The Sim Cafe~

From PICU Trailblazer To Simulation Leader: Tonya Schneidereith On Innovation, Teaching, And Safe Practice

• Deb Tauber • Season 3 • Episode 114

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What does it take to build safer clinicians, not just better test takers? We sit down with pediatric critical care pioneer and simulation leader Tonya Schneidereith to trace a career defined by curiosity, courage, and a relentless focus on patient safety. From early days as one of the first PICU nurse practitioners in the country to associate director of simulation at Johns Hopkins, Tonya reveals how mentorship, research, and design thinking shaped her approach to teaching and assessment.

We dig into her medication safety work using Google Glass to capture the learner’s point of view, exposing why accurate math still leads to dangerous IV pump programming when context is missing. That insight led to national recommendations on verifying dosage calculation competence and a sharper focus on debriefing. Tanya shares a memorable morphine case where most learners turned up oxygen as ventilation failed, and how a single probing question in debrief uncovered the real driver behind a “correct” action. The lesson is clear: simulation must illuminate decision-making, not just outcomes.

Tonya also opens the doors to SIMPL Simulation, the consultancy she co-founded to elevate faculty development, program design, and simulation operations. She walks us through a bold project with BSA LifeStructures and Wake Tech Community College: a true simulation hospital spanning EMS arrival, diagnostics, acute care rooms, an operating room, and a live MRI. It’s a blueprint for interprofessional education that makes teamwork the default. We then explore responsible AI in healthcare simulation, drawing on a new white paper Tonya helped shape. Ethical integration, transparent limits, and scenario design that builds judgment are essential as AI becomes part of daily clinical work.

If you care about better debriefing, safer medication practices, AI in nursing education, and simulation spaces that teach as powerfully as people do, this conversation will sharpen your approach. Listen, share with your team, and tell us the one change you’ll make in your next sim. Subscribe for more expert stories and leave a review to help others find the show.

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Disclaimer/ Beaker Health Ad/ Intro:

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. 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 :

Welcome to another episode of The Sim Cafe. Today, Jerrod and I are here with Tanya Schneiderreit. And Tonya is going to tell us a little bit about herself. And thank you so much for being a guest. Why don't you tell our listeners a little bit about yourself?

Tonya :

Thank you. Thanks for inviting me to this. This is really wonderful. So my name is Tonya Schneidereith. I am a pediatric critical care nurse practitioner by training. And I am currently an associate professor at Johns Hopkins University School of Nursing, where I teach child health for our master's entry to nursing program. And then I'm also the associate director of simulation for the master's entry to nursing program as well.

Deb :

Thank you. Why don't you go ahead and share your journey into simulation for our listeners? Like what inspired you to leap into simulation from practice?

Tonya :

So I've always been that person that just enjoyed learning, and I've always enjoyed learning new things. So when I started out as a pediatric intensive care unit nurse practitioner, I worked with one of my attending physicians, and he noticed that there was a difference in the way that patients with sickle cell disease metabolized lidocaine when they compared to normal post-op controls. So that got me interested in patients with hemoglobinopathies. And so I decided to go back to school to get a PhD where my doctoral work was looking at pharmacogenetic pathways, basic science stuff involved in fetal hemoglobin production. And around that same time, I started growing my family. And so I stepped away from the bedside and I met a woman in the infant toddler class in Jim Burie. And Jared, you may be able to relate with some young children. But one of these ladies happened to be a nurse practitioner, and she was telling me about her role in higher education. And so I started looking for some positions, thinking, is this something that I might be interested in doing? And that led me into higher education. So I joined the faculty at a small university in northern Baltimore County here in Maryland. And I was selected as one of the first designees to attend the Maryland Faculty Academy for Simulation and Teaching at Johns Hopkins University. And that was spearheaded by this wonderful innovator named Dr. Pam Jeffries. And that was my introduction into simulation. And I had no idea at the time that she would become my fairy godmother in terms of simulation education. And so from there I was hooked. I learned all that I could about simulation. And we were a small, small little institution where I first started. So I was an island. I was everything. I was sim ops, I was facilitator, and I was everything in between. And a few years later, I was selected for the 2015 NLN SIM Leader Program. And that's still impacting my life today. Ten years later, I met colleagues, lifelong friends from all around the globe, and they've helped me and guided me through my simulation journey. That fed into work with the NLN through working with Dr. Marion Rizzolo and Sue Fernares and Mary Fay. That allowed me to author the Thomas Sykes case for the ACE, the Pediatric Evolving Simulations. I started revising and reviewing CHSE- A applications for our advanced healthcare simulation education certification. And now I'm on the SSH board of directors. So it has been a winding journey. It's been amazing, and that's what led me to today.

