February 24, 2025 • 27 mins
What if you could transform patient care with the power of simulation? Join us for an enlightening conversation with Lisa Paganotti from George Washington University, an expert in simulation education, as she shares her inspiring journey from the emergency department to becoming a leader in the field. Lisa unpacks the concept of translational simulation, explaining how it bridges the gap between theoretical learning and practical patient outcomes. With her extensive experience, Lisa delves into the structured stages of integrating simulation into clinical practice, emphasizing the critical role of theories and conceptual models.<br><br>We also tackle the hurdles and triumphs of implementing effective translational simulation programs. This episode offers actionable insights into overcoming historical resistance and sustainability challenges, with practical advice from 18 seasoned experts. Discover how to develop a robust dissemination plan and maintain successful simulation-based education programs. Lisa Ann Buckley adds her perspective as a site reviewer, focusing on the significance of systems integration for accreditation. Whether you're just starting or looking to enhance existing programs, this conversation promises to equip you with valuable strategies for advancing simulation in healthcare.
Lisa Paganotti's email- Lisaannbuckley@gwu.edu
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Welcome to The Sim Cafe, apodcast produced by the team at
Innovative Sim Solutions, editedby Shelly Houser.
Join our host, Deb Tauber, andco-host, Jerrod Jeffries, as
(00:44):
they sit down with subjectmatter experts from across the
globe to reimagine clinicaleducation and the use of
simulation.
So pour yourself a cup ofrelaxation, sit back, tune in
(01:05):
and learn something new from TheSim Cafe.
Deb Tauber (01:16):
Welcome to another episode of The Sim Cafe.
Today, Jerrod and I are herewith Lisa Paganotti from George
Washington University.
So So than yo 'lis fo joinin usa Thank you, Lisa, for joining
us and thank you, Jared, forbeing here.
Jared's in Mexico right now.
Jerrod Jeffries (01:31):
Yeah, w ell, thanks for being here with us,
Lisa.
Lise Paganotti (01:33):
Yeah, thank you for having me, and would you
want to?
vel e set set with all ourlisteners about telling us a
little bit about yourself.
Yeah, sure.
So clinically, my background isa physician assistant and I
practiced in the emergencydepartment, and the emergency
department always pairs wellwith simulation all the
procedures and skills that weneed.
(01:55):
So back in 2011, I started at amedical school as their
simulation coordinator and thenlater their manager, and then I
moved into the hospital-basedsimulation side, versus being on
an academic campus, and at thatpoint I really wanted to figure
out how to tie my work in thatsimulation lab to patient
(02:19):
outcomes and how are we actuallyimproving patient outcomes.
And at that point I was kind oflooking around and saying I
don't even know where to start.
Honestly, I don't know thefirst thing about this, even
though it was something that Ithink across the simulation
industry, we all think, oh,we're out here for patient care
(02:40):
and patient outcomes and patientsafety, but I just didn't
really see that more direct tieto the work that I was doing,
and so that's kind of how I gotinterested in what I'll talk
about today.
But also I want to say yes,currently I'm assistant
professor for the Doctor ofHealth Sciences program at
George Washington University andthere I focus more on the
(03:01):
leadership and research aspectsof simulation.
Deb Tauber (03:05):
Great, how long have you been there?
Lise Paganotti (03:07):
About two years now.
Deb Tauber (03:09):
And prior to that you were at Ross, correct?
Yes?
Jerrod Jeffries (03:11):
Yeah exactly ctly.
What made you get started insimulation?
Was there a certain catalyst,or i it?
Lise Paganotti (03:20):
just more of an interest, internal interest.
You know, I actually alwayswanted to get into education.
My undergrad was education andthen I did my master's in
physician assistant.
So there just became an openingthat was available and I
thought, oh, this might be anice way to kind of segue into
like an education role.
And it happened to be withinthe simulation lab and as soon
as I went in I was so fascinatedand just so excited about the
(03:45):
opportunity to really allowpeople to practice.
I think for me personallythat's a great way to learn.
I learn a lot more by doing itmyself and experimenting than by
reading or hearing about it.
Jerrod Jeffries (03:59):
That's the beauty of simulation.
Deb Tauber (04:01):
Yep, that's what draws us into it.
Now, Lisa, can you tell us alittle bit about translational
simulation?
Lise Paganotti (04:09):
Yeah, thanks for asking.
I think it's really importantto talk about the definition.
So, as I was mentioning, thiswas kind of that area that I got
interested in where I thought,okay, how do I know that what
we're doing is actually tyinginto the patients and their
experience and their outcomes?
So I actually was getting myPhD at the time in translational
health sciences and there'ssomething called the
(04:32):
translational continuum thatcomes from biomedical sciences
and research and it's basicallytalking about, from the basic
science, discovery ofinformation.
So, let's say, we discoversomething in the lab setting,
there's a lot of steps andstages that it takes for that to
(04:53):
get into clinical practice.
So you need to move it from thelab to the clinical environment
.
So you got to think about youknow, what we found in,
potentially, mice or rats.
Does that work in humans?
Then you got to think about,okay, if it works in humans,
like what kind of humans?
How do we study how safe it isand who it works for?
(05:14):
And that kind of gets you tothat proven clinical application
.
And then from there you need tofigure out well, how do we get
clinicians then to adopt this,to start doing it, to implement
this practice?
How do we get that to be morewidespread across, you know, all
of the different providers, allthe different clinics or
hospitals all across the country.
(05:35):
And then from there, how do weunderstand kind of that bigger
public health impact?
So that's like a littlebackground on kind of where this
comes from.
