May 6, 2025 • 28 mins
What if healthcare professionals could practice high-stakes procedures hundreds of times before ever touching a real patient? Dr. Ryan Ribeira is making this vision a reality through virtual reality medical simulation.
As both an emergency physician and the founder of SimX, Ribeira bridges the worlds of clinical practice and technological innovation. His journey began in quality improvement and patient safety, where he recognized that traditional approaches weren't creating the dramatic safety improvements healthcare needed. Looking to aviation's remarkable safety record achieved through simulation, he saw an opportunity to transform medical education using virtual reality.
Traditional medical simulation centers face significant limitations – they're expensive, require dedicated space, and offer limited availability that typically restricts training to quarterly sessions. Mannequins can't display neurological symptoms or traumatic injuries, and capturing the psychosocial complexity of real patient interactions is nearly impossible. Ribiera's solution? Create virtual patients and environments that can be deployed anywhere in minutes.
The impact has been transformative. Healthcare organizations using VR simulation have increased training frequency from quarterly to several times weekly. Modern headsets with improved refresh rates have largely eliminated motion sickness concerns, making the technology accessible to virtually everyone. The technology allows learners to experience rare but critical scenarios repeatedly, building muscle memory and decision-making skills without risking patient harm.
Looking forward, Ribiera envisions AI-generated training scenarios, mixed reality combining physical task trainers with virtual overlays, and biometric monitoring that keeps learners in the optimal stress zone for skill acquisition. These innovations represent a fundamental paradigm shift from "see one, do one, teach one" to "see one, sim a hundred, then do one."
For healthcare educators, administrators, and practitioners facing increasing patient volumes and staffing challenges, VR simulation offers a powerful solution for rapid, effective training. Join us as Dr. Ribiera shares his insights on this revolutionary approach to medical education and his vision for a future where patients never have to be someone's first attempt at a procedure.
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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
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
(00:58):
and learn something new from theSim Cafe, from The Sim Cafe.
Deb Tauber (01:07):
Welcome to another episode of The Sim Cafe, and
today we're here with Dr RyanRivera.
He is a prominent emergencymedicine physician, health
technology interviewer andeducator based in California.
He currently serves as themedical director of the Sanford
Adult Emergency Department andholds a clinical assistant
professorship at StanfordUniversity School of Medicine.
(01:29):
In addition to that, beyond itsclinical roles, Dr A is the
founder and CEO of Cimex, whichis a leading provider of virtual
reality medical simulationsoftware.
So thank you so much, and wealready talked.
You said I could call you Ryan.
So, ryan, do you want to addanything to your introduction?
Dr. Ryan Riberia (01:51):
Maybe the only other thing to add.
I appreciate that introduction.
I think maybe the only otherthing to add is you know, prior
to founding Cimex and maybewe'll get into this as we go
along I was pretty involved inquality improvement, patient
safety work.
So I worked for CMS and AHRQlike building packages of
quality metrics, and I also wason the board of trustees of the
(02:11):
American Medical Associationworking on like public health
work to try to make healthcaresafer, and that's actually the
kind of the thing that broughtme into the SIM community.
I came from the angle of nottechnology actually, but from
patient safety, qualityimprovement and how can we use
SIM to make care safer?
Deb Tauber (02:29):
Wow, you certainly have your hands full and have
done so many things, and I thankyou for all the things that
you've contributed to.
Dr. Ryan Riberia (02:38):
Why don't you tell us a little bit about your
current emergency departmentexperience and some of your
challenges, since you're stillcurrently yeah, yeah no, yeah, I
do actively practice and, asyou mentioned, I kind of work as
a medical director and I thinkwe face probably a lot of the
challenges same challenges thatpeople do across the country in
emergency departments right now,which is more and more people
(02:59):
coming in the door needingemergency care and often not
enough places to put them.
And so you know that's a lot ofmy work as a you know
operations lead at Stanford istrying to figure out how we can
make sure that we're able tosafely care for the increasing
number of patients that comeinto our doors.
And I say, you know, one of theother challenges that we face a
(03:22):
little bit less at Stanford butwe still do face and many other
hospitals are facing is how doyou make sure that you have
sufficient staff that areadequately trained right as
volumes go up and, as you know,I think post COVID we've
continued to suffer a bit from anursing shortage especially.
You know how do you make sureyou get people in and you train
(03:44):
them up for you know the skillsthat they sure you get people in
and you train them up for.
You know the skills that theyneed for their role and how you
do that quickly.
So that's something that wedeal with as well.
And then you know, on a personalnote, emergency medicine
requires you to do days andafternoons and I did a night
shift last week and then I did a5 pm to 1 am yesterday.
And how do I navigate that withthe 9 to 5 or you know, more
(04:07):
like 7 to 7 job of running atech company?
You know that's some of thethings that I face every day,
but you know I love it,emergency medicine.
You really get to see newthings all the time.
You really get the satisfactionof helping people who have an
acute need and getting to helpthem through that.
So I wouldn't trade it foranything.
Deb Tauber (04:25):
Thank you, thanks.
Now, what inspired you to startCimex and how do you see
virtual reality transformingmedical education and training?
Dr. Ryan Riberia (04:35):
Yeah well, so, yeah, big question there.
And I, you know, gave you someof the background, I guess,
already, which is that I camefrom the world of quality
improvement, patient safety andtrying to think about, you know,
how can we, how can we improvethe quality of the care that we
provide?
And, after spending years inmetric development and sepsis,
bundle compliance programs andthings like that, I mean that's
(04:55):
really important stuff.
But I started to feel like,well, you know, we really we
need to do more than just reducethis one certain part of
medical errors by 7%.
We need to be, you know,decreasing all of our medical
errors by 80%.
And how can we do that?
And I really got interested insimulation because it was such a
(05:18):
big part of how the airlineindustry has become so safe and
I see a lot of analogies betweenthe airline industry and
medicine.
I mean, we both have a lot, alarge number of low frequency
but high consequence events thatwe need to be prepared for, and
that's exactly what sim is goodat.
So that was kind of the gristfor it.
And then, as I was goingthrough medical school, I was
(05:41):
going through sim trainingmyself and you know I noticed
that there were a couple flawsthat prevented us from being
able to achieve the same successthey've had in the airline
industry.
Airline industry, they've gotthese hyper-realistic simulators
that are like a perfectone-to-one matchup with real
life.
We don't have that.
We had mannequins, which aregreat but can't really have
traumatic injuries.
