July 21, 2023 • 43 mins
Join me this week for a conversation with Dr. Tara Lemoine. Dr. Lemoine is the Executive Director of the Center for Healthcare Improvement and Patient Simulation (CHIPS) at the University of Tennessee Health Science Center. Dr. Lemoine and I discuss the various simulation methods and designs. We also discuss the importance of simulation with the interprofessional team to improve outcomes for our patients. Dr. Lemoine brings an exciting perspective and a wealth of experience and knowledge to CHIPS and the UTHSC campus.
https://uthsc.edu/simulation/staff.php
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(00:00):
Welcome to That's Healthful, a podcastabout health and advocacy with a special focus
on rural and vulnerable populations. Nowhere's your host, family nurse practitioner and
health advocate, doctor Lisa Beasley.Hello. I'm Lisa Beasley, and this
is That's Helpful today. My guestis doctor Tara Lemoyne. She's the executive
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director of the Center for Healthcare Improvementand Patient Simulation or CHIPS, which you
will be hearing us referred to thiscenter as doctor Lemoine. Welcome. Thank
you Lisa for having me. I'mexcited to be here today. I'm very
happy to have you here today forthis discussion. We're going to be talking
about simulation, just for those ofyou listening to warm me up a bit.
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But before we get started, Iwould like for doctor Lemoinne to please
tell us a little bit about yourself. Yes, Lisa, well, I,
as you stated, I am thecurrent medical and executive director for the
Center for Healthcare Improvement and Patient Simulationhere on the campus of UTHSC. My
clinical background is in pediatric critical caremedicine. I was trained as a pediatrician
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and then as a critical care specialistand then subsequently received an additional fellowship training
in simulation medicine. I've spent thelast almost twenty years of my life inside
of a ICU taking care of criticallyill and injured children, and then the
last fifteen years of my life buildingsimulation inside of healthcare facilities before onboarding to
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the UTHSC system. As healthcare professionals, we're fairly familiar with simulation. But
I don't know that healthcare professionals areas familiar with simulation as they think they
are. I don't think that weunderstand the vastness of simulation, and a
lot of providers today that were trainedand educated early on, they didn't have
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a lot of simulation. And Iwant you to expand on that and tell
us what is healthcare simulation? Well, I think you're a correct Lisa.
Even in my era, simulation wasn'tas prominent as it is today, And
certainly depending on where you trained inthe health professions career path back in the
late nineties in the early two thousands, really decided on whether you were influenced
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by simulation in your career or not. I will say that simulation simply is
the recreation of real life events sothat we have the opportunity to practice and
train in an environment where we canlearn to be safe for our patients.
Simulation could be basic skills training thatwe're learning to put an IV in a
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mannequin, so that we have aprocedural skill set that we're acquiring. So
that's starting an IV, intubating apatient, putting in a Foley catheter,
and in G tube practicing CPR.Those are the very basic struts of simulation.
It can be as advanced as goingthrough a cardiac arrest situation with our
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interprofessional team of nursing, medicine pharmacy. It can be identifying a room full
of errors so that we anchor downinto what our patient safety mechanisms need to
look like. Simulation can take placemuch like it does at the Center for
Healthcare Improvement and Patient Simulation on theUTSC campus and a very lab situation setting
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separate from a healthcare institution or Simulationcan take place in the language that we
use as in situ actually inside ofa healthcare facility, an operating room,
a acute care patient clinic. Itcan be in an emergency department. It
could be on the street with adeployment of EMS and firefighters moving senter a
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simulated patient into an er setting,all the way up to an operating room
and backdown. There's also simulation thatis done that's really focused on communication.