So for simulation, if we thinkabout kind of applying that same
idea to simulation, we need tohave kind of these theories and
conceptual models that supporttranslational simulation, which
(05:59):
I'll define in just a minute.
There's a couple definitionsout there, but right now, if you
just kind of think of it asthis big bucket of how do we tie
simulation to patient care andpatient outcomes, so you need
these theories and conceptualmodels.
And then from there you need toknow within the simulation lab,
are the people learning theseknowledge, these skills, these
(06:22):
attitudes, whatever it is we'retrying to train them to in the
simulation lab?
You know, did they learn thatthing?
And then from there, if theydid learn it, then are they
using it when they go into thepatient care areas?
And then, even if they areusing it in the patient care
areas, then how do we know thatit's actually impacting the
(06:44):
patients?
So again, you kind of see allthese different stages in this
process that you need to gothrough, and so I think that
kind of gives an overview of youknow where this comes from and
what we're talking about.
But to be a little more concrete, I do have a couple of
definitions that are out therefrom the literature.
So the first one came out in2017.
(07:08):
This was from Dr Brazel out inAustralia, and she defined
translational simulation as afunctional descriptor of
healthcare stimulation with thepurpose of directly improving
patient care and healthcaresystems through diagnosing,
safety and performance issuesand then delivering these
(07:30):
simulation-based interventionsto address those.
And then in 2021, nixon andcolleagues, they kind of defined
it as activities that might bediagnostic, so determining the
problems that exist and what arethose characteristics of the
problems, or interventional, soproviding solutions to the
(07:51):
problem, or potentially you doboth you figure out what are the
problems and then you kind ofsolve those problems.
I think based on where we're atin simulation.
Now there's a couple differentways that this has evolved.
So something that the way thatI've kind of been thinking about
(08:11):
is there's kind of somedifferent buckets, if you will,
within translational simulation.
So there's kind of the systemsintegration piece, which is more
about the simulation centerprogram, integrating with the
quality and the risk managementdepartment.
So that's kind of one piece ofit.
(08:32):
There's systems testing, whichis kind of focused on the
testing for new equipment, ormaybe you have a new ward that's
opening and you want to testthat system, maybe you have a
new process that's in place soyou're going to do some
simulation around understandinghow the humans in that event
interact with that new process.
(08:54):
That's kind of the systemstesting.
And then there's also like theskills translation, and I think
the kind of classic example ofthat is all the work that Dr
McGehee and colleagues have doneon central line training, where
again I think you could kind ofsee how I was talking about you
they studied that in the simlab and then could we move this
(09:14):
from the sim lab to patient careand then to the outcomes, and
they even also took that to likereturn on investment, which is
a great example of kind of thatskills translation piece.
Deb Tauber (09:25):
Yeah, Excellent, excellent.
Now how did you decide ongetting into that for your PhD?
What drew you to that?
Lise Paganotti (09:53):
the hospital as a whole and I thought I really
want to be able to know, tomeasure, to be able to say that
we're having these impacts thatI really felt that we were
having.
But I didn't have any data andI just really honestly didn't
know where to start.
I didn't even know the firststep in doing it.
I felt like it's like do Istart with the hospital
leadership doing it?
(10:13):
I felt like it's like do Istart with the hospital
leadership?
Do I start with my program?
You know where do I go, andthat's really where I came up
with this.
You know what ended up being mydissertation.
Research is these questions tosay where do I start?
What do we know about this?
What are the experts doing?
I know people are doing this,so how can I learn from them and
understand?
You know what are the thingsdoing.
I know people are doing this,so how can I learn from them and
understand?
(10:33):
You know what are the thingsthat are going to be barriers,
what are the things that couldfacilitate me in this process?
Jerrod Jeffries (10:41):
And Lisa.
If I can ask another questionabout the overall aspect in
terms of transitional simulationfrom the clinical space,
testing process, development andculture pieces, Do you find one
to be a larger barrier thanothers for people trying to
(11:02):
enter this?
Lise Paganotti (11:05):
That's a really good question.
Honestly, I don't think thatreally came up in anyone's story
and I guess I'll tell you why Ithink that happened Because
basically everyone was workingfrom kind of a similar place to
what I described, which is likeyou're working in a place, you
(11:25):
look around you and you're likeokay, we have this problem, let
me try to address that problem.
So it really, I think, camemore from the, I guess, just the
setting that you were in thecontext to say, okay, let me try
to address this problem.
So it's kind of figuring outyou know what's an important
(11:46):
problem within your organizationthat you can address with
simulation.
So I think that's really howmost people have kind of gotten
into this.
Deb Tauber (11:56):
Can you describe the research study and what you
found?
Lise Paganotti (12:00):
Yeah, thanks for asking.
So I kind of mentioned some ofthe research questions that I
had.
So one of them was you knowwhat are the barriers and the
facilitators to running thesetranslational simulation
programs?
And I wanted to know where tostart.
(12:20):
So I ended up asking 18 expertsfrom our very wonderful
simulation community so shoutout to my anonymous wonderful
participants who allowed me tointeract with them.
We had three different types ofdata collection, so I collected
documents to understand somecontext behind them, and then I
interviewed these individualsand then had a focus group as
well so that I could triangulatethe different data sources to
(12:41):
make sure that I was reallyunderstanding what they were
sharing with me.
So I'll start with kind of thebarriers and facilitators and
then I'll move into the kind ofthe recommendations that they
have, which hopefully will bekind of some actionable
takeaways for the audience too,if they're thinking like, oh,
this sounds great, but again, Idon't know where to start.
So all right.
(13:03):
So in terms of the barriers andfacilitators, there actually
were a lot of facilitators andthat was kind of a surprising
finding.