They can't really haveneurologic symptoms.
(06:03):
There's not a lot ofpsychosocial interaction there,
and then we really weren'tsimming all that often.
I mean, the sim centers arevery expensive, the time is hard
to get, the equipment is prettylimited and so, you know, when
you're at a big academic center,that's sharing between your
nursing program and your MDtraining programs and your APP
training programs and all thisstuff.
We ended up simming like once aquarter.
(06:26):
I was going through my owntraining and thinking, well, you
know how can we resolve this?
You know how can we resolvethis, and I had a background in
technology and entrepreneurshipalready and was looking at the
kind of upcoming VR, AR world.
This was back in 2013 andthought, you know, this might be
the solution.
Right, it was a virtual patient.
They can have neurologicsymptoms, they can have
(06:46):
traumatic injuries.
You can have any demographicthat you need and you don't need
to buy a bunch of equipment tomake a multimillion dollar sim
center.
You can just, you know, be inan OR or in the PACU or, you
know, in the back of anambulance and all it takes is
kind of software development.
So it seemed like there was alot of potential there to solve
those issues.
And, you know, back in thosedays there weren't really any VR
(07:09):
headsets available for anaverage consumer.
So we just started building thesoftware, knowing that one day
someone would make the hardware,and we were doing that for many
years and then eventually, 2018, 2019, our headsets started to
become released and we startedto have customers.
And then 2020 is when theOculus Quest came out, which
really made it dramaticallyeasier for people to use VR, and
(07:31):
that's things kind of took offfrom there.
And you know, I do think when wetalk about the benefits of VR,
that is really where a lot ofthe power is the fact that you
can pop up a high fidelity simexperience in any empty space in
less than five minutes.
Right, and there's obviouslypros and cons.
You're not going to get thetactile element with VR that you
(07:53):
get with traditional simulationtraining, but you are getting a
lot of great psychosocialcomplexity.
You are getting a lot of greatenvironmental complexity.
The visible physiology that youcan portray on a patient is
really flexible and awesome.
And, again, many of ourcustomers have gone from simming
once a quarter to three or fourtimes a week because it's
(08:13):
something that they can justpull out back to the classroom,
pop up their sim center and go,and so that that's our hope is
that what vr lets you do is simmore realistically and sim way,
way, way more frequently, andtherefore we can, you know,
improve the quality of the carethat we provide and save more
lives.
Deb Tauber (08:31):
Absolutely, and we know repetition right and I
think, especially with your, youknow people who are more
experienced to be able to use it.
And you know we talked a littlebit before the podcast about
the myth of the nausea.
Why don't you talk a little bitabout?
You know, repeat that to ourlisteners.
Dr. Ryan Riberia (08:50):
Sure, yeah, yeah, V VR as as come a long
way.
You know, in the very earlydays of VR technologies,
headsets weren't particularlypowerful, and so I think you had
a lot of challenges with framerates and refresh rates and
people were still learning howto use VR well and they were
using things like warping andusing joysticks to move around
(09:11):
the virtual world.
And all those things we nowknow cause nausea, right, and it
makes sense.
If there's a discrepancybetween what your eyes see and
what your body feels, that'swhat causes motion sickness.
And so if you're in a headsetand you're moving around and the
refresh rate is not good and so, like, what you see is delayed
compared to what your body feels, that makes you sick.
Now the newer headsets even I'dsay the last three years, but
(09:34):
you know they keep gettingbetter it lasts one year and the
headsets are so much morepowerful.
The frame rates, the refreshrates are much, much easier to
keep sufficiently high.
That you know you don't seethat disconnect between what you
see and what you feel.
And then you know some of it issoftware design too.
I think at SimX we don't reallyuse warping navigation, you just
(09:57):
if you want to walk to theother side of the room.
In VR, you just walk, and sothat maintains this.
You know synchronicity betweenwhat you see and what you feel,
and if you do all those things,it doesn't need to be nausea.
Actually, I don't think nauseaand VR are not inherent to each
other.
It really is.
It really is a matter of howyou design the software, and so
(10:17):
for us, we've had customers dospecific studies on user
acceptance and nausea with SimX,and one of them in particular I
think it was University ofNebraska who ran a study that
where they found only 4% oftheir students I believe it was
I'm quoting this off the top ofmy head, so there's little
discrepancies here 4% of theirstudents, I believe it was.
I'm putting this off the top ofmy head, so there's little
discrepancies here.
Forgive me, but it was lowsingle digits that experienced
(10:39):
meaningful nausea when they wereusing the product, and again, I
think that's attributable tothe more powerful headsets these
days and also careful softwaredesign.
Deb Tauber (10:48):
Excellent.
Now, how do you evaluate realworld impact of emerging
technologies like AI and VR inthe clinical setting?
Dr. Ryan Riberia (10:59):
Yeah, this is, I think, an exciting area where
there is a lot of opportunitythat is yet to be untapped.
Now there's tons of studies outthere on the efficacy of VR
medical training.
I think we recently did a litreview and there were over 4,000
studies in PubMed on XR inmedical training.
I think we recently did a litreview and there were over 4,000
studies in PubMed on XR inmedical training and the large
majority of them show verypositive impact, especially, you
(11:22):
know, even in head-to-heads,compared to other simulation
modalities.
Though usually those studiesare looking at, you know, things
like pre-post performance onyou know, structured exams, or
they're looking at individualuser evaluations of the efficacy
, or they're looking at learningretention or things like that.
Those are meaningful endpointsfor research, but they don't
(11:44):
really speak all the way toclinical performance.
Now, it is not a problem that'sparticular to VR.
I think all of us who are kindof in the education community
know that it is very hard to beable to demonstrate that an
educational initiativetranslates all the way to better
clinical care.
There's just so many thingsthat happen along the way.
(12:05):
But we are looking at a fewcollaborations that I think
could do it, and part of it isthat there's more sim being done
now in the in-practice space,you know, especially in nursing
when they're doing likecross-training, and there's more
large hospital systems that aredeveloping simulation programs
and so I think because of thatthere's opportunity to do stuff
like CAUTI, like you can saylet's do a simulation training
(12:30):
program and see if we can reducecatheter urinary tract
infections pre-post by trainingpeople through VR on the proper
insertion and cleaning andmaintenance mechanisms.
And you know that's an endpointthat hospitals care about.
That is real clinical practiceas meaningful patient safety
impact and where you can kind ofdo a pre-post analysis.