We do that with standardized patients orpaid actors who are coached into a series
of history and physical series of complaints. The ability to teach people how to
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be empathetic, how to be greatcommunicators, no matter what their healthcare profession
background is medicine, nursing, pharmacy, ptot. It really is the ability
to practice, hone your skill andmove away from what I think the old
era was, which was c one, do one, teach one. Now
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we have the opportunity to scale back, slow down, understand with faculty and
people who are area experts in ourfield to show us how we should be
doing something on or with our patients. I would say simulation really has its
roots in the field of nursing.If you look all the way back to
the early nineteen hundreds, there areimages of mannequins that were essentially straw mannequins
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that were built had clothing placed onthem, and that's how some of the
nursing community of healthcare provider started withsome of their skills that if you fast
forward to today, it's a muchmore technologically advanced I would say the biggest
imprint of simulation started in the latenineteen nineties with a book that was published
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called to Er as Human and thatreally looked at what does the healthcare system
need in order to provide safe patientcare. I think it was our first
really transparent open awareness that some ofthe patient harm that was happening inside of
our medical healthcare systems was due tocommunication errors, the lack of streamlined processes,
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etc. And out of that reallybore this idea of simulation medicine hyper
focused on crisis resource management, situationalawareness of what was happening, and most
importantly, really communication that happens betweenthe entire healthcare team, because no one
of us is more important than theother. We may have different roles in
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different responsibilities, but as we marchforward in healthcare, whether we're in a
clinic, an operating room, anemergency department, an ICU, everything that
we do involves a large team ofpeople that are touching this patient or interfacing
with this patient in different ways,and those breakdowns and communication and mutual respect
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is where patient harm occurs, andsimulation is there to mitigate that, not
only to make you technically good atwhat you do before you interface with a
patient, but to bring up yournon technical skill set of communication, mutual
respect, and how to work asa team to keep our patients safe and
care for appropriately. You mentioned somethingthat made me think about when amputations occur
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and from the beginning of the patientsin their room at the hospital and you
as that point of cares the nurse, You're communicating no, it's the right
leg, yes? Or which legis it that you're having amputated, and
it just keeps getting carried on.And the reason that that was occurring is
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because there were wrong limbs being removed. So that communication piece among the healthcare
the whole team is extremely important andgetting that education early and getting that education
while you can still practice. AndI would look at it as rehearsal for
the performance. And I don't meanto minimize it, but that's how I
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kind of look at it. Thisis where you get a chance to mess
up because the performance. No,you need to be spot on. I
mean everybody does make mistakes, butyou need to be spot on with the
performance. Yeah, that's correct.I think when we look at simulation and
we take our nod from aeronautics andaviation, that's really where this came from.
There is high risk every time somebodygets in a plane or every time
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astronaut was going to board a spaceshuttle. So's that industry very early on,
prior to the healthcare sector adopting simulationnew we have got to have a
streamline set of processes where we getit right. We have a checklist system
in place that we deploy every timewe do something so that there is this
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cockpit mentality. Everybody's on the samepage. We're listening for those verbal cues
of our step by step process becauseit opens up the door for anyone to
say time that process isn't going theway that it's supposed to. Is very
transparent. So we took what aviationand aeronautics was doing, which had created
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a very high safety profile for ahigh risk industry, and overlaid it into
the healthcare sector. So it tookit away from each individual to decide how
am I going to do X,Y or Z, and said, this
system has these guardrails around it sothat we approach each individual with the basic
set of constructs to keep them safe. There's always the art of healthcare,
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the art of medicine that comes intothat, but the things that keep every
single human being safe are really rootedin how aviation and aeronautics changed a safety
profile and gave us an opportunity toreplicate that. And when you mentioned these
never ever events right, this wrongleg amputation, those things were happening because
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of a Swiss cheese model effect wherea series of things could potentially go wrong
that led to a catastrophic event ora catastrophic injury. And I think what
we have all looked back and reflectedon and healthcare in general, is there
were opportunities for us to have peoplespeak up to change that, but we
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hadn't enculturated in people into this ideaquite yet that although we have different roles,
we are all on the equal playingfield of the opportunity to step up
and stand for patient safety. AndI think that's what we coach to or
teach to in the simulation space herecertainly is yes, you have to be