I think we had about 10different facilitators and we
ended up having basically fourbarriers.
So I'll talk through each ofthose.
But there was kind of adiscrepancy there, you know,
with so many facilitators, and Idon't know if that's because,
(13:25):
again, I was talking to experts.
I'm talking to people in ourfield who are doing this, who
are very successful, who are outthere talking about it or
publishing about it in ways thatI could know who they are and
reach out to them.
So we did have lots offacilitators, which I think is
also encouraging for people whoare interested in this or maybe
just beginning in this area.
(13:45):
So the facilitators I'll justlist a couple of them because I
don't want to go into too muchdetail.
But if you have a really strongsimulation team as well as a
research team, that's going tobe helpful.
Some of the characteristics ofindividuals they talked about,
so people who have really goodrelationships with other people
(14:08):
throughout their system, some ofthose informal leaders, you
know, maybe they don't have thejob title but you know that they
have influence.
Also, the human factors sohaving somebody who has some
knowledge of human factors,which I think a lot of
simulationists do.
Now I don't think you need tobe a degree or some kind of
specific training in it, butjust understanding you know what
(14:30):
does that mean?
To kind of have that lens forlooking at these different types
of translational simulations.
All right, so for the barriers,there were four main barriers.
The first one I think everyonecan relate to, which is I called
it historical, but basicallyit's the historical context of
healthcare and medicine and Ithink this just ties into
(14:54):
behavior change.
It's really pretty easy toshare knowledge and to share
information, but it's verydifficult to get people to
actually change and to do thatchange, to implement that change
in their practice and thenconsistently do it.
Deb Tauber (15:10):
Do you think that's because people say, well, this
is the way we always have doneit?
Lise Paganotti (15:14):
Yes, exactly, you nailed it.
That is like the absolute quotefrom this, this code of you
know being historical.
That's exactly right.
We've done it this way.
Maybe they don't feel there's aproblem with the way we've
always done it.
You know, why do we have tochange?
Why do we have to improve?
I mean, this is classic, Ithink, across all of simulation,
(15:35):
not just translationalsimulation, but it is one of the
biggest barriers that we face,for sure.
Deb Tauber (15:42):
I think it's especially pervasive in
healthcare and in education.
Yeah, yeah.
Yeah, yep, a barrier, all right, so continue, continue.
Thank you.
Lise Paganotti (15:55):
So the next one is or the next two actually kind
of go together it's thedissemination and sustainability
.
So dissemination is reallythinking about how do you get
this work out there after you doit.
And the reason that is abarrier is because we don't
always have time built into ourschedules, our days, our jobs,
(16:17):
to actually share thatinformation, to get it out there
and share with otherorganizations or other
individuals who are looking todo this same kind of thing.
So throughout this study, theparticipants really talked about
kind of having some sort ofdissemination plan actually at
the beginning of your project,where you can say, okay, this is
how I'm going to share it withother people so that they know
(16:40):
what's going on, so they canlearn from what we've done.
Jerrod Jeffries (16:44):
Well, and to that part right, you spend 80,
90% of the overall scope of theproject doing the work and if
it's not shared, it's almostshooting yourself in the foot
because it's like oh yeah, Ipresented once to this room of
five people, for example, and itdoesn't leave that those four
walls is a little, yeah, lastfour sides.
So I'm happy to see thatthere's in the beginning.
(17:06):
It's how do you disseminate?
What are some of those waysthat different ones are
disseminated?
Lise Paganotti (17:10):
If you know off the top of your head, yeah, well
, I mean, this is one of themhonestly doing podcasts, sharing
on social media, sharing at thedifferent simulation
conferences, really any way thatyou can get this information
out there.
I mean, publishing is also oneway, and this study has been
published.
But I'll tell you, out of mywhole dissertation study, what I
could publish was a very smallpart of this, and actually most
(17:37):
of what I'm talking about todayisn't even an article, because
it's condensed down to such ashort number of words that you
can share.
So I think the more ways thatyou can share and the more
conferences and avenues that youcan get to, the better, because
you get a different audience ateach one.
Jerrod Jeffries (17:51):
yeah, yeah, and you never know what's gonna.
I don't want to say sticky what.
What's going to be relevant towhat audience?
And some of them might beconstrained on certain resources
, or others might be solely ontime or space.
You just don't know what'sgoing to be relevant or
applicable towards each audience.
Deb Tauber (18:10):
Lisa, I'm curious about your 18 experts.
Were they all in the UnitedStates or was it global?
Did you have people from othercountries?
Lise Paganotti (18:18):
Yeah, it was global.
Yeah, intentionally, becausethere's a lot of this really
good work happening in othercountries.
So because it was kind of thefirst overview study like this
to say, okay, we don't reallyhave a lot of information, let's
try to pull all this together.
I wanted to get just I went forthe top experts in this area,
so it was from anywhere in theworld.
Deb Tauber (18:40):
Thank you.
And how many questions werethere?
What did this look like?
Lise Paganotti (18:44):
Yeah, that's a good question.
The interviews lasted about anhour for everyone.
I forget the exact number ofinterview questions, but I would
say it was probably around 12questions because they were
pretty open ended to really heartheir stories and their
experiences, to extract whatthey're doing.
Deb Tauber (19:04):
Now.
Do you have an actionabletakeaway for our listeners?
Lise Paganotti (19:08):
Yeah, I do.
I actually have two morebarriers, if you don't mind, oh
of course.
Yeah, because I wanted to talkabout the sustainability piece
because that was another barrier.
So this one kind of speaks tothat idea that there's a lot of
kind of excitement.
Again, I think people canreally relate to this.
There's a lot of excitementaround a new program, right.