Deb :

Thank you. Thank you for that introduction and for your story about how you got into sim.

Jerrod:

You knocked it out of the park there, Tonya. That's I mean, a lot of things to dig into. But I think there was one little piece that I and you mentioned the pediatric critical care. Did I hear that you're one of the first pediatric critical care nurse practitioners in the country? Yes. Yeah.

Tonya :

Yes, I think I maybe was number seven. I know I was the fourth. What I was the fourth in Maryland, and I think there were three in Utah prior to my starting.

Jerrod:

Wow. I mean, so being a pioneer, I mean, because like I mean, now it's also you went through simulation in some of the early days too. I mean, you're you're used to a lot of differences or pushing the boulder uphill, so to speak. So what are some of the moments you remember most and and any advice to maybe some that are trying to do new movers and shakers in new industries as well?

Tonya :

Well, so it it feels like as being one of the first people in that role, we were definitely building the plane as we were flying it. And that's so much like simulation, right? There's there's so many things that you have to take on and figure out as you're going along. But I think it's really rewarding to think of having originated this role, goodness gracious, 25 plus years ago, and know that there's over 500 pediatric critical care nurse practitioners now. So that just warms my heart when I'm walking down the halls and see people who are training for that same thing. Back in the day, there wasn't an exam. So we had to sit for the pediatric primary care exam. And so you can tell the the oldies based on our certification, where our certification originates from. But it's it's also really similar to what we were going through with certification for simulation, trying to develop those educator certifications and then advancing to the advanced certification. And then the same for our operations specialist and helping them to move into an advanced operations specialist certification as well. So there are a lot of parallels. It may seem like they're completely different fields, but very, very similar to what I'm doing now.

Deb :

Thank you. Amazing work, amazing work. Tell us a little about simple, your simulation company that you have.

Tonya :

Yes. So as I mentioned, I was in the 2015 cohort of the NLN Sim Leader program. And um, out of the 20 amazing people that I met in that journey, four were from Maryland. And one of those individuals was the amazing Dr. Crystal Farina, who is at currently, she's currently at George Washington University, drawn there by Dr. Pam Jeffries when she was there as the dean. And Crystal, hands down, has to be one of the smartest simulationists that I've ever met. And when we were in the simulator program, in our conversations, in our travels, and going to conferences, we recognized very readily that there was a need for professional development. And so two years later, we founded Simple Simulation and we derived the name simple. We took SIM from simulation, the P is for practices, and the L is for learning. So that's where that uh simple comes from and the name. And our job right now is to try to help individuals with anything that they need to help develop their simulation programs, be it professional development, be it, well, currently we are in a really fun place where we are working with architectural firms to design and develop sim spaces. And one of the things that we're doing now, which is uh it's a project that just it makes my heart swell. I'm so incredibly proud, is we're working with BSA Life Structures to design a simulation hospital for Wake Tech Community College down in Raleigh, North Carolina. And it is literally going to be a simulation hospital. So can you imagine three floors where you come into the entrance as if you're coming off an ambulance, you get diagnostics, screening, you move to the third floor where you would have acute care rooms. There's also going to be an OR. They have a live MRI machine that's been donated that will be there for them to help train. They have a variety of programs: nursing, ultrasound tech, radiography, MRI, mammography, respiratory therapy, to just name a few of them. So can you imagine everybody in there to learn? And when we think about what we're looking for for interdisciplinary learning, that that's just that's gonna be the mecca there. So I'm really excited to be a part of that that project. They are definitely trailblazers.

Deb :

When do you think they'll be done?

Tonya :

So they just broke ground um this past summer.