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technically good at what you do,you have to have the skill set and
understand your equipment, but you alsohave to have the ability to communicate effectively
and respectfully to all of the peoplethat are part of that care team for
that patient. So tell us aboutthe Center for Healthcare Improvement and Patient Simulation,
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or CHIPS as we've been referring toit as the Center for Healthcare Improvement
and Patient Simulation on the UTHSSE campus. Is one of the largest simulation centers,
certainly in the South, the biggestone in the mid South, and
there is nothing like it in thestate of Tennessee. We rival some of
the largest healthcare center simulation spaces inthe country. It was built in two
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thousand and eighteen and has been inoperation for the last five years. We
provide simulation base collaborative services with allof our healthcare profession programs on the campus
of UTHSC and some of the externalpartners here within the Memphis community. It
was borne out of this idea thatalthough there was simulation happening years ago within
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the College of Nursing and within theCollege of Medicine, to unifocalize that experience,
for the lack of better word,and have a central place where people
could come and work through simulation basedexercises, either in silo, which is
important at certain phases in people's healthcareeducation or as an inner professional team,
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which we are in our real experienceson a day to day basis. We
provide procedural based simulation that things wetalked about at the beginning of this in
terms of being able to put inan IV, a central line, an
airway, etc. All the waythrough immersive experiences where we use high fidelity
mannequins that have the capacity to blink, talk through these mannequins, they have
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the ability to be intubated. Wecan do almost any procedure that you do
with a real human being on thesemannequins. A fleet of from premature infants
all the way to a geriatric agemannequin that we have for our learners to
interface with mannequins that can go throughthe full birthing process. As we train
people in obstruct trics and gynecology forlabor and delivery services, whether that's in
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our nurse midwiffery program or that's withinthe College of Medicine, Obeguide residency,
etc. We also provide standardized patientlevel work, which is the capacity to
be able to start that interface withpatients, how to communicate effectively, how
to show empathy, how to deliverbad news, all of the things that
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make us healthcare providers, and everysingle healthcare professions on the campus of UTSC
collaborates within our program and utilizes ourservices across that entire spectrum. We do
somewhere north of about thirty five thousandlearner hours a year of simulation based activity,
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all the way from the procedural tostandardized patient to the hybrid simulation that
we talk about with mannequin based technology. So you made me think about during
the pandemic, and I think healthcareproviders and healthcare education is the educators are
so creative. So during the pandemic, a lot of shift was focused to
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telehealth. I know that we innursing did a lot of telehealth. We
had to have a quick or rapidresponse to what was occurring out in the
real world. You want to talkabout that a little absolutely, And I
think one of the things that wewill find with simulationists across the country,
and simulationists are really defined as anyonewho is developing or executing simulation based exercises.
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You can be a PhD faculty,you can have a master degree in
healthcare education, you can be aperson who has been an EMS or a
paramedic background. Anyone who is engagedin delivering simulation activities is considered a simulationist.
Those individuals are very flexible, innovativepeople that can pivot on a dom
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and make something happen. The individualswithin this building, the simulationists that are
the employees within CHIPS, were ableto take what was typically an in person
only done physically format and quickly turnthat into a virtual experience for people so
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that they were still able to getthe education that they needed. But we're
doing it in a melieu that notonly developed a skill set that they had
to have, but also that additionallayer of Yes, as healthcare providers now
we do tell a health work,so you have to be technologically savvy and
trained at on both realms of howdo you interface within the technological limitations or
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adaptations that we have to have tobe healthcare providers, as well as the
core stuff that they needed for communication, being able to obtain a history and
physical with standardized patients. None ofthat ever stops. So I think this
building and some of the work theydid inside of the pandemic shows the creativity
of simulation and the growth and changeof simulation that it will continue to happen
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over time because there are ongoing demandsof how we deliver education, how fast
I will need to be, howquickly things change, how quickly technology adapts
as well well. On CHIPS isa pretty impressive building. And it's not
just the building, it's the peoplewithin the building, and it's all the
different areas of simulation or different disciplinesthat can use CHIPS. And I know
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you've touched on it. If youwant to elaborate further on how CHIPS is
used to teach students and talked aboutwhy it's important, but if you have
any further thoughts on that, pleasego ahead and elaborate on that. Yeah.
Absolutely so. I think with whenwe talk about the technical skill,
the procedural piece of it, wehave things that are just task trainers.