(19:30):
There's not as much excitementabout maintaining a great
program and I don't know whythere just isn't, you know, and
sometimes there's not evenfunding around maintaining the
program.
So I think that was really oneof the struggles that I want to
point out, because, again, youwant to think about this if
you're going to embark on this,you don't want to create a
really great program that againdoesn't continue because it's
(19:53):
kind of a waste of time andenergy and effort.
Jerrod Jeffries (19:57):
Lisa, I just see every single listener
nodding their heads to that.
Yep yep, there is sustainabilityand maintenance it's.
It's the shiny new toy rightwhen you're, when you're
building a new lab and it's justthere's so much attention on it
and I think the importance toyour point of being a barrier it
just kind of drops off a littlebit and it's more important
(20:17):
than ever to be like okay, let'smake sure that they're getting
the right education, let's makesure that we're facilitating all
faculty instructor development,let's make sure that the right
equipment's being used.
And what metrics or data do wehave to actually show that
products that we've spent Xdollars on is art being used?
And so I think that one reallyresonates with a lot of our
(20:39):
listeners.
Lise Paganotti (20:40):
And then you had a final one as well.
Yeah, I just had one final onewhich I think will also resonate
, of course, is scheduling.
I think scheduling is difficultfor a lot of reasons, and this
one actually reminds me of kindof the interprofessional
education world and theirscheduling issues.
But a lot of these simulationsmight take place in situ versus
(21:00):
in the sim lab, not always.
It just depends on you knowwhat the goal is, what you're
trying to do, but thinking aboutyou know that, in situ
scheduling and how do you makesure that there's an adequate
staff for the patient, theactual patient care needs and
people for the simulation, andthat it's a good time and a good
day and all of these things tomake sure that everybody is safe
(21:21):
.
So again, I think that's acommon one, but again, good
things to.
I think the barriers are soimportant to know about because
if you can go in anticipatingthese things, I just think you
can really try to mitigate themfrom the beginning.
Deb Tauber (21:36):
And what about the actionable takeaway for our
audience?
Lise Paganotti (21:40):
Yeah, thanks for asking that.
One Depends on where you are inyour program.
But if you can kind of lookaround an inventory where your
program is at and see how youcan start to think about
translational simulation foryour program, whatever that
looks like, try to kind of startto weave some of this into your
(22:03):
work.
It might mean having aconversation with your quality
and patient safety departmentwithin your organization.
It might be building some kindof intentional relationships
with maybe some other leadershipindividuals within your
organization or keeping your earout for some kind of really
(22:25):
important need that simulationcould fill, some kind of really
important need that simulationcould fill.
And then you can kind of startwith that, you know, hopefully
like small but successfulproject, and then grow and build
from there.
So I think it just depends alot on where you are, I think if
you are at an academic site.
So I'll use myself as anexample.
(22:45):
When I was just in the academicsetting, I really didn't think
that much about kind of thepatient care side.
I just felt like it was verydisconnected from what I was
doing and I would encouragepeople to try to think about it
as connected.
You may not be able to measurethat because, as we know,
there's a lot of confoundersthere that are going to happen
(23:07):
between the training here andthe patient care.
But I think it's important toeven just have that idea in your
mind that I'm training them forthis, and maybe there is one
small thing that I could measureor find out.
Maybe I can add a question toone of our surveys to find out,
even if it's as simple as do mylearners think they'll use this
(23:29):
in patient care, and I knowthat's a very kind of low level
outcome, but at least it's astarting point for trying to
figure out okay, are we beingsuccessful in helping them
really kind of move this forwardinto that patient care space?
Deb Tauber (23:43):
Yeah, this is a lot of systems integration with this
.
So, especially programs thatare going for accreditation for
systems integration, this wouldlend well to their work and to
their application.
Lise Paganotti (23:57):
Yeah, definitely .
Deb Tauber (23:58):
Yeah.
Now if our listeners wanted toget ahold of you and ask you
about this, where would they goahead and do that?
Lise Paganotti (24:03):
Yeah, sure, probably email is going to be
the best way to get a hold of me, and that's going to be.
It's lisaannbuckley at gwuedu.
So that'sl-i-s-a-a-n-n-b-u-c-k-l-e-y at
gwu for George WashingtonUniversity dot edu.
Deb Tauber (24:24):
And that'll be in the show notes.
We can include that in the shownotes.
Yeah, now, lisa, you're also asite reviewer for the Society
for Simulation in Healthcare, sowhy don't you want to share a
little bit about what you do andif you've had a favorite review
that you've done?
Lise Paganotti (24:42):
Yeah, sure yeah.
I've been a site reviewer sinceabout 2013.
Since about 2013.
And then, more recently, I'vetaken on a couple leadership
roles within accreditation forthe Society for Simulation
Healthcare, so I'm excited tocontinue in that realm.
Oh man, my favorite thing aboutthe reviews is really just
(25:04):
seeing a variety of programs,because people do things really
differently and everyone has alittle different context.
I think there's so much goodwork going on out there.
It's really fun to kind of havethat eye into multiple
different programs just to seeyou know how are people doing it
and how are they doing itdifferently.
Related to the topic today, myfavorite is when I get to do a
(25:28):
review that includes systemsintegration, because I get to
see exactly what people aredoing in this particular topic
area.
So that's always exciting.
Jerrod Jeffries (25:37):
Well, and seeing so many too, you see the
good and the bad, of course, andthen you say, okay, this is the
best practices, so let's makesure we implement this in our
own institution.
So good spot to be.
Lise Paganotti (25:47):
Yeah, it's a real benefit in that way.
Deb Tauber (25:50):
Great.
Any questions for Jared and I.
