
Simulation practice happens before patient contact
Transcript
[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Students at Upstate Medical University may have some of their learning take place in the Simulation Center, which has a new director, Dr. Hesham Masoud is a vascular and interventional neurologist at Upstate and an associate professor of neurology, neurosurgery, and radiology. He's also taken on the role of director of Upstate Medical University's Simulation Center, and he's here to tell us about it. Welcome back to "The Informed Patient," Dr. Masoud.
[00:00:40] Hesham Masoud, MD: Hi Amber. Thanks for having me.
[00:00:42] Host Amber Smith: I should have said you also direct the vascular neurology fellowship program, and you're also certified as a healthcare simulation educator. So it seems like this is a natural for you. Can you define what "sim" is and why it's so useful in teaching?
[00:00:57] Hesham Masoud, MD: Yeah. So simulation in healthcare, and specifically in this field -- it's called simulation in healthcare education -- is this idea that you can take these clinical insights that are gleaned by demonstrating what can happen in patient rooms and ORs (operating rooms) and outpatient settings in a controlled fashion, such that the medical learner can focus on a learning objective. And the fidelity of that scenario being recreated allows those insights to then be retrievable when that learner is at the bedside, or when that physician is at the bedside. It's being applied very broadly speaking, and there's a history of its use in formative assessments, summative assessments, in universities, medical learning, specifically early on, obviously medical schools, nursing schools, and really broadly speaking, all the healthcare professions.
But it's also being used in interprofessional education. It's being used in continual medical education. So you can see that we're all learners, for the duration of our practice. And simulation is now, because of the technological advances and its ability to demonstrate higher and higher fidelity things -- for instance, if you think about the types of manikins that can be created now with the types of overlay 3D printing moulage, you can do, you can really create something fairly realistic looking. And so you can now apply it in settings where that limitation used to be a barrier for learners to get over, to then be able to start to get into the learning objectives. I see its growth, too. So it's pretty exciting to be part of the team here at Upstate that's involved in this endeavor.
[00:02:48] Host Amber Smith: So it sounds like it's a place where students who are learning all of this stuff in medicine can focus on that on, like you said, a manikin that looks like a person, before they have to deal with a human interaction.
[00:03:03] Hesham Masoud, MD: Right. And, you know, there's all kinds of different things. Manikins are just one way of doing things. Really the idea is, oh what's your learning objective and how best you can recreate that. And you see a lot of overlap with the theater. Lots of people who are engaged in simulation at all levels of healthcare have, sometimes, a background in theater.
And I can see why, because you have to set the stage, and you have to get creative with how to demonstrate what is in reality, but with sort of a limited controlled fashion. You have the stage. But you can still evoke the same authentic feelings, and in this example evoke the same types of learning opportunities and cognitive thinking that can occur in the classroom, but much more effective because it's experiential.
And you can really work out kinks in a very nonjudgmental way. And I think that's one part of the sim that I'd like to talk about, the environment of sim very much being one where you suspend disbelief. And you also have this basic assumption that we're all here to benefit, ultimately, patients. We're all smart. We're all doing the best we can. And this is a cool way to do it.
[00:04:17] Host Amber Smith: Well, tell us about the sim center at Upstate.
[00:04:21] Hesham Masoud, MD: Yeah, so the sim center at Upstate is a pretty impressive investment, I think, in this educational way of doing things at the universities. We have a patient ward that can be simulated. We have patient rooms, six of those. We have debriefing rooms. Each room is outfitted with a control room, such that someone on the outside can have prompts and even voice a manikin if that's being used.
Oftentimes we'll use standardized patients, which is someone who's acting the role of a patient in the bed. And then we may be communicating through an earpiece, different lines depending on what our learning objective is. And sometimes it'll be dynamic, if the learner is demonstrating something that needs maybe an elevation in the learning objective. We have a pretty impressive surgical suite, which has all the resources of a real operating room. And that's one of the cool places that we have where you can have very differentspecialties -- a surgeon versus an anesthesiologist versus a nurse. You know, they don't really have that many opportunities to engage outside of spaces like the OR. And so it becomes one of those places where you can have shared learning for all of these different disciplines in one space. And so we have a pretty great operating room that affords that.