So if you're learning to place anIV, you literally are looking at what
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is a replica of a human being'sarm. There's the capacity to learn how
to clean an arm in order tostart an IV, how to hold your
pieces of equipment. When you goin to be a start that IV,
you get an immediate flash of blood, just like if you were putting it
in a real life patient. Youhave hands on instruction on how to secure
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that IV, how to tape thatIV, the dressings that go on that
IV, and a very similar experiencethat happens if you're learning to put in
a central line in our arterial line. There are task trainers that are done
and design that look and feel asmuch like a human being as humanly possible.
There's also the piece that goes withit of you know, even the
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beds that we have our replicas,real life replicas of either a patient journey
or a true patient bed when we'reworking with our physical therapist or occupational therapist.
Even being in that space that lookslike a clinical bedspace with the equipment,
learning how to reposition a patient,how to move a patient off of
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a bed to prevent falls, understandingwhy we do certain things within a patient's
bed to prevent pressure ulcers, orall of the other pieces that get overlaid
into our healthcare that aren't done inisolation. They're done for a reason so
people have that real experience to gothrough those movements before they move out into
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their experience. There's the upper levelpiece of it, where you're interfacing with
that mannequin where you have to walkin, you have to acknowledge that there
is a patient monitor there. Youhave to pull from your didactic education some
of those critical thinking skills and thenhave to act on those critical thinking skills.
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It's not just seeing it, butit's seeing and then what do we
do next? And having these highfidelity mannequins that can be anywhere from sixty
to three hundred thousand dollars each onethat we purchase, having to go through
the step by step process of criticalthinking, intervention communication for whatever scenario has
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been built by the faculty or educationalistthat works within CHIPS, sort of merging
the flat work that we do aswe learn our trade and then actually implementing
what that looks like. And simulationcan be so real. And I recall
showing instructing in a skills lab anddemonstrating how to start an IV, and
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all the students were kind of gatheredaround and you stick the the IV the
needle in, you get that flashbackof blood and I hear a plot behind
me, and one of the studentshad passed out because it appeared so real
for her that I was actually startingan IV. A person's arm or in
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their vein, in their arm andshe fainted. Yeah, it can just
be so real on that. I'llnever forget that story. There is great
evidence based research and literature that supportsthe feelings that you feel in a simulation
based experience or exactly what happens inthe real world. They've gone down to
do the biometrics of that and measuredcortisol levels out of people's saliva who are
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in an experience that simulation based andthey have the same stress markers as if
they were experiencing a real life event. And I think simulation also does that
in terms of it builds some ofthe resiliency. You essentially are able to
see the things or experience the thingsthat you're going to see in the real
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world, and it allows you towork through some of those emotions, some
of those stressors in that space beforeyou actually are doing it in real life
or where you're maybe you're on clinicaland your back here and you're doing it
as an adjunct. That help adds, that helps add to the entire experience
as we become healthcare providers. Socan you talk about the steps of a
simulation. There's the prebrief, youknow, the actual simulation, and then
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what are the actual steps of asimulation. The CHIP Center is an accredited
program for the Society of Simulation andHealthcare, so we hold that designation much
just like the College of Nursing inthe College of Medicine and graduate medical education
programs do they have the seal ofaccreditation that says you are the gold standard.
You meet the requirements in order toprovide healthcare profession education on your campus.
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Simulation has a mirror image of that. When we are an accredited center.