Lise Paganotti (25:53):
No, I don't think so, but thank you so much
for interviewing me and allowingme to share this information.
I'm excited about it.
I welcome anyone to reach outto me if they have any questions
or interest in this topic.
I love to talk about it.
Jerrod Jeffries (26:06):
Yeah, I think it's very powerful what you're
doing, and I love theapplication towards practice.
I think that you've really hitsomething there, Lisa, and
really look forward to hopefullymaking some connections with
some of our listeners that aregetting in touch with you.
Deb Tauber (26:19):
Yeah, all right.
Well, thank you so much andhappy simulating.
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and learn something new from TheSim Cafe.
Deb Tauber (01:16):
Welcome to another episode of The Sim Cafe.
Today, Jerrod and I are herewith Lisa Paganotti from George
Washington University.
So So than yo 'lis fo joinin usa Thank you, Lisa, for joining
us and thank you, Jared, forbeing here.
Jared's in Mexico right now.
Jerrod Jeffries (01:31):
Yeah, w ell, thanks for being here with us,
Lisa.
Lise Paganotti (01:33):
Yeah, thank you for having me, and would you
want to?
vel e set set with all ourlisteners about telling us a
little bit about yourself.
Yeah, sure.
So clinically, my background isa physician assistant and I
practiced in the emergencydepartment, and the emergency
department always pairs wellwith simulation all the
procedures and skills that weneed.
(01:55):
So back in 2011, I started at amedical school as their
simulation coordinator and thenlater their manager, and then I
moved into the hospital-basedsimulation side, versus being on
an academic campus, and at thatpoint I really wanted to figure
out how to tie my work in thatsimulation lab to patient
(02:19):
outcomes and how are we actuallyimproving patient outcomes.
And at that point I was kind oflooking around and saying I
don't even know where to start.
Honestly, I don't know thefirst thing about this, even
though it was something that Ithink across the simulation
industry, we all think, oh,we're out here for patient care
(02:40):
and patient outcomes and patientsafety, but I just didn't
really see that more direct tieto the work that I was doing,
and so that's kind of how I gotinterested in what I'll talk
about today.
But also I want to say yes,currently I'm assistant
professor for the Doctor ofHealth Sciences program at
George Washington University andthere I focus more on the
(03:01):
leadership and research aspectsof simulation.
Deb Tauber (03:05):
Great, how long have you been there?
Lise Paganotti (03:07):
About two years now.
Deb Tauber (03:09):
And prior to that you were at Ross, correct?
Yes?
Jerrod Jeffries (03:11):
Yeah exactly ctly.
What made you get started insimulation?
Was there a certain catalyst,or i it?
Lise Paganotti (03:20):
just more of an interest, internal interest.
You know, I actually alwayswanted to get into education.
My undergrad was education andthen I did my master's in
physician assistant.
So there just became an openingthat was available and I
thought, oh, this might be anice way to kind of segue into
like an education role.
And it happened to be withinthe simulation lab and as soon
as I went in I was so fascinatedand just so excited about the
(03:45):
opportunity to really allowpeople to practice.
I think for me personallythat's a great way to learn.
I learn a lot more by doing itmyself and experimenting than by
reading or hearing about it.
Jerrod Jeffries (03:59):
That's the beauty of simulation.
Deb Tauber (04:01):
Yep, that's what draws us into it.
Now, Lisa, can you tell us alittle bit about translational
simulation?
Lise Paganotti (04:09):
Yeah, thanks for asking.
I think it's really importantto talk about the definition.
So, as I was mentioning, thiswas kind of that area that I got
interested in where I thought,okay, how do I know that what
we're doing is actually tyinginto the patients and their
experience and their outcomes?
So I actually was getting myPhD at the time in translational
health sciences and there'ssomething called the
(04:32):
translational continuum thatcomes from biomedical sciences
and research and it's basicallytalking about, from the basic
science, discovery ofinformation.
So, let's say, we discoversomething in the lab setting,
there's a lot of steps andstages that it takes for that to
(04:53):
get into clinical practice.
So you need to move it from thelab to the clinical environment
.
So you got to think about youknow, what we found in,
potentially, mice or rats.
Does that work in humans?
Then you got to think about,okay, if it works in humans,
like what kind of humans?
How do we study how safe it isand who it works for?
(05:14):
And that kind of gets you tothat proven clinical application
.
And then from there you need tofigure out well, how do we get
clinicians then to adopt this,to start doing it, to implement
this practice?
How do we get that to be morewidespread across, you know, all
of the different providers, allthe different clinics or
hospitals all across the country.
(05:35):
And then from there, how do weunderstand kind of that bigger
public health impact?
So that's like a littlebackground on kind of where this
comes from.
So for simulation, if we thinkabout kind of applying that same
idea to simulation, we need tohave kind of these theories and
conceptual models that supporttranslational simulation, which
(05:59):
I'll define in just a minute.
There's a couple definitionsout there, but right now, if you
just kind of think of it asthis big bucket of how do we tie
simulation to patient care andpatient outcomes, so you need
these theories and conceptualmodels.
And then from there you need toknow within the simulation lab,
are the people learning theseknowledge, these skills, these
(06:22):
attitudes, whatever it is we'retrying to train them to in the
simulation lab?
You know, did they learn thatthing?
And then from there, if theydid learn it, then are they
using it when they go into thepatient care areas?
And then, even if they areusing it in the patient care
areas, then how do we know thatit's actually impacting the
(06:44):
patients?
So again, you kind of see allthese different stages in this
process that you need to gothrough, and so I think that
kind of gives an overview of youknow where this comes from and
what we're talking about.