(12:52):
And so we're looking at thingslike that.
And so we're looking at thingslike that.
And then back to my roots withSIFSIS bundle compliance as well
.
Yeah, I think that's where theopportunity is is to do these
studies for in-practice nursingin hospital systems.
On those subjects where it is,hospitals are incentivized and
(13:12):
they also are meaningful from apatient safety perspective.
So I think there's a bigopportunity there.
I don't think there's a lot ofresearch out there yet, but
we're in the midst of finalizingsome partnerships to do that
type of research.
Deb Tauber (13:25):
You have come so far .
I remember meeting you atNASCIL when it was in Milwaukee
when it was in.
Milwaukee yeah, and it's justbeen really fun to watch how far
you've come and how many peoplehave adopted your work.
Dr. Ryan Riberia (13:44):
Believe it or not, we were already years in.
At that point there were fiveyears or so before that many of
which were just me and two otherpeople just working on it.
Deb Tauber (13:56):
And how many people are there now?
Dr. Ryan Riberia (13:59):
We're closing in on 100 employees actually.
So yeah, it's grown a lot.
Deb Tauber (14:03):
That is just great.
That's just fantastic.
What do you see in the future?
Dr. Ryan Riberia (14:09):
So, yeah, I mean, I think there's a lot of
opportunities in the future andthere's probably a few
categories that I would point to.
One is obviously AI.
I think AI is going to have abig impact on a lot of aspects
of education.
Ai is something that we've kindof cared a lot about, and from
the beginning, one of ourco-founders is an expert in AI
(14:33):
actually, and we've got a numberof other team members that have
really true exceptionalexpertise in this space.
And I think with the advent ofLLMs and you know, I think with
the advent of LLMs, there is thekind of obvious low hanging
fruit of being able to haveconversations with virtual
patients.
You know, the LLMs just makethat way way better, and
(14:53):
definitely that's something thatwe are in the process of
integrating, but there'sactually more opportunity there
too.
So, simx, we build our platformin a very.
The platform is very structuredin such a way that environments
and patients and tools can kindof be intermixed, and so that
lends itself to a world whereyou know, if you've ever used
(15:15):
generative AI to make a photo ora video or something you know
you can type in a paragraphformat hey, can you make me a
picture of a cute cat wearing abirthday hat or something, and
it will put that together.
Now imagine a world where youcould type in and say, hey, make
me a virtual reality medicaltraining scenario suitable for
second year nursing studentsthat teaches them the importance
(15:37):
of five rights of medicationadministration five rights of
medication administration and itgenerates that you put on a
headset and then you can run it,and that is.
That might sound very sci fi,but it is actually very
achievable with LLM technologyand with a platform like ours,
where everything is kind ofcarefully segmented because it's
(15:58):
really just piecing thosecomponents together, live, and
so it's really just a matter oftraining the AI agent and how to
put that together.
So that is something that Ithink is definitely coming down
the pipeline and is going to bevery exciting.
I think mixed reality is anothercategory that is quite exciting
.
If you've seen some of thenewer headsets from Apple or
(16:19):
even from Oculus or HTC, they'reall really making a big push
towards mixed reality, where thereal world and the virtual
world are kind of intertwined,and I think there's a big
opportunity there for us to kindof get the best of both worlds
right.
You can imagine a really highfidelity task trainer that has a
virtual patient projected overit and so you can have the
(16:40):
conversation with them, that canbe rolling around in pain and
you can have that kind ofpsychosocial and environmental
complexity from the virtualcomponent.
But then you can still use thetask trainer to get really high
tactile fidelity.
And that is, I think, in someways probably going to be the
gold standard of training andthere's going to be a big
opportunity there as the mixedreality headsets start coming
(17:04):
out.
We expect them from Oculus thisyear and HTC probably shortly
after that.
So I think there's going to bea lot of opportunity there.
And then, finally, I would saysomething that excites me a lot
as an educator myself, is theopportunity that mixed reality
and VR give us for assessments.
(17:24):
Right, because you know rightnow, very often, if you're doing
traditional sim, you'restanding behind a one-way mirror
and you're kind of watching thestudents and you're furiously
writing down okay, they gavethis dose, they probably should
have given this dose, or maybethey should have asked this
first, and then you're doingyour debriefs and it's a lot of
cognitive load for you as aninstructor.
But VR already kind of takes alot of that away, because it can
(17:48):
tell here's the dose that theygave, here's how long it took
them to put the patient on themonitor.
All that's already pre-recorded.
But we can actually take that astep further.
In VR, we can tell where peopleare looking.
So you can imagine a worldwhere we say, hey, you were only
looking your patient in theeyes 41% of the time that you
were talking to them and youknow, average for your level of
training is 76%.
(18:09):
So maybe let's talk about thepersonal touch that you can add
to these encounters or the otherthing.
So there's just the sheeramount of information that we
have available in these virtualtrainings about what people are
actually doing, I think is stillmostly untapped.
So there's a lot of opportunitythere.
And the other thing is biometricsensing.
(18:29):
So you can already buy thirdparty biometric sensors and they
basically use minute changes in, like skin temperature and
sweat, to evaluate your levelsof physiologic stress.
And, as we all know, there'skind of a sweet spot in stress
for learning.
If you're not stressed enough,then obviously you're not being
pushed.
If you're too stressed, you'refreaking out, you're crying, you
(18:50):
don't, you're not going toremember anything from this sim,
and so you really got to keepyour students kind of like right
at the edge, but notoverwhelmed.
And so we have some customersalready that are using these
third party biometric sensors inconjunction with VR to kind of
like modify the scenario in realtime and really keep them in
that sweet spot.
But some of the headsetmanufacturers are looking to
(19:10):
build that into the headsets inthe coming years, and so you can
imagine a world where you'rerunning a sim and you have like
a running graph of theirphysiologic stress and whether
they're in the sweet spot or not, and you can either
intentionally or automaticallythrough the software make the
scenario harder or easier tokeep them in that sweet spot.
(19:32):
And that, I think, is reallyexciting, because when we talk
about the need to cross trainand quickly train up nurses and
things, how do you quickly trainsomeone up?
You do it by making sure everysingle minute of sim counts
right, that they are always inthat sweet spot.
They're always being pushedright to the edge.
I mean, that's how they trainOlympic athletes, right.
They're always staying in theirsweet spot, and so I think the
(19:55):
prospect of being able to dothat with medical training is
really, really exciting.
