Lou Clark:So that's a really interesting clarification, Jared, because there are so many different ways to name who are SPs. And I will say today you know, late in 2024, we are really adopting simulated participant as a term widely and this is because the methodology, the SP methodology, while very widely used in healthcare simulation, is also used in other kinds of disciplines. Our ASPE members have trained school principals, We've trained chaplains in the military, lawyers, law students, police. So we really look at simulated participant as a term that is being more increasingly adopted worldwide.
Jerrod Jeffries:Okay, and then you mentioned ASPE. I know that you are leading ASPE. Could you give us what the acronym stands for and then give us a little bit more about that organization as well?
Dr. Lou Clark:Sure ASPE stands for, and it's great because it relates to this idea of what do we call SPs.
Dr. Lou Clark:Aspe was founded over 20 years ago as the Association of Standardized Patient Education and a few years ago our membership voted to change the name to the Association of SP Educators because it's more inclusive, and so that's the official name now the Association of SP Educators.
Dr. Lou Clark:We have just under 1,000 members worldwide from 44 different countries, and our members tend to be concentrated in North America. But again, we're really on everywhere in terms of the globe and the primary folks who are ASPE members tend to be people like the kind of job I had starting out in New Mexico people who routinely coach SPs as part of their work day to day. And there's so much that goes with that work which I can speak to now or later, but I would say that, as ASPE president, a big part of my sort of calling to do this is to raise up and amplify the hidden work of SP educators, because a lot of it takes place behind the scenes, especially because the SPs are the ones front facing with learners and faculty. So all that kind of preparatory work that happens before and even behind the scenes during a simulation and after tends to go unnoticed. Not for any sort of bad reason. It's just that so much of it is happening behind the scenes that people don't often notice it, and so I've really been trying to amplify that.
Jerrod Jeffries:But it also goes ties in pretty well to your acting and theater background, where there's so much prep for an actor. I assume right, correct me if I'm wrong but reading lines, memorizing those, trying to get in the right flow, and then when it comes to that 15 minutes of fame on the screen or whatever it may be on the stage, then you're like, oh, that must be really easy. But you don't really see the, and so there's a little bit of a crossover.
Dr. Lou Clark:I definitely think that. I think that very much, Jerrod. That's really astute is that probably 95% of the work that we do with SPs is happening where learners and faculty, who aren't in a center day to day can't see it. And it is that behind the scenes, that offstage work. And so most recently I've collaborated with nine other SP educators who are also researchers from around the world, with nine other SP educators who are also researchers from around the world, and we will soon have published in the journal Simulation Healthcare Journal an editorial, a peer-reviewed, invited editorial, called Call to Action Honoring SPs and Collaborating with SP Educators. And what we've sought to do in this publication is to really call out the contributions of the SPs, who I see as educational change agents they really are and then the work that we do as SP educators behind the scenes, that often hidden work that supports them in making these contributions.
Deb Tauber:To follow up on that. How do you see simulated participants contribute to health professions education?
Dr. Lou Clark:Such a great question. I see it every day. I see it in small ways, in big ways. You walk through anybody who has one of our programs, any of our ASPE members. You go to their center and you see, say, a medical student, a nursing student, an allied health profession student role playing with an SP in a formative setting. You know there could be a situation where I think constructive verbal and written feedback is the gold here. I really do.
Dr. Lou Clark:I think it's great you can work with SPs to assess your learners, but where I see a lot of the real learning happening is through that feedback process where the SPs can provide the feedback directly to the learner from the patient perspective. Because we know the power of this methodology is that actual patients don't often give you that feedback right. It's really rare to have a patient give a clinician feedback in the clinical setting, whether that's an outpatient clinic, the hospital, and so the whole point, one of the whole points of SP methodology, is that patient perspective in the scope of learning. And how does that influence and support and guide the learner? Of course we know there are clinical milestones in every sort of health professions program. The SPs add the patient-centered component.
Deb Tauber:Yes, it certainly is a great outlet for feedback for the learner because, you're right, they don't get that opportunity to get feedback on how they're doing as a clinician and how that directed the feelings of the actual, standardized simulated participants.
Dr. Lou Clark:I think, also to add to that in a way that we strive, through our professional ASPE standards of best practices, to do this in a rigorous way. There is an ASPE methodology and there are five domains of our best practices. This is a publication that anybody can find. It's freely downloadable. It was published in 2017 in Advances in Simulation and it's currently being revised. I'm very excited there's going to be a new version of the standards out within the next year or so. But these standards number one domain is safety and so, just like any other sort of simulation modality because we know safety is paramount throughout simulations why we do it in part.