But to be a little more concrete, I do have a couple of
definitions that are out therefrom the literature.
So the first one came out in2017.
(07:08):
This was from Dr Brazel out inAustralia, and she defined
translational simulation as afunctional descriptor of
healthcare stimulation with thepurpose of directly improving
patient care and healthcaresystems through diagnosing,
safety and performance issuesand then delivering these
(07:30):
simulation-based interventionsto address those.
And then in 2021, nixon andcolleagues, they kind of defined
it as activities that might bediagnostic, so determining the
problems that exist and what arethose characteristics of the
problems, or interventional, soproviding solutions to the
(07:51):
problem, or potentially you doboth you figure out what are the
problems and then you kind ofsolve those problems.
I think based on where we're atin simulation.
Now there's a couple differentways that this has evolved.
So something that the way thatI've kind of been thinking about
(08:11):
is there's kind of somedifferent buckets, if you will,
within translational simulation.
So there's kind of the systemsintegration piece, which is more
about the simulation centerprogram, integrating with the
quality and the risk managementdepartment.
So that's kind of one piece ofit.
(08:32):
There's systems testing, whichis kind of focused on the
testing for new equipment, ormaybe you have a new ward that's
opening and you want to testthat system, maybe you have a
new process that's in place soyou're going to do some
simulation around understandinghow the humans in that event
interact with that new process.
(08:54):
That's kind of the systemstesting.
And then there's also like theskills translation, and I think
the kind of classic example ofthat is all the work that Dr
McGehee and colleagues have doneon central line training, where
again I think you could kind ofsee how I was talking about you
they studied that in the simlab and then could we move this
(09:14):
from the sim lab to patient careand then to the outcomes, and
they even also took that to likereturn on investment, which is
a great example of kind of thatskills translation piece.
Deb Tauber (09:25):
Yeah, Excellent, excellent.
Now how did you decide ongetting into that for your PhD?
What drew you to that?
Lise Paganotti (09:53):
the hospital as a whole and I thought I really
want to be able to know, tomeasure, to be able to say that
we're having these impacts thatI really felt that we were
having.
But I didn't have any data andI just really honestly didn't
know where to start.
I didn't even know the firststep in doing it.
I felt like it's like do Istart with the hospital
leadership doing it?
(10:13):
I felt like it's like do Istart with the hospital
leadership?
Do I start with my program?
You know where do I go, andthat's really where I came up
with this.
You know what ended up being mydissertation.
Research is these questions tosay where do I start?
What do we know about this?
What are the experts doing?
I know people are doing this,so how can I learn from them and
understand?
You know what are the thingsdoing.
I know people are doing this,so how can I learn from them and
understand?
(10:33):
You know what are the thingsthat are going to be barriers,
what are the things that couldfacilitate me in this process?
Jerrod Jeffries (10:41):
And Lisa.
If I can ask another questionabout the overall aspect in
terms of transitional simulationfrom the clinical space,
testing process, development andculture pieces, Do you find one
to be a larger barrier thanothers for people trying to
(11:02):
enter this?
Lise Paganotti (11:05):
That's a really good question.
Honestly, I don't think thatreally came up in anyone's story
and I guess I'll tell you why Ithink that happened Because
basically everyone was workingfrom kind of a similar place to
what I described, which is likeyou're working in a place, you
(11:25):
look around you and you're likeokay, we have this problem, let
me try to address that problem.
So it really, I think, camemore from the, I guess, just the
setting that you were in thecontext to say, okay, let me try
to address this problem.
So it's kind of figuring outyou know what's an important
(11:46):
problem within your organizationthat you can address with
simulation.
So I think that's really howmost people have kind of gotten
into this.
Deb Tauber (11:56):
Can you describe the research study and what you
found?
Lise Paganotti (12:00):
Yeah, thanks for asking.
So I kind of mentioned some ofthe research questions that I
had.
So one of them was you knowwhat are the barriers and the
facilitators to running thesetranslational simulation
programs?
And I wanted to know where tostart.
(12:20):
So I ended up asking 18 expertsfrom our very wonderful
simulation community so shoutout to my anonymous wonderful
participants who allowed me tointeract with them.
We had three different types ofdata collection, so I collected
documents to understand somecontext behind them, and then I
interviewed these individualsand then had a focus group as
well so that I could triangulatethe different data sources to
(12:41):
make sure that I was reallyunderstanding what they were
sharing with me.
So I'll start with kind of thebarriers and facilitators and
then I'll move into the kind ofthe recommendations that they
have, which hopefully will bekind of some actionable
takeaways for the audience too,if they're thinking like, oh,
this sounds great, but again, Idon't know where to start.
So all right.
(13:03):
So in terms of the barriers andfacilitators, there actually
were a lot of facilitators andthat was kind of a surprising
finding.
I think we had about 10different facilitators and we
ended up having basically fourbarriers.
So I'll talk through each ofthose.
But there was kind of adiscrepancy there, you know,
with so many facilitators, and Idon't know if that's because,
(13:25):
again, I was talking to experts.
I'm talking to people in ourfield who are doing this, who
are very successful, who are outthere talking about it or
publishing about it in ways thatI could know who they are and
reach out to them.
So we did have lots offacilitators, which I think is
also encouraging for people whoare interested in this or maybe
just beginning in this area.
(13:45):
So the facilitators I'll justlist a couple of them because I
don't want to go into too muchdetail.
But if you have a really strongsimulation team as well as a
research team, that's going tobe helpful.
Some of the characteristics ofindividuals they talked about,
so people who have really goodrelationships with other people
(14:08):
throughout their system, some ofthose informal leaders, you
know, maybe they don't have thejob title but you know that they
have influence.