Deb Tauber (20:01):
Yeah, yeah, I love that.
Wow, very, very fascinating.
Dr. Ryan Riberia (20:06):
We've really come a long way in the last five
years, but really on theprecipice of a lot of exciting
changes, I think, in medicaleducation.
Deb Tauber (20:14):
Now, how do you stay grounded with everything that
you do between you know, an ERphysician, a CEO, a dad?
How do you hold it all together?
Dr. Ryan Riberia (20:24):
an ER physician, a CEO, a dad how do
you hold it all together?
Yeah, that's a good question.
I mean I would say these thingsaren't completely disparate,
like there's definitely a lot ofsynergy here, right?
When I go on clinical shifts, Iget new ideas for things that
we should build in SimEx, and orwhen I'm training residents you
know, and I still dotraditional sim with residents
(20:45):
all the time it gives me newideas for how we can make it
easier for our instructors.
And when we're doing things inSimX, sometimes I myself get in
headsets and run cases and Ibuild up my own skills along the
way, as we're kind of gettingthings ready to ship, and so
they're really very synergisticand I think that is key.
(21:08):
If I was doing things that arecompletely unrelated, it'd be
quite a bit more overwhelming,but you mentioned a couple of
things there.
Obviously, if your life is allwork in one form or another,
even if it's fun work, that's alittle too much.
I've got four kids and theyjust keep me grounded every time
I interact with them.
Right, the age is 16, all theway down to five, and so we
(21:30):
really got the spread and goingto all the tennis matches and
piano recitals and everythingthat comes with those age groups
is a ton of fun.
We live out here, right next tothe Santa Cruz mountains
actually too, and so I've takena mountain biking recently,
which maybe it doesn't soundthat relaxing to some people,
but it is very relaxing actually.
(21:51):
You get out into the woods andwe've got a lot of beautiful
redwoods out here.
Spend some time in nature, Ithink that's really key.
And then I've also I've takenup meditation over the last
several years, which has beenreally helpful.
You know, even just a fewminutes a day, I think, of that
kind of centering and being inthe moment has been really key
for me when things are goingcrazy, wow.
Deb Tauber (22:14):
What do your kids think about all this virtual
reality?
Dr. Ryan Riberia (22:18):
They think it's pretty cool.
I would say they thought it waspretty cool.
It's kind of old hat for them.
Now we have videos of them, youknow, 10 years ago not quite 10
years ago, maybe eight yearsago wearing like the backpack
computers and like the big oldheadsets, when they were very
young and so they were exposedto VR before most people even
knew it was a thing.
And you know, we've always hadprobably a minimum of 10 VR
(22:42):
headsets around the house forone reason or another.
So I think I think my son forhis eighth or ninth birthday.
So again, this was very earlyin the VR world.
We had a Minecraft themedbirthday party and we brought a
bunch of VR headsets and all thekids did VR Minecraft together
and blew their nine year oldminds.
So oh my gosh side benefits, Iguess, of having a dad who's in
(23:07):
the VR industry.
Deb Tauber (23:08):
Yeah, I do a little bit with my grandsons.
I play a little bit of VR games, some kind of squirrel game
where you catch it.
Dr. Ryan Riberia (23:14):
Oh yeah, akron , we play that one at home all
the time.
That's my five-year-old'sfavorite.
He loves to be the tree andthrow the acorn at people.
Deb Tauber (23:22):
Yep, yep, yeah.
Now, do you have any finalwords that you'd like to leave
our listeners with today?
Dr. Ryan Riberia (23:29):
Yeah, you know , I think we've talked about a
lot of different things.
For me, and probably for mostof us, what it really does come
down to is patient safety.
So I think you're kind of righton the nose asking, like, how
do we make sure this translatesinto a clinical setting?
And you know, you asked alittle bit about what prompted
me to go into this space and Ishared a couple of those
experiences.
There was another experience Ithink that is was a part of what
(23:54):
pushed me over the edge, andthat was, you know, when you're
going through medical school,they teach you things, and they
teach you a little bit about thehistory too, and like all the
things we did wrong in the pastand everything from bloodletting
and things to like Tuskegeeexperiments, and you know that
all the mistakes that themedicine has made along the way,
and they also tell you.
(24:16):
Fortunately, a certainpercentage of the things that
we're teaching you now are alsogoing to turn out to be wrong.
And the problem is we don'tknow which parts right, like
what are the things thatgenerations from now they'll
look back and say I can'tbelieve that they did that, Like
that was nuts.
And as I was going throughtraining.
(24:38):
It struck me that obviously wedon't know what the future will
hold, but certainly it'splausible that what that thing
will be for us is the fact thatwe practiced on real people like
that.
We, you basically go and youlisten to a bunch of lectures
and you maybe do like one or twosim cases and then you just go
(24:58):
out and start working withpatients and you know of course
we do do a lot in in health careto try to make that a safe
transition, but still, you know,at some point you're sticking
needles in people with verylittle experience and you're
cutting on people with verylittle experience.
And you know there's that wholesaying see one, do one, teach
(25:18):
one in healthcare, which youknow you kind of got to do out
of necessity.
But is that really the best wayto do it?
If we had other options itwould not be, and I think as SIM
becomes more realistic and moreaccessible, it doesn't have to
be that way.
Right, like this is perhaps, inmy view, the key to changing
(25:38):
that, so that it's not see one,do one, teach one.
It's, you know, see one, SIM ahundred, then do one right and
then teach.
And I think that really is thefuture and I do think people
will look back on us and say,like that was so barbaric that
they just send you out into theworld without putting you in a
(26:00):
headset and having you do 100first.
So hopefully we can be part ofcreating that better future for
our healthcare system and forour patients.
Deb Tauber (26:08):
That better future for our healthcare system and
for our patients.
I love that.
That is amazing.
Now do you guys use theheadsets for hiring decisions?
Dr. Ryan Riberia (26:16):
Oh, put people into VR interviews.
Yeah, you know we haven't yet,but that would be interesting.
Pop people in a headset andkind of see their decision
making process along the way.
We have had some peopleapproach us though about vr for
motivational interviewing or forde-escalation, like for front
(26:38):
desk staff in an er and havingto do de-escalations and things.
So it's, it can be used forthat kind of stuff.
But we have we haven't used itat simx for that purpose not yet
not yet yeah right, I thinkthat's.
Deb Tauber (26:52):
And if our listeners want to get a hold of you, what
, uh?