Dr. Lou Clark:This is a little bit interesting because there are nuances when you are working with human beings that are the vehicle or that they're allowing themselves to be the teaching tool, right. So SPs are partners. They're our allies in teaching. One of the tenets in this new publication I mentioned is we're really trying to get a cultural shift and a linguistic shift going among the simulation community so that we stop saying that we're using SPs because that using people carries a negative connotation. We don't want to use people in our daily lives right In our lives, in work and just personal daily living. Well, we shouldn't use SPs right. The SPs are our partners, they're our allies, they're the people who are with us.
Dr. Lou Clark:You know teaching and so I think part of that shift, that cultural and linguistic shift, is about safety, not only in the space for learners but in the space for SPs who are helping us carry out the learning.
Dr. Lou Clark:So we need to regard SPs as adult learners themselves. So we need to regard SPs as adult learners themselves. SP educators, coach SPs and then SPs themselves are the instrument of the education, the human living instrument, and so this is why safety in SP education and SP methodology is a very nuanced topic, because you really have to pay attention to psychosocial safety and where we're seeing this so importantly especially, I think there's been such a shift in call since the pandemic to further diversify SP programs and pools. Every you know I hear this a lot from our members, I experienced it myself. My home institution is the University of Minnesota in Minneapolis, and we have a lot of faculty coming to us saying can we get a sim that helps students learn about how to care for transgender patients? Can we get a sim where we're really making sure that we have BIPOC or Black Indigenous People of Color as the SPs, or Black Indigenous people of color as the SPs.
Dr. Lou Clark:And it's great to want to diversify health professions education and we need to be mindful to support the individuals who are stepping up and saying I will be your SP from a BIPOC community, I will be your SP as a transgender person. We have to support them as they do the work, prepare them to do it and we call it de-roll them after they do the work, because the last thing we would want to do is further marginalize or hurt a person coming from a community that is historically underserved health professions and healthcare. So this is the kind of safety that SP educators promote, advocate for and navigate on a routine basis with our SPs.
Jerrod Jeffries:That's wonderful and I want to dig into actually one piece you talked in there and that was about the SP educators. So what is their role or what does it entail? And maybe even more specifically, how do they coach or support? Because I think we also touched upon the before, during and after, because I also wanted to hammer in a little on the after piece. But yeah, SP, educators and kind of the process throughout.
Dr. Lou Clark:I really appreciate that question. And again, it's hidden work often. So SP educators do everything from recruiting SPs. So when a faculty member comes and says we really want to do this, I'll give you an example. In my own institution, a really collaborative group of pharmacy faculty came and said we want to do inclusive cases and we want to do them with SPs. One in particular we want to do involves transgender care trying to explain medication to a transgender patient who opts to start going on hormones. And so as we began to think about OK, well, how do we approach this, to think about okay, well, how do we approach this?
Dr. Lou Clark:The work of myself and another member of our SP education team included collaboratively writing the case or the scenario. So we collaborate on creating the SP case, the curriculum the students will experience. Often I'm coaching faculty who don't have as much experience in sim on things like writing learning objectives to make the sim effective. That's very standard for our SP educators. To help create that, we give advice on performance assessment tools that have to do with communication skills. That's a very standard for us. We have knowledge of that. Anybody who's been in SP methodology for a while you kind of get that knowledge of how do I write, how do I help that faculty member write the case so that it really works effectively when it's brought to life? So you can imagine that was one of the first things I really grabbed onto as a playwright, because and a lot of, I should mention this a strength of ASPE is the interdisciplinary nature of the members. So ASPE members come from all different backgrounds, most predominantly education, psychology, theater and the performing arts, communication. We do have healthcare folks in there as well, but it's a real mix and it really leans towards arts, social sciences, education. So we really bring that piece to the work as SP educators and again, it's often hidden work, you know.
Dr. Lou Clark:So we help create the scenarios I mentioned about the safety. Not only are we helping to create the scenarios from a curricular standpoint, we're also offering guidance on logistics as to how to bring the SIM to life. And that's not just about moving people around, it's about, well, how many encounters should that trans SP do before they get a break? What kind of content in the case would be appropriate for them to portray? And have we involved a trans person in the writing of the case? And so in our standards and in the work that we promote. We're really promoting inclusive case writing. So to involve, as they are willing and want to be involved, some of the SPs or community members in and around our SP programs who could help advise us from their own lived experience right?