Also, the human factors sohaving somebody who has some
knowledge of human factors,which I think a lot of
simulationists do.
Now I don't think you need tobe a degree or some kind of
specific training in it, butjust understanding you know what
(14:30):
does that mean?
To kind of have that lens forlooking at these different types
of translational simulations.
All right, so for the barriers,there were four main barriers.
The first one I think everyonecan relate to, which is I called
it historical, but basicallyit's the historical context of
healthcare and medicine and Ithink this just ties into
(14:54):
behavior change.
It's really pretty easy toshare knowledge and to share
information, but it's verydifficult to get people to
actually change and to do thatchange, to implement that change
in their practice and thenconsistently do it.
Deb Tauber (15:10):
Do you think that's because people say, well, this
is the way we always have doneit?
Lise Paganotti (15:14):
Yes, exactly, you nailed it.
That is like the absolute quotefrom this, this code of you
know being historical.
That's exactly right.
We've done it this way.
Maybe they don't feel there's aproblem with the way we've
always done it.
You know, why do we have tochange?
Why do we have to improve?
I mean, this is classic, Ithink, across all of simulation,
(15:35):
not just translationalsimulation, but it is one of the
biggest barriers that we face,for sure.
Deb Tauber (15:42):
I think it's especially pervasive in
healthcare and in education.
Yeah, yeah.
Yeah, yep, a barrier, all right, so continue, continue.
Thank you.
Lise Paganotti (15:55):
So the next one is or the next two actually kind
of go together it's thedissemination and sustainability
.
So dissemination is reallythinking about how do you get
this work out there after you doit.
And the reason that is abarrier is because we don't
always have time built into ourschedules, our days, our jobs,
(16:17):
to actually share thatinformation, to get it out there
and share with otherorganizations or other
individuals who are looking todo this same kind of thing.
So throughout this study, theparticipants really talked about
kind of having some sort ofdissemination plan actually at
the beginning of your project,where you can say, okay, this is
how I'm going to share it withother people so that they know
(16:40):
what's going on, so they canlearn from what we've done.
Jerrod Jeffries (16:44):
Well, and to that part right, you spend 80,
90% of the overall scope of theproject doing the work and if
it's not shared, it's almostshooting yourself in the foot
because it's like oh yeah, Ipresented once to this room of
five people, for example, and itdoesn't leave that those four
walls is a little, yeah, lastfour sides.
So I'm happy to see thatthere's in the beginning.
(17:06):
It's how do you disseminate?
What are some of those waysthat different ones are
disseminated?
Lise Paganotti (17:10):
If you know off the top of your head, yeah, well
, I mean, this is one of themhonestly doing podcasts, sharing
on social media, sharing at thedifferent simulation
conferences, really any way thatyou can get this information
out there.
I mean, publishing is also oneway, and this study has been
published.
But I'll tell you, out of mywhole dissertation study, what I
could publish was a very smallpart of this, and actually most
(17:37):
of what I'm talking about todayisn't even an article, because
it's condensed down to such ashort number of words that you
can share.
So I think the more ways thatyou can share and the more
conferences and avenues that youcan get to, the better, because
you get a different audience ateach one.
Jerrod Jeffries (17:51):
yeah, yeah, and you never know what's gonna.
I don't want to say sticky what.
What's going to be relevant towhat audience?
And some of them might beconstrained on certain resources
, or others might be solely ontime or space.
You just don't know what'sgoing to be relevant or
applicable towards each audience.
Deb Tauber (18:10):
Lisa, I'm curious about your 18 experts.
Were they all in the UnitedStates or was it global?
Did you have people from othercountries?
Lise Paganotti (18:18):
Yeah, it was global.
Yeah, intentionally, becausethere's a lot of this really
good work happening in othercountries.
So because it was kind of thefirst overview study like this
to say, okay, we don't reallyhave a lot of information, let's
try to pull all this together.
I wanted to get just I went forthe top experts in this area,
so it was from anywhere in theworld.
Deb Tauber (18:40):
Thank you.
And how many questions werethere?
What did this look like?
Lise Paganotti (18:44):
Yeah, that's a good question.
The interviews lasted about anhour for everyone.
I forget the exact number ofinterview questions, but I would
say it was probably around 12questions because they were
pretty open ended to really heartheir stories and their
experiences, to extract whatthey're doing.
Deb Tauber (19:04):
Now.
Do you have an actionabletakeaway for our listeners?
Lise Paganotti (19:08):
Yeah, I do.
I actually have two morebarriers, if you don't mind, oh
of course.
Yeah, because I wanted to talkabout the sustainability piece
because that was another barrier.
So this one kind of speaks tothat idea that there's a lot of
kind of excitement.
Again, I think people canreally relate to this.
There's a lot of excitementaround a new program, right.
(19:30):
There's not as much excitementabout maintaining a great
program and I don't know whythere just isn't, you know, and
sometimes there's not evenfunding around maintaining the
program.
So I think that was really oneof the struggles that I want to
point out, because, again, youwant to think about this if
you're going to embark on this,you don't want to create a
really great program that againdoesn't continue because it's
(19:53):
kind of a waste of time andenergy and effort.
Jerrod Jeffries (19:57):
Lisa, I just see every single listener
nodding their heads to that.
Yep yep, there is sustainabilityand maintenance it's.
It's the shiny new toy rightwhen you're, when you're
building a new lab and it's justthere's so much attention on it
and I think the importance toyour point of being a barrier it
just kind of drops off a littlebit and it's more important
(20:17):
than ever to be like okay, let'smake sure that they're getting
the right education, let's makesure that we're facilitating all
faculty instructor development,let's make sure that the right
equipment's being used.