How can they do that?
Dr. Ryan Riberia (26:57):
you know simxvrcom.
They can head there.
They could probably message methrough Linkedin too, and it's
probably the best way to get ahold of me.
But yeah, either of thosesources and I'm happy to connect
.
Deb Tauber (27:09):
And I thank you so much for taking your time today
and meeting with me, andfortunately, Jerrod couldn't be
here today.
He's going to be disappointed.
He missed such an interestingconversation.
Thank you for everything thatyou've done.
It's just an honor to get tospeak with you today.
Dr. Ryan Riberia (27:28):
Yeah, no, thanks so much for having me.
It's been a great conversationand it's been great.
Deb Tauber (27:32):
Thank you and happy simulating.
Disclaimer/ Innovative S (27:42):
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We hope you enjoyed.
Visit us at www.
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com and be sure to hit that likeand subscribe button so you
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(28:03):
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saving you time and money.
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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
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
(00:58):
and learn something new from theSim Cafe, from The Sim Cafe.
Deb Tauber (01:07):
Welcome to another episode of The Sim Cafe, and
today we're here with Dr RyanRivera.
He is a prominent emergencymedicine physician, health
technology interviewer andeducator based in California.
He currently serves as themedical director of the Sanford
Adult Emergency Department andholds a clinical assistant
professorship at StanfordUniversity School of Medicine.
(01:29):
In addition to that, beyond itsclinical roles, Dr A is the
founder and CEO of Cimex, whichis a leading provider of virtual
reality medical simulationsoftware.
So thank you so much, and wealready talked.
You said I could call you Ryan.
So, ryan, do you want to addanything to your introduction?
Dr. Ryan Riberia (01:51):
Maybe the only other thing to add.
I appreciate that introduction.
I think maybe the only otherthing to add is you know, prior
to founding Cimex and maybewe'll get into this as we go
along I was pretty involved inquality improvement, patient
safety work.
So I worked for CMS and AHRQlike building packages of
quality metrics, and I also wason the board of trustees of the
(02:11):
American Medical Associationworking on like public health
work to try to make healthcaresafer, and that's actually the
kind of the thing that broughtme into the SIM community.
I came from the angle of nottechnology actually, but from
patient safety, qualityimprovement and how can we use
SIM to make care safer?
Deb Tauber (02:29):
Wow, you certainly have your hands full and have
done so many things, and I thankyou for all the things that
you've contributed to.
Dr. Ryan Riberia (02:38):
Why don't you tell us a little bit about your
current emergency departmentexperience and some of your
challenges, since you're stillcurrently yeah, yeah no, yeah, I
do actively practice and, asyou mentioned, I kind of work as
a medical director and I thinkwe face probably a lot of the
challenges same challenges thatpeople do across the country in
emergency departments right now,which is more and more people
(02:59):
coming in the door needingemergency care and often not
enough places to put them.
And so you know that's a lot ofmy work as a you know
operations lead at Stanford istrying to figure out how we can
make sure that we're able tosafely care for the increasing
number of patients that comeinto our doors.
And I say, you know, one of theother challenges that we face a
(03:22):
little bit less at Stanford butwe still do face and many other
hospitals are facing is how doyou make sure that you have
sufficient staff that areadequately trained right as
volumes go up and, as you know,I think post COVID we've
continued to suffer a bit from anursing shortage especially.
You know how do you make sureyou get people in and you train
(03:44):
them up for you know the skillsthat they sure you get people in
and you train them up for.
You know the skills that theyneed for their role and how you
do that quickly.
So that's something that wedeal with as well.
And then you know, on a personalnote, emergency medicine
requires you to do days andafternoons and I did a night
shift last week and then I did a5 pm to 1 am yesterday.
And how do I navigate that withthe 9 to 5 or you know, more
(04:07):
like 7 to 7 job of running atech company?
You know that's some of thethings that I face every day,
but you know I love it,emergency medicine.
You really get to see newthings all the time.
You really get the satisfactionof helping people who have an
acute need and getting to helpthem through that.
So I wouldn't trade it foranything.
Deb Tauber (04:25):
Thank you, thanks.
Now, what inspired you to startCimex and how do you see
virtual reality transformingmedical education and training?
Dr. Ryan Riberia (04:35):
Yeah well, so, yeah, big question there.
And I, you know, gave you someof the background, I guess,
already, which is that I camefrom the world of quality
improvement, patient safety andtrying to think about, you know,
how can we, how can we improvethe quality of the care that we
provide?
And, after spending years inmetric development and sepsis,
bundle compliance programs andthings like that, I mean that's
(04:55):
really important stuff.
But I started to feel like,well, you know, we really we
need to do more than just reducethis one certain part of
medical errors by 7%.
We need to be, you know,decreasing all of our medical
errors by 80%.
And how can we do that?
And I really got interested insimulation because it was such a
(05:18):
big part of how the airlineindustry has become so safe and
I see a lot of analogies betweenthe airline industry and
medicine.
I mean, we both have a lot, alarge number of low frequency
but high consequence events thatwe need to be prepared for, and
that's exactly what sim is goodat.
So that was kind of the gristfor it.
And then, as I was goingthrough medical school, I was
(05:41):
going through sim trainingmyself and you know I noticed
that there were a couple flawsthat prevented us from being
able to achieve the same successthey've had in the airline
industry.
Airline industry, they've gotthese hyper-realistic simulators
that are like a perfectone-to-one matchup with real
life.
We don't have that.
We had mannequins, which aregreat but can't really have
traumatic injuries.
They can't really haveneurologic symptoms.
(06:03):
There's not a lot ofpsychosocial interaction there,
and then we really weren'tsimming all that often.
I mean, the sim centers arevery expensive, the time is hard
to get, the equipment is prettylimited and so, you know, when
you're at a big academic center,that's sharing between your
nursing program and your MDtraining programs and your APP
training programs and all thisstuff.
We ended up simming like once aquarter.
(06:26):
I was going through my owntraining and thinking, well, you
know how can we resolve this?
You know how can we resolvethis, and I had a background in
technology and entrepreneurshipalready and was looking at the
kind of upcoming VR, AR world.
This was back in 2013 andthought, you know, this might be
the solution.
Right, it was a virtual patient.
They can have neurologicsymptoms, they can have
(06:46):
traumatic injuries.
You can have any demographicthat you need and you don't need
to buy a bunch of equipment tomake a multimillion dollar sim
center.