We have two task labs. And essentially these are just big rooms where you can set up task trainers. So task trainers are for instance, someone wants to practice suturing or there is a special insertion of a catheter or essentially a process or procedure that is a task that one is learning. And so they have these tabletop task trainers and rooms that we can sort of use to house that kind of educational endeavor.
And then we have clinical skills exam rooms, which is a whole separate wing of the sim center. And this is where a lot of the summative assessments at the medical school are done with our standardized patients. And so that is a pretty impressive part of the simulation infrastructure because it's outfitted also with audio and video to record these encounters for assessments, evaluations that are used in grading medical students and certainly has its standards.
So, a pretty big place. I think it's a little over 8,500 square feet. So, a pretty large center and really has the gamut of resources to afford all kinds of simulation experiences.
[00:07:08] Host Amber Smith: Now, is it common, do you know, at other academic medical centers to have something like a sim center?
[00:07:13] Hesham Masoud, MD: It's not very common in the sense that I think most, if not all, medical schools will have some sort of clinical skills center where they do summative assessments with standardized patients, and certain specialties inherent to their practice have adopted task trainers, things like that. But because of the level of investment necessary to get the floor space, have these resources -- you know, mannequins are pretty expensive. The OR is pretty expensive. We have haptic trainers, which are things that give you tactile feedback so that you can practice laparoscopic surgery or practice endovascular stuff, which is some of the practice that I do, coiling aneurysms, taking out clots, flow models. So it really is a level of resource that when you have a large center, it's typically big regional, educational hubs that will have a sim lab.
[00:08:16] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Upstate Simulation Center director, Dr. Hesham Masound.
Now you used the term moulage. That's makeup, essentially?
[00:08:29] Hesham Masoud, MD: Yeah, makeup, and little -- I'm not great at describing this because I'm not a theater person -- but sometimes it'll take little bits of silicone, and then it'll look like a wound, and then put some makeup on it. And so almost like partial silicone masks that standardized patients can wear. And sometimes we'll put it on a manikin and then voice the manikin. There are really cool, creative ways to get the medical learner in the same physical, or I should say psychological, almost cognitive space that they are when they see something like that at the bedside. And there's lots of literature to demonstrate how you can evoke that with some creative solutions.
[00:09:08] Host Amber Smith: Now, even before you became the sim center director, you were already incorporating simulation into your teaching. Can you tell us how?
[00:09:16] Hesham Masoud, MD: Oh, absolutely. Yes. Yes. And I think it is representative of how I think sim is finding its way in all kinds of learning opportunities, or I should say learner cohorts.
So my early engagement with simulation wasin relation to stroke codes. So a patient who has sudden onset symptoms .... how do you evaluate that? And so that was one learning objective, a clinical assessment. There was a learning objective related that we were designing about decision making. We wanted to teach the decision making with different configurations of variables. So for instance, if someone had really high blood pressure, how do you manage the workflow? If someone has this other need, how do you prioritize? And then, how do you do your clinical assessment.
And the clinical assessment in stroke, certainly in the early setting where you're trying to triage involves this standard scoring system that you use. And we have a way to do that online, and the medical learner would give it to us, and we'd have a certification. But this was a great way to verify that in real time, while they were also engaging other cognitive tasks. And so we had broken it down like that for our neurology learners. And so I was involved early on with some of the most exciting stuff, to me, in simulation is really the debriefing of like, "hey, what happened in the room?" And people feeling comfortable enough to share how the decisions were made. And you can glean so many great insights. And people leave a great debriefing session with so much value added.
So learning about how to do that, because that's a skill that you need to learn, and designing this with the team -- this is before I joined Upstate -- was something that we saw benefit our patients because we saw treatment times get shorter. And so it was a QI, a quality improvement award that was given as a result of it. And there's literature about this more broadly, applied. And I think here, even at Upstate, the residents before I joined here had written about an experience that was very similar, where they designed a simulation for stroke codes that moved the needle in terms of therapeutic time.
And so that was sort of the platform that I saw the value of simulation in delivering on the teaching, in a verifiable way, and an impactful way. I also was really excited by how we could blend medical learners and how that then facilitated workflow, post hoc. So, we engaged emergency room learners, residents, and then the next month the interactions between the neurology residents and the emergency room residents was just so synergistic because everyone knew what the priorities were, and there were no black boxes in terms of the healthcare practice.