And what metrics or data do wehave to actually show that
products that we've spent Xdollars on is art being used?
And so I think that one reallyresonates with a lot of our
(20:39):
listeners.
Lise Paganotti (20:40):
And then you had a final one as well.
Yeah, I just had one final onewhich I think will also resonate
, of course, is scheduling.
I think scheduling is difficultfor a lot of reasons, and this
one actually reminds me of kindof the interprofessional
education world and theirscheduling issues.
But a lot of these simulationsmight take place in situ versus
(21:00):
in the sim lab, not always.
It just depends on you knowwhat the goal is, what you're
trying to do, but thinking aboutyou know that, in situ
scheduling and how do you makesure that there's an adequate
staff for the patient, theactual patient care needs and
people for the simulation, andthat it's a good time and a good
day and all of these things tomake sure that everybody is safe
(21:21):
.
So again, I think that's acommon one, but again, good
things to.
I think the barriers are soimportant to know about because
if you can go in anticipatingthese things, I just think you
can really try to mitigate themfrom the beginning.
Deb Tauber (21:36):
And what about the actionable takeaway for our
audience?
Lise Paganotti (21:40):
Yeah, thanks for asking that.
One Depends on where you are inyour program.
But if you can kind of lookaround an inventory where your
program is at and see how youcan start to think about
translational simulation foryour program, whatever that
looks like, try to kind of startto weave some of this into your
(22:03):
work.
It might mean having aconversation with your quality
and patient safety departmentwithin your organization.
It might be building some kindof intentional relationships
with maybe some other leadershipindividuals within your
organization or keeping your earout for some kind of really
(22:25):
important need that simulationcould fill, some kind of really
important need that simulationcould fill.
And then you can kind of startwith that, you know, hopefully
like small but successfulproject, and then grow and build
from there.
So I think it just depends alot on where you are, I think if
you are at an academic site.
So I'll use myself as anexample.
(22:45):
When I was just in the academicsetting, I really didn't think
that much about kind of thepatient care side.
I just felt like it was verydisconnected from what I was
doing and I would encouragepeople to try to think about it
as connected.
You may not be able to measurethat because, as we know,
there's a lot of confoundersthere that are going to happen
(23:07):
between the training here andthe patient care.
But I think it's important toeven just have that idea in your
mind that I'm training them forthis, and maybe there is one
small thing that I could measureor find out.
Maybe I can add a question toone of our surveys to find out,
even if it's as simple as do mylearners think they'll use this
(23:29):
in patient care, and I knowthat's a very kind of low level
outcome, but at least it's astarting point for trying to
figure out okay, are we beingsuccessful in helping them
really kind of move this forwardinto that patient care space?
Deb Tauber (23:43):
Yeah, this is a lot of systems integration with this
.
So, especially programs thatare going for accreditation for
systems integration, this wouldlend well to their work and to
their application.
Lise Paganotti (23:57):
Yeah, definitely .
Deb Tauber (23:58):
Yeah.
Now if our listeners wanted toget ahold of you and ask you
about this, where would they goahead and do that?
Lise Paganotti (24:03):
Yeah, sure, probably email is going to be
the best way to get a hold of me, and that's going to be.
It's lisaannbuckley at gwuedu.
So that'sl-i-s-a-a-n-n-b-u-c-k-l-e-y at
gwu for George WashingtonUniversity dot edu.
Deb Tauber (24:24):
And that'll be in the show notes.
We can include that in the shownotes.
Yeah, now, lisa, you're also asite reviewer for the Society
for Simulation in Healthcare, sowhy don't you want to share a
little bit about what you do andif you've had a favorite review
that you've done?
Lise Paganotti (24:42):
Yeah, sure yeah.
I've been a site reviewer sinceabout 2013.
Since about 2013.
And then, more recently, I'vetaken on a couple leadership
roles within accreditation forthe Society for Simulation
Healthcare, so I'm excited tocontinue in that realm.
Oh man, my favorite thing aboutthe reviews is really just
(25:04):
seeing a variety of programs,because people do things really
differently and everyone has alittle different context.
I think there's so much goodwork going on out there.
It's really fun to kind of havethat eye into multiple
different programs just to seeyou know how are people doing it
and how are they doing itdifferently.
Related to the topic today, myfavorite is when I get to do a
(25:28):
review that includes systemsintegration, because I get to
see exactly what people aredoing in this particular topic
area.
So that's always exciting.
Jerrod Jeffries (25:37):
Well, and seeing so many too, you see the
good and the bad, of course, andthen you say, okay, this is the
best practices, so let's makesure we implement this in our
own institution.
So good spot to be.
Lise Paganotti (25:47):
Yeah, it's a real benefit in that way.
Deb Tauber (25:50):
Great.
Any questions for Jared and I.
Lise Paganotti (25:53):
No, I don't think so, but thank you so much
for interviewing me and allowingme to share this information.
I'm excited about it.
I welcome anyone to reach outto me if they have any questions
or interest in this topic.
I love to talk about it.
Jerrod Jeffries (26:06):
Yeah, I think it's very powerful what you're
doing, and I love theapplication towards practice.
I think that you've really hitsomething there, Lisa, and
really look forward to hopefullymaking some connections with
some of our listeners that aregetting in touch with you.
Deb Tauber (26:19):
Yeah, all right.
Well, thank you so much andhappy simulating.
Disclaimer/ Beaker Healt (26:25):
Thanks to Beaker Health for sponsoring
this week's podcast.
Beaker Health, wheredissemination and measuring
impact comes easy.
Thanks for joining us here atthe Sim Cafe.
We hope you enjoyed it.
(26:45):
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