You can just, you know, be inan OR or in the PACU or, you
know, in the back of anambulance and all it takes is
kind of software development.
So it seemed like there was alot of potential there to solve
those issues.
And, you know, back in thosedays there weren't really any VR
(07:09):
headsets available for anaverage consumer.
So we just started building thesoftware, knowing that one day
someone would make the hardware,and we were doing that for many
years and then eventually, 2018, 2019, our headsets started to
become released and we startedto have customers.
And then 2020 is when theOculus Quest came out, which
really made it dramaticallyeasier for people to use VR, and
(07:31):
that's things kind of took offfrom there.
And you know, I do think when wetalk about the benefits of VR,
that is really where a lot ofthe power is the fact that you
can pop up a high fidelity simexperience in any empty space in
less than five minutes.
Right, and there's obviouslypros and cons.
You're not going to get thetactile element with VR that you
(07:53):
get with traditional simulationtraining, but you are getting a
lot of great psychosocialcomplexity.
You are getting a lot of greatenvironmental complexity.
The visible physiology that youcan portray on a patient is
really flexible and awesome.
And, again, many of ourcustomers have gone from simming
once a quarter to three or fourtimes a week because it's
(08:13):
something that they can justpull out back to the classroom,
pop up their sim center and go,and so that that's our hope is
that what vr lets you do is simmore realistically and sim way,
way, way more frequently, andtherefore we can, you know,
improve the quality of the carethat we provide and save more
lives.
Deb Tauber (08:31):
Absolutely, and we know repetition right and I
think, especially with your, youknow people who are more
experienced to be able to use it.
And you know we talked a littlebit before the podcast about
the myth of the nausea.
Why don't you talk a little bitabout?
You know, repeat that to ourlisteners.
Dr. Ryan Riberia (08:50):
Sure, yeah, yeah, V VR as as come a long
way.
You know, in the very earlydays of VR technologies,
headsets weren't particularlypowerful, and so I think you had
a lot of challenges with framerates and refresh rates and
people were still learning howto use VR well and they were
using things like warping andusing joysticks to move around
(09:11):
the virtual world.
And all those things we nowknow cause nausea, right, and it
makes sense.
If there's a discrepancybetween what your eyes see and
what your body feels, that'swhat causes motion sickness.
And so if you're in a headsetand you're moving around and the
refresh rate is not good and so, like, what you see is delayed
compared to what your body feels, that makes you sick.
Now the newer headsets even I'dsay the last three years, but
(09:34):
you know they keep gettingbetter it lasts one year and the
headsets are so much morepowerful.
The frame rates, the refreshrates are much, much easier to
keep sufficiently high.
That you know you don't seethat disconnect between what you
see and what you feel.
And then you know some of it issoftware design too.
I think at SimX we don't reallyuse warping navigation, you just
(09:57):
if you want to walk to theother side of the room.
In VR, you just walk, and sothat maintains this.
You know synchronicity betweenwhat you see and what you feel,
and if you do all those things,it doesn't need to be nausea.
Actually, I don't think nauseaand VR are not inherent to each
other.
It really is.
It really is a matter of howyou design the software, and so
(10:17):
for us, we've had customers dospecific studies on user
acceptance and nausea with SimX,and one of them in particular I
think it was University ofNebraska who ran a study that
where they found only 4% oftheir students I believe it was
I'm quoting this off the top ofmy head, so there's little
discrepancies here 4% of theirstudents, I believe it was.
I'm putting this off the top ofmy head, so there's little
discrepancies here.
Forgive me, but it was lowsingle digits that experienced
(10:39):
meaningful nausea when they wereusing the product, and again, I
think that's attributable tothe more powerful headsets these
days and also careful softwaredesign.
Deb Tauber (10:48):
Excellent.
Now, how do you evaluate realworld impact of emerging
technologies like AI and VR inthe clinical setting?
Dr. Ryan Riberia (10:59):
Yeah, this is, I think, an exciting area where
there is a lot of opportunitythat is yet to be untapped.
Now there's tons of studies outthere on the efficacy of VR
medical training.
I think we recently did a litreview and there were over 4,000
studies in PubMed on XR inmedical training.
I think we recently did a litreview and there were over 4,000
studies in PubMed on XR inmedical training and the large
majority of them show verypositive impact, especially, you
(11:22):
know, even in head-to-heads,compared to other simulation
modalities.
Though usually those studiesare looking at, you know, things
like pre-post performance onyou know, structured exams, or
they're looking at individualuser evaluations of the efficacy
, or they're looking at learningretention or things like that.
Those are meaningful endpointsfor research, but they don't
(11:44):
really speak all the way toclinical performance.
Now, it is not a problem that'sparticular to VR.
I think all of us who are kindof in the education community
know that it is very hard to beable to demonstrate that an
educational initiativetranslates all the way to better
clinical care.
There's just so many thingsthat happen along the way.
(12:05):
But we are looking at a fewcollaborations that I think
could do it, and part of it isthat there's more sim being done
now in the in-practice space,you know, especially in nursing
when they're doing likecross-training, and there's more
large hospital systems that aredeveloping simulation programs
and so I think because of thatthere's opportunity to do stuff
like CAUTI, like you can saylet's do a simulation training
(12:30):
program and see if we can reducecatheter urinary tract
infections pre-post by trainingpeople through VR on the proper
insertion and cleaning andmaintenance mechanisms.
And you know that's an endpointthat hospitals care about.
That is real clinical practiceas meaningful patient safety
impact and where you can kind ofdo a pre-post analysis.
(12:52):
And so we're looking at thingslike that.
And so we're looking at thingslike that.
And then back to my roots withSIFSIS bundle compliance as well
.
Yeah, I think that's where theopportunity is is to do these
studies for in-practice nursingin hospital systems.
On those subjects where it is,hospitals are incentivized and
(13:12):
they also are meaningful from apatient safety perspective.
So I think there's a bigopportunity there.
I don't think there's a lot ofresearch out there yet, but
we're in the midst of finalizingsome partnerships to do that
type of research.
Deb Tauber (13:25):
You have come so far .
I remember meeting you atNASCIL when it was in Milwaukee
when it was in.
Milwaukee yeah, and it's justbeen really fun to watch how far
you've come and how many peoplehave adopted your work.
Dr. Ryan Riberia (13:44):
Believe it or not, we were already years in.
At that point there were fiveyears or so before that many of
which were just me and two otherpeople just working on it.