Dr. Lou Clark:So in the example I'm sharing, that is not my way. I identify as transgender. I identify as cisgender, with she, her pronouns, so I needed to go and see was there an expert I could go to? A trans person? And there was a wonderful person within our SP pool who worked with me to write this case with the pharmacy faculty and the case was better for it. This person opted not to portray the case, which we always respect. So there are different ways you can involve SPs and be mindful of their comfort, you know, and safety be mindful of their comfort, you know, and safety.
Jerrod Jeffries:So is all this, these benefits, because of the membership into ASPE, or how do you tap into these resources in this, in this community?
Dr. Lou Clark:Well, I would say a really great resource are the ASPE highlighting for and advocating transgender non sort of initiatives within our organization? So I think to your question, Jerrod, it really depends on what the initiative is or the idea is and, that being said, we pride ourselves on being very inclusive and open organization.
Jerrod Jeffries:Wonderful.
Deb Tauber:What new initiatives are on the horizon for ASPE?
Dr. Lou Clark:We have a very exciting initiative, which is a new accreditation program for ASPE. It's long due because of some of the very nuanced sort of things I've been sharing about how we work with ASPEs and ASPE really is the foremost international organization that has this expertise among our members, and so immediate past president, Sean Gilleen I really want to call him out has done a wonderful job with a group of past presidents of ASPE and others in launching this initiative. So right now we are in the inaugural year of an accreditation program for SP programs from ASPE, and so we're very excited, and our conference will be in June 2025 in Montreal in Canada, Quebec, Canada, and the programs that are accepted for this inaugural year will be recognized at that conference. So we're very excited. We're less than a year away from the first SP programs around the world being recognized with the official ASPE SP program accreditation.
Jerrod Jeffries:And I love it. I absolutely love it, lou. One what are the steps to learn more? Two what's that process look like and how long does it take?
Dr. Lou Clark:Yeah, so we have. Anybody can find out more about it on our website and we just closed last week the letter of intent to apply for the accreditation. So there is an LOI process and if listeners are familiar to the NACSIL endorsement program, you would probably be familiar with the type of process this is. We designed it to be as streamlined as possible and the accreditation program is designed around our five domains of our standards of best practices. So I had mentioned I think I'd mentioned just two of them because I sort of went off on a tangent, but that is, five domains are safety case development, so I mentioned that one.
Dr. Lou Clark:We really promote collaborative work from subject matter experts, sp educators, sps, community members, anybody relevant. It always makes it better. Domain three is the coaching or the training of the SPs, where we really want to see our SP educators adopting adult learning theory, best practices in coaching adults, unless, of course, your SP is pediatric or adolescent. You know, then there are other kinds of training you might employ, but really, when it comes to working with SPs, most of us are working with adults, not all. So we really want to see those best practices of how do you coach adults, because adults bring lived experience to any training situation and you want to honor it and you want to. I think the nuance of training SPs, at least for me, has always been to honor the lived experience of the SPs in the room, keep us on track, to stick to what do we need to get to to cover the material, to best serve the learning objectives and be prepared to work with the learners. And then to be thinking about things like affect, you know, because nonverbal communication is 75 to 80 percent of all communication. So we think about things like that. And then if you're doing any sort of assessment, you know that and feedback I've already mentioned. So those are really things encapsulated in the training.
Dr. Lou Clark:And then domain four is the management of SP programs. That's a lot, even more of that hidden work Jared with that recruitment, onboarding of SPs, making sure the SPs are paid If you have paid SPs as opposed to volunteer or student SPs really just keeping them on track, scheduling them all that hidden work. And then making sure that your program adheres to institutional policies and then we hope is guided by these ASPE standards and best practices. And then addition to all of that, domain five is professional development, and we really think about professional development for SP educators and SPs, and so one resource ASPE has is an annual research award that is administered through our grants and research committee of ASPE. We know that SIM programs tend to run really lean.
Dr. Lou Clark:While we get a lot of requests to do innovative work, we aren't always the ones who get to drive it. We aren't often the ones who get to drive it. Oftentimes we're reacting to projects that are presented to us and we're collaborating on those projects. Something I love about the ASPE grant is that SP educators can apply and we use it to help fund innovative work, and past grants have included just projects around how to promote new curricula, and often within the last few years it's been leaning towards initiatives around equity, diversity, inclusion and social justice, which again probably tells you a little bit about ASPE as an organization.
Deb Tauber:Right, those are all very exciting things. How many programs have set out to achieve this designation in June?