Deb :

How exciting!

Tonya :

Yeah, so they have a couple of years of building, and then it's it's it's gonna be a premier place to be.

Jerrod:

And that's out of Raleigh.

Tonya :

That's in Raleigh, yes.

Jerrod:

Yeah, that's cool. That was the first I've heard of that. Yeah, that's so cool.

Tonya :

Yeah, so that's that's sort of an area now that we are we are focusing on, but still our our passion and love is also in professional development.

Jerrod:

You've spanned so many places. So maybe even more with simple, but but even with your time at Hopkins, you've seemed to have experimented with some pretty cool stuff. Uh so I think with what you've learned and where you have been, where would your thoughts be on healthcare simulation with AI? Do we need to keep it human? Or should we, or should we not? Does it matter? Uh I want to tap more into some of the new technologies and where you think that's headed.

Tonya :

Uh, that's a loaded question. Um, my tech journey started with Google Glass. So back in the mid-uh, early 2000s, when Google Glass was first launched, uh, I had a girlfriend of mine who was telling me about this really cool technology and where you could you could watch movies, you could talk on the phone, you could video record from the wearer's perspective. And that's what perked my ears up. What do you mean you can video record from the wearer's perspective? Because my research had been in safe medication administration and looking at the behaviors of students in simulation, um, and just starting with the basic five rights. Like how how many times are they running through all five rights before giving uh medication? And then that sort of took me down this path of dosage calculation and realizing that our students they could do the math, right? If you said what's two times two, they would know readily it's four. What got in the way was these long provider orders that had all of this information in there, and you didn't know what to extract to put in these very complicated formulas to then try to come up with the right answer to either administer a medication or to program an IV pump or sort of anything in between. So I was able to secure some grant funding and I got Google Glass and was able to record from the wearer's perspective. And it just was a really, really fascinating peek into what it was that they were doing. And it confirmed that yes, they they knew how to do the math, but they but they also didn't have the context to critically apply if the answer even made sense. For example, if they are having to program an IV pump for uh 15-minute infusion, and they could only use an hourly setting to program the pump. Sometimes, if there was 10 mils that needed to infuse, they would set the pump at 0.1 mils per hour, which is going to take many more hours than 15 minutes, or they would set it at some other rate that just didn't make sense. So then that took me into well, how are we teaching dosage calculation? And how are we verifying that dosage calculation is actually something that they know? Or are they just learning enough to be able to take a test and pass the test? How many tests should they be allowed to take? How many items should be on that test? So I did a national survey and I published that a couple of years ago with some recommendations on how we should both test and verify that students are competent in medication administration. So that's sort of that initial role of tech. But then with my work with SSH, the Society for Simulation and Healthcare, I was on a committee that wrote a white paper on how to integrate artificial intelligence in simulation. And we published that white paper. It's on the Simulation Healthcare Collaborative website, and that was in conjunction with SSH. And what we've realized is that we have an enormous responsibility, both in how how we utilize AI, but also how we're teaching AI. And artificial intelligence, it's here. I mean, we all know this. This is not a surprise, right? It's here, people are using it. I use it just about every day. I love using AI, but I think that we need to teach responsible usage because when our students go into the hospital, it's there. It's there. So I think we as educators, and we know that a lot of our educators are older generations. And we have a responsibility to learn about the technology, to have an idea of how the technology works. And then how might we integrate the technology in both our classroom and our clinical and our simulation settings so that we're preparing our students to use it ethically and responsibly?

Deb :

Yes. Well, yeah, well said. Now, Tonya, we're gonna take the show in a little bit of a different direction. Do you have a favorite simulation story you'd like to share with our listeners? It's always my favorite question.