Deb Tauber (13:56):
And how many people are there now?
Dr. Ryan Riberia (13:59):
We're closing in on 100 employees actually.
So yeah, it's grown a lot.
Deb Tauber (14:03):
That is just great.
That's just fantastic.
What do you see in the future?
Dr. Ryan Riberia (14:09):
So, yeah, I mean, I think there's a lot of
opportunities in the future andthere's probably a few
categories that I would point to.
One is obviously AI.
I think AI is going to have abig impact on a lot of aspects
of education.
Ai is something that we've kindof cared a lot about, and from
the beginning, one of ourco-founders is an expert in AI
(14:33):
actually, and we've got a numberof other team members that have
really true exceptionalexpertise in this space.
And I think with the advent ofLLMs and you know, I think with
the advent of LLMs, there is thekind of obvious low hanging
fruit of being able to haveconversations with virtual
patients.
You know, the LLMs just makethat way way better, and
(14:53):
definitely that's something thatwe are in the process of
integrating, but there'sactually more opportunity there
too.
So, simx, we build our platformin a very.
The platform is very structuredin such a way that environments
and patients and tools can kindof be intermixed, and so that
lends itself to a world whereyou know, if you've ever used
(15:15):
generative AI to make a photo ora video or something you know
you can type in a paragraphformat hey, can you make me a
picture of a cute cat wearing abirthday hat or something, and
it will put that together.
Now imagine a world where youcould type in and say, hey, make
me a virtual reality medicaltraining scenario suitable for
second year nursing studentsthat teaches them the importance
(15:37):
of five rights of medicationadministration five rights of
medication administration and itgenerates that you put on a
headset and then you can run it,and that is.
That might sound very sci fi,but it is actually very
achievable with LLM technologyand with a platform like ours,
where everything is kind ofcarefully segmented because it's
(15:58):
really just piecing thosecomponents together, live, and
so it's really just a matter oftraining the AI agent and how to
put that together.
So that is something that Ithink is definitely coming down
the pipeline and is going to bevery exciting.
I think mixed reality is anothercategory that is quite exciting
.
If you've seen some of thenewer headsets from Apple or
(16:19):
even from Oculus or HTC, they'reall really making a big push
towards mixed reality, where thereal world and the virtual
world are kind of intertwined,and I think there's a big
opportunity there for us to kindof get the best of both worlds
right.
You can imagine a really highfidelity task trainer that has a
virtual patient projected overit and so you can have the
(16:40):
conversation with them, that canbe rolling around in pain and
you can have that kind ofpsychosocial and environmental
complexity from the virtualcomponent.
But then you can still use thetask trainer to get really high
tactile fidelity.
And that is, I think, in someways probably going to be the
gold standard of training andthere's going to be a big
opportunity there as the mixedreality headsets start coming
(17:04):
out.
We expect them from Oculus thisyear and HTC probably shortly
after that.
So I think there's going to bea lot of opportunity there.
And then, finally, I would saysomething that excites me a lot
as an educator myself, is theopportunity that mixed reality
and VR give us for assessments.
(17:24):
Right, because you know rightnow, very often, if you're doing
traditional sim, you'restanding behind a one-way mirror
and you're kind of watching thestudents and you're furiously
writing down okay, they gavethis dose, they probably should
have given this dose, or maybethey should have asked this
first, and then you're doingyour debriefs and it's a lot of
cognitive load for you as aninstructor.
But VR already kind of takes alot of that away, because it can
(17:48):
tell here's the dose that theygave, here's how long it took
them to put the patient on themonitor.
All that's already pre-recorded.
But we can actually take that astep further.
In VR, we can tell where peopleare looking.
So you can imagine a worldwhere we say, hey, you were only
looking your patient in theeyes 41% of the time that you
were talking to them and youknow, average for your level of
training is 76%.
(18:09):
So maybe let's talk about thepersonal touch that you can add
to these encounters or the otherthing.
So there's just the sheeramount of information that we
have available in these virtualtrainings about what people are
actually doing, I think is stillmostly untapped.
So there's a lot of opportunitythere.
And the other thing is biometricsensing.
(18:29):
So you can already buy thirdparty biometric sensors and they
basically use minute changes in, like skin temperature and
sweat, to evaluate your levelsof physiologic stress.
And, as we all know, there'skind of a sweet spot in stress
for learning.
If you're not stressed enough,then obviously you're not being
pushed.
If you're too stressed, you'refreaking out, you're crying, you
(18:50):
don't, you're not going toremember anything from this sim,
and so you really got to keepyour students kind of like right
at the edge, but notoverwhelmed.
And so we have some customersalready that are using these
third party biometric sensors inconjunction with VR to kind of
like modify the scenario in realtime and really keep them in
that sweet spot.
But some of the headsetmanufacturers are looking to
(19:10):
build that into the headsets inthe coming years, and so you can
imagine a world where you'rerunning a sim and you have like
a running graph of theirphysiologic stress and whether
they're in the sweet spot or not, and you can either
intentionally or automaticallythrough the software make the
scenario harder or easier tokeep them in that sweet spot.
(19:32):
And that, I think, is reallyexciting, because when we talk
about the need to cross trainand quickly train up nurses and
things, how do you quickly trainsomeone up?
You do it by making sure everysingle minute of sim counts
right, that they are always inthat sweet spot.
They're always being pushedright to the edge.
I mean, that's how they trainOlympic athletes, right.
They're always staying in theirsweet spot, and so I think the
(19:55):
prospect of being able to dothat with medical training is
really, really exciting.
Deb Tauber (20:01):
Yeah, yeah, I love that.
Wow, very, very fascinating.
Dr. Ryan Riberia (20:06):
We've really come a long way in the last five
years, but really on theprecipice of a lot of exciting
changes, I think, in medicaleducation.
Deb Tauber (20:14):
Now, how do you stay grounded with everything that
you do between you know, an ERphysician, a CEO, a dad?
How do you hold it all together?
Dr. Ryan Riberia (20:24):
an ER physician, a CEO, a dad how do
you hold it all together?
Yeah, that's a good question.
I mean I would say these thingsaren't completely disparate,
like there's definitely a lot ofsynergy here, right?
When I go on clinical shifts, Iget new ideas for things that
we should build in SimEx, and orwhen I'm training residents you
know, and I still dotraditional sim with residents
(20:45):
all the time it gives me newideas for how we can make it
easier for our instructors.