Dr. Lou Clark:We've had several and because we're right in the thick of the application process, I will not provide an exact number, but I will say what is very exciting is the response has exceeded our expectations. So we've had a wonderful response and more to come on the numbers of this, but I think I feel very confident that Sean and the team who are working on this are ready, and it's a wonderful problem to have when you're in the midst of bulking up the reviewer pool, if you will, because you had such a great response. So that's really literally what we were talking about last week. So it's a really nice situation and I wanted to share, just to kind of like wrap up, why did I go through all the standards? Because that accreditation program is guided by the standards. Programs that will be participating will need to demonstrate competency in all the areas I spoke to.
Jerrod Jeffries:Safety case development, coaching and training, management of SP programs and professional development.
Dr. Lou Clark:Yeah, excellent, you nailed it.
Jerrod Jeffries:Yep.
Dr. Lou Clark:Yep. And then another initiative I just want to mention because I'm very excited about it is in Montreal. Our conference will be pre-conferences start May 31st 2025, and the conference will run through June 4th in Montreal, Quebec, canada 2025. And we are going to be holding the first ever Human Simulation Research Forum. We are going to be having special programming in terms of different types of workshops to support ASPE members and attendees on research skills to utilize with SPs, really going to that mindset of not using SPs but working with SPs, and how do you take on practices of research when you're doing research with human simulation. And I'm very excited because coming out of this will be an ASPE driven research agenda for human simulation.
Jerrod Jeffries:It's very exciting. Has that been done before?
Dr. Lou Clark:To my knowledge, no, not by ASPE. And so Sean's passion, which is resulting in this incredible project and gift to ASPE, as I mentioned, is this accreditation and my real passion as a artist, as someone who's trained as a qualitative researcher and really I started my doctorate at age 40. I came to this to being involved in research through the membership I received as a part of the ASPE Grants and Research Committee. It was the senior members of that committee who mentored me from the moment I kind of walked in the door as someone very interested in training and what does it mean to train SPs and how can we talk about the skills that only uniquely ASPE members bring?
Dr. Lou Clark:A unique interdisciplinary skill set and I have seen over time how special that is and the unique contributions that our members as SP educators make behind the scenes in the development of SP education. And I want to see our members celebrated and recognized and it's critical that we document in the research, in the literature, our own practices and the hidden labor of what we do. So that's what I feel I can contribute as someone who really started off as an artist SP educator coaching SPs, went on to engage in research because I was mentored. So my real passion is mentoring members and making sure that all the great work our members are doing is documented, really, and we're advancing simulation as a profession through our innovations and that needs to be called out and it needs to be recognized. And for us to have that happen, we have to take responsibility and make it happen. So that's why we're doing this.
Deb Tauber:For sure. It's very obvious that you're extremely passionate about standardized patients and simulated participants, as the new language would have it, and we're thankful to you for all that you're doing. Do you have anything that you want to leave our listeners with?
Dr. Lou Clark:I think I would say this, and it may be surprising I think a lot about technology as well.
Dr. Lou Clark:I think about AI.
Dr. Lou Clark:It's the new thing, right, and so I think for years, what's been really interesting because this is almost 20 years for me working with SPs is that a new sort of technology comes along and a friend, a good-natured friend, who errs more towards technical sim, will say, well, there won't be SPs a few years from now, and they give me kind of like a nod or a wink or whatever.
Dr. Lou Clark:So I'll say I don't think so. I think, as long as healthcare professionals are treating and caring for us as human beings, the role and the contribution of the SP is singular, it's unique, and I also think it's critical for us who identify more on the human simulation side of the profession, we must engage and collaborate with people who have technical expertise, and so I think it's really critical that we approach this in a collaborative way, and so I just want to leave listeners with that. There is room for everyone to be a part of SP methodology, and I think we need to collaborate with our colleagues who have the experience and the expertise in AI and virtual reality and augmented reality, because we bring what is uniquely human and that will inform their technology, and together we can really innovate and push this profession forward.
Deb Tauber:Thank you. Yeah, thank you for your contributions. We appreciate. Will you be at IMSH this year?
Dr. Lou Clark:I will. I'm really looking forward to it and I hope I see you there. Yeah, yeah, all right, this is fantastic.
Jerrod Jeffries:Thank you so much for the time yeah.
Dr. Lou Clark:Thank you for having me. Thank you so much for having me and for highlighting ASPE. We appreciate it.
Deb Tauber:You're very welcome. It's been a pleasure and honor. Thank you and happy simulating.
Disclaimer/Beaker 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.