Tonya :

Yeah, it's like asking your favorite child, right? Do you have a favorite story like that? Um, but I I think for me, one of the things that really stands out, it's a super simple, super simple simulation. There were uh simulations that I I've run previously where we would bring students, senior students getting ready to graduate. We would would bring them into an individual one-on-one simulation. And this scenario, there was a female patient who was post-op who needed to receive morphine for pain. And the students did a really great job. They administered her morphine, and her respiratory rate started to drop, her oxygen saturation started to drop. And she eventually got to a respiratory rate of four. And every I would say 99% of the time, I would watch the students and they'd go and they'd turn up the oxygen flow on her nasal cannula. It's not a bad first thought, but then they would be perplexed as to why that's not working, and they turn it up a little more and they turn it up a little more. And it wasn't until the debrief where we would have a conversation about ineffective ventilation and how we might be able to support that with the tools that we have in the room. But there was one time a student, she reached for the bag valve mask and she started bagging the patient. And I thought, yay, it's happened. I have somebody who understands the difference between oxygenation and ventilation. And we got into our debriefing conversation, and I said, I noticed that when she started dropping her oxygen saturations and she dropped her respiratory rate, that you reached for the bag valve mask and began to ventilate her. And I know that that was the right action because she wasn't breathing effectively. So walk me through your thinking in that moment. And how is it that that you came to make those decisions? And she said, Well, what I really wanted to do was turn up the oxygen, but it was on the other side of the bed. I couldn't reach it. And this was the thing that was closest to me. And so I grabbed the bag and I started bagging her. And I thought, well, isn't this a beautiful place for debriefing? Because had I not asked the question, she would have gone into practice. And if somebody would have desaturated without effective ventilation, she also would have reached to increase the oxygen flow, which is not the right thing, right? So my favorite aspects of simulation is that debriefing piece. And I think in my journeys, I have seen so many places that bring in instructors to teach in a simulated setting. And it very much mimics what they would do in the clinical setting, right? They give feedback, they correct behaviors, right? But but not being trained to dig into those aspects of why did they make that decision? Was it because they didn't have enough knowledge and can we fill that knowledge gap? Or was there some other reason? What what was their frame? And so I think that that also, you know, takes me back to our consulting company, Simple Simulation, where we need to have people who are facilitating our simulation debriefings that are trained in the pedagogy, that understand it. And ultimately, that's what we're all trying to do is to create safe people, safe professionals. And if we make the assumption that we know why they did something and provide feedback, that unidirectional conversation, then we're never going to know whether they did the right thing for the right reason or the wrong thing for the wrong reason, or any combination in between. So that's one of my favorite stories.

Deb :

That's a great story.

Jerrod:

Yeah, that's a good one. Yeah, it just depends on the side of the bed that they're on.

Tonya :

Apparently.

Jerrod:

What can I reach? Yeah. Okay. I I want to take us home, Tanya. I want to hear final thoughts, but also what do you want listeners to remember you by, or how do you want to leave this?

Tonya :

Oh, it sounds like something that should be on my tombstone. How would you like to leave this? Well, so uh I think that I've shared just sort of bits and pieces about how my journey in academia sort of came to be. It was just a lot of it was just serendipitous, right? Just sort of asking questions and being in places. But no matter what, I was willing to try something and try something new. And so I I think what I would encourage all of your guests to do is just be willing to try something new. Be willing to be part of a team that's working to improve patient safety. Be willing to be flexible. We all have to be flexible in what we're doing. Nothing ever, ever goes to plan. Be willing to look at a situation and ask, what can I do to improve the process and remove barriers? And be willing to embrace the ride. We're a unique and we're a special group of people, but we're all here for one another. And so I think everyone needs to find your tribe. If you're an island like I was in that first place where I worked, reach out to me and I'll connect you with other islands so that you have a support system. I think that we are a mighty group. I think that we make a big impact. And I'm just super proud to be a simulationist.

unknown:

Yeah.

Jerrod:

And with that, how can our listeners find you?

Tonya :

So you can find me at you can go to our website, www.simplesimulation.com, and that's simple without the e, simulation.com, or you can reach me at the Johns Hopkins University School of Nursing. So either way, I'll respond.

Deb :

Thank you. Thank you very much for being on being a guest and just so impressed by all of the things that you've done. It's very encouraging, and you've certainly given a lot to simulation.

Tonya :

Thank you. It's been my pleasure.

Deb :

Thank you. With that, happy simulating.

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Thanks to Beaker Health for sponsoring this week's podcast. Beaker Health, where dissemination and measuring impact comes easy. We hope you enjoyed. Visit us at www.innovative simsolutions.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.

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