And when we're doing things inSimX, sometimes I myself get in
headsets and run cases and Ibuild up my own skills along the
way, as we're kind of gettingthings ready to ship, and so
they're really very synergisticand I think that is key.
(21:08):
If I was doing things that arecompletely unrelated, it'd be
quite a bit more overwhelming,but you mentioned a couple of
things there.
Obviously, if your life is allwork in one form or another,
even if it's fun work, that's alittle too much.
I've got four kids and theyjust keep me grounded every time
I interact with them.
Right, the age is 16, all theway down to five, and so we
(21:30):
really got the spread and goingto all the tennis matches and
piano recitals and everythingthat comes with those age groups
is a ton of fun.
We live out here, right next tothe Santa Cruz mountains
actually too, and so I've takena mountain biking recently,
which maybe it doesn't soundthat relaxing to some people,
but it is very relaxing actually.
(21:51):
You get out into the woods andwe've got a lot of beautiful
redwoods out here.
Spend some time in nature, Ithink that's really key.
And then I've also I've takenup meditation over the last
several years, which has beenreally helpful.
You know, even just a fewminutes a day, I think, of that
kind of centering and being inthe moment has been really key
for me when things are goingcrazy, wow.
Deb Tauber (22:14):
What do your kids think about all this virtual
reality?
Dr. Ryan Riberia (22:18):
They think it's pretty cool.
I would say they thought it waspretty cool.
It's kind of old hat for them.
Now we have videos of them, youknow, 10 years ago not quite 10
years ago, maybe eight yearsago wearing like the backpack
computers and like the big oldheadsets, when they were very
young and so they were exposedto VR before most people even
knew it was a thing.
And you know, we've always hadprobably a minimum of 10 VR
(22:42):
headsets around the house forone reason or another.
So I think I think my son forhis eighth or ninth birthday.
So again, this was very earlyin the VR world.
We had a Minecraft themedbirthday party and we brought a
bunch of VR headsets and all thekids did VR Minecraft together
and blew their nine year oldminds.
So oh my gosh side benefits, Iguess, of having a dad who's in
(23:07):
the VR industry.
Deb Tauber (23:08):
Yeah, I do a little bit with my grandsons.
I play a little bit of VR games, some kind of squirrel game
where you catch it.
Dr. Ryan Riberia (23:14):
Oh yeah, akron , we play that one at home all
the time.
That's my five-year-old'sfavorite.
He loves to be the tree andthrow the acorn at people.
Deb Tauber (23:22):
Yep, yep, yeah.
Now, do you have any finalwords that you'd like to leave
our listeners with today?
Dr. Ryan Riberia (23:29):
Yeah, you know , I think we've talked about a
lot of different things.
For me, and probably for mostof us, what it really does come
down to is patient safety.
So I think you're kind of righton the nose asking, like, how
do we make sure this translatesinto a clinical setting?
And you know, you asked alittle bit about what prompted
me to go into this space and Ishared a couple of those
experiences.
There was another experience Ithink that is was a part of what
(23:54):
pushed me over the edge, andthat was, you know, when you're
going through medical school,they teach you things, and they
teach you a little bit about thehistory too, and like all the
things we did wrong in the pastand everything from bloodletting
and things to like Tuskegeeexperiments, and you know that
all the mistakes that themedicine has made along the way,
and they also tell you.
(24:16):
Fortunately, a certainpercentage of the things that
we're teaching you now are alsogoing to turn out to be wrong.
And the problem is we don'tknow which parts right, like
what are the things thatgenerations from now they'll
look back and say I can'tbelieve that they did that, Like
that was nuts.
And as I was going throughtraining.
(24:38):
It struck me that obviously wedon't know what the future will
hold, but certainly it'splausible that what that thing
will be for us is the fact thatwe practiced on real people like
that.
We, you basically go and youlisten to a bunch of lectures
and you maybe do like one or twosim cases and then you just go
(24:58):
out and start working withpatients and you know of course
we do do a lot in in health careto try to make that a safe
transition, but still, you know,at some point you're sticking
needles in people with verylittle experience and you're
cutting on people with verylittle experience.
And you know there's that wholesaying see one, do one, teach
(25:18):
one in healthcare, which youknow you kind of got to do out
of necessity.
But is that really the best wayto do it?
If we had other options itwould not be, and I think as SIM
becomes more realistic and moreaccessible, it doesn't have to
be that way.
Right, like this is perhaps, inmy view, the key to changing
(25:38):
that, so that it's not see one,do one, teach one.
It's, you know, see one, SIM ahundred, then do one right and
then teach.
And I think that really is thefuture and I do think people
will look back on us and say,like that was so barbaric that
they just send you out into theworld without putting you in a
(26:00):
headset and having you do 100first.
So hopefully we can be part ofcreating that better future for
our healthcare system and forour patients.
Deb Tauber (26:08):
That better future for our healthcare system and
for our patients.
I love that.
That is amazing.
Now do you guys use theheadsets for hiring decisions?
Dr. Ryan Riberia (26:16):
Oh, put people into VR interviews.
Yeah, you know we haven't yet,but that would be interesting.
Pop people in a headset andkind of see their decision
making process along the way.
We have had some peopleapproach us though about vr for
motivational interviewing or forde-escalation, like for front
(26:38):
desk staff in an er and havingto do de-escalations and things.
So it's, it can be used forthat kind of stuff.
But we have we haven't used itat simx for that purpose not yet
not yet yeah right, I thinkthat's.
Deb Tauber (26:52):
And if our listeners want to get a hold of you, what
, uh?
How can they do that?
Dr. Ryan Riberia (26:57):
you know simxvrcom.
They can head there.
They could probably message methrough Linkedin too, and it's
probably the best way to get ahold of me.
But yeah, either of thosesources and I'm happy to connect
.
Deb Tauber (27:09):
And I thank you so much for taking your time today
and meeting with me, andfortunately, Jerrod couldn't be
here today.
He's going to be disappointed.
He missed such an interestingconversation.
Thank you for everything thatyou've done.
It's just an honor to get tospeak with you today.
Dr. Ryan Riberia (27:28):
Yeah, no, thanks so much for having me.
It's been a great conversationand it's been great.
Deb Tauber (27:32):
Thank you and happy simulating.
Disclaimer/ Innovative S (27:42):
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 likeand subscribe button so you
never miss an episode.
Innovative Sim Solutions isyour one-stop shop for your
(28:03):
simulation needs A turnkeysolution.
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