And I think simulation is a really great way of breaking down those invisible barriers of practice and knowledge sharing. And there's a lot of collateral learning that can occur. So those were early on things. And then, going into my subspecialty of practice, which was procedurally related to catheter-based interventions, there are simulators for that, that have been used very much so in part and parcel of the education of practitioners early on. So industry for endovascular devices have adopted simulation techniques from the jump because they had to have ways to demonstrate their models and then teach how one would deploy them in a safe way. And so I was, "oh, this is simulation, right? I'm doing this on a flow model." And then there, there are some that are hybrid haptic models. And so it, it just became this natural evolution that very much so, I think I saw the parallels because of my practice.
Now, this is not novel, I should say. Other disciplines like anesthesiology and emergency physicians have been using simulation for a very, very long time, and historically have the broadest utilization of simulation at centers, learning how to intubate, codes, CPR, advanced cardiac life support, stuff like that. So, to me it was just, I guess, me getting hip to it late and then applying it in our cohort of neurology learners that got me a little bit more excited about it and wanting to get a little bit more sophisticated practice in it.
[00:13:56] Host Amber Smith: So, looking ahead a little bit, what are your goals for the sim center?
[00:14:01] Hesham Masoud, MD: One, I think is to help usher in what I think is already happening, but catalyze and provide hopefully some support to the natural evolution of what I see simulation being embedded into a lot of the ways that we do things in healthcare.
I see simulation being part of a feedback loop of how we look at processes in the hospital and how we verify that we're addressing them in ways that I think are a lot more sophisticated and certainly can be verified in these feedback loops. So for instance, if you have a clinical outcome that you're trying to improve on, you can get all of those stakeholders, recreate those, simulate that scenario and uncover all kinds of insights, that seemingly may have been hidden because of a root cause analysis that wasn't as necessarily infiltrative.
So I see that really as being, to me, maybe the longest view of how it's incorporated into quality improvement. And there are lots of examples of how we're moving toward these learning health systems. And really I just, I hope to see,or be part of its growth in its utilization in education at Upstate, across all of the healthcare profession schools. So medical school, nursing, and there's some new legislation about clinical hours for nursing students, which can be replaced with high quality simulation.
And so there's now a responsibility for us to provide high quality simulation opportunities for nursing learners, which is really an exciting opportunity because they represent the largest part of the healthcare workforce. Those are two big things that our team is focused on. That includes standardization of processes, accreditation, scholarly output, and developing a pipeline so that we have a set of expertise to offer an expansive set of services going forward.
[00:15:55] Host Amber Smith: It sounds like Upstate is going to be making full use of the sim center. Do you see any role for outside companies to participate in anything?
[00:16:03] Hesham Masoud, MD: Oh, very much so. Yeah. So there are lots of ways that the Simulation Center has been, and have been used in other places too. Off the top of my head, a very intuitive use is startups or companies that don't have great budgets for centers of their own to simulate their own devices, test out their own stuff, bring their engineers with the users of the tech in a shared, place, have a way to record that, those interactions, glean insights that may not have been apparent from a more structured conversation, or less structured conversation, whatever the case may be. So I can see its use in the private sector that are in the development of healthcare devices. And, I can certainly even see it as a backdrop. So for instance, if you have a device and you need to take promotional pictures, where can you really take pictures in a clinical environment, really?
So simulation centers are creative places like that.There are these creative ways that we can do things, after hours when we don't have our medical learners on board. You can see how intuitively once you open that door, you can see so many value propositions, from being able to simulate a healthcare environment in all these different settings. And that's essentially what Upstate is able to do.
[00:17:29] Host Amber Smith: Well, it's exciting, and I appreciate you taking time to tell us about it.
[00:17:33] Hesham Masoud, MD: Oh, a pleasure, always.
[00:17:35] Host Amber Smith: My guest has been Dr. Hesham Masoud. He's the director of Upstate Medical University's Simulation Center. " The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed. If you enjoyed this episode, please tell a friend to listen too. And you can rate and review "The Informed Patient" podcast on Spotify, Apple Podcast, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.