There is a set of best practicesand standards that have evolved over time
and simulation that probably weren't there fifteenyears ago, but now we're anchoring and
tethering down into those that set thegold standard of how you set up a
simulation in terms of making sure thatthe learner cohort group understands the reasoning behind
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the simulation, that we enter intosome of these contractual things mentally of suspending
disbelief, understanding that this is apsychologically safe place for you to practice,
that this is a confidential experience,especially when we have learners who have their
faculty that are standing there as anovice healthcare provider you have the sense of
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worry or consternation that somebody is judgingyou where they're looking at what you're doing
in simulation and making some assessment thatyou're not going to be able to do
that necessarily in real life. Sowe establish the boundaries of simulation about what
we're going to do, and that'swhat we talk about when we say prebrief
essentially, and then we go throughthe process of actually doing the simulation,
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whether that's in silo with just ourown cohort group with our healthcare profession or
that's interprofessional in nature. We movethrough the simulation and then we get to
what really is the meat of simulation, and that is debriefing it. It
is sitting down or standing back andhaving an open, transparent dialogue to try
to peel back and to dig intowhy were we making the decisions that we
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made, What potential impacts does thathave on our patient? Are there other
things that we should have done orcould have done to get to the root
of how we're thinking and moving ashealthcare providers, so that you walk away
from the simulation experience one have learningsomething. There's none of us who no
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matter where you are in your careertrajectory. We're always going to learn something
in that experience in the simulation environment, but also how are we going to
change our behaviors that may positively impactour patients. There are high stake simulation
experiences you have alluded to in thepast, when people come in and they
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interface with standardized patients. Sometimes thatis actually an exam. It is as
equal to taking a test that youhave to pass in order to matriculate further
into your program. We're just doingit with a patient interface. So there
are places where simulation you may makea mistake, and that mistake could potentially
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mean that you don't matriculate forward.But that's really a safety net to make
sure we are producing healthcare professionals thatare going to meet the standard of safety,
education, and care moving forward inour space. There's always the opportunity
to duplicate that experience to get anotherattempt to come back so that we are
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able to make sure that everyone isable to matriculate in the program. But
there's low stakes work or formative workwhere're really just helping people educate in a
different experiential learning milieu, which issimulation, and then the high stakes summitive
work where you've got to show competencyin this in order to move forward in
your education. It's important to getthem to think about this is a this
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is greater than you. It's there'sa bigger picture out there, and we're
responsible to the public, or elsewe would not have a license. What
are some simulation modalities and technologies thatare being used today? Right you hear
me talk about how the root ofsimulation started with a straw mannequin and the
nursing realm pushed forward to today andyou have mannequins that literally are animatronic so
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that they can cry salty tears,they can bleed from their finger, they
can turn and look at you,they can have facial expressions, they are
as fidel as Shining a light intheir eyes will change their pupillary response.
A mannequin that we have that canfully birth a human being, a baby
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mannequin. The place we say wheremannequins come to have baby mannequins. All
of that technology currently exists within thisbuilding, and you can even take it
a step further where there is moreand more utilization of virtual reality, the
ability to see things in almost thisfour dimensional space, not to just see
a flat heart on a drawn Netterdiagram, but actually to stand physically inside
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of a heart in virtual reality,to be able to turn around and look
at all of the vessels that comefrom the heart. Same thing with the
brain. There's virtual reality that allowsus to be interfacing with a patient where
we're walking essentially into a room,making clinical decisions from the information we see
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in that virtual reality space, havingan algorithm that we have to follow,
having not just us in that virtualreality space, but having multiple people in
that virtual reality space. So you'redoing it in an inner professional way,
in a format that you could doover and over and over again, whether
you're at a simulation lab, whetheryou're at your house in your study.
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All of that technology is growing andadvancing. We have mannequins now that in
my era, if you wanted tohear an abnormal heart rhythm, you literally
had to wait until that abnormal heartrhythm showed up in your physical world of
seeing patients do that anymore. Nowwe have the capacity for people to hear
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normal and abnormal start that imprint anddownload in their brain of knowing this is
what I should be hearing, andwhen I hear something different here the potential
things that are out there, sothat you're already cued. It's not the
late game that probably you and Itrained in and a lot of the healthcare
providers that are coming out of theirera in the late nineties and early two
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thousands. So we have the technologythat continues to change over time, and
every year there is something new thatis moving the needle of how sophisticated our
simulation experience is. It's amazing.And when you were speaking, it was
reminding me of this latest conversation ofAI. And I don't know with folks
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out there and know this, butwith some of the healthcare AI, these
types of modalities, some of themget smarter and smarter with the interaction that
they have with the person that's usingthem, and it's great in so many
ways, and then other ways,to me, it's just a little it's
a little scary. Yeah. Ithink our in healthcare is going to be,
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especially at the educational level, isgoing to be to adapt to some
of those technological demands that are outthere and to teach our learners how to
navigate through that. You look atthe College of Nursing and some of the
ACN requirements that are going to comeup competency by a design, and we
have to acknowledge the way that weused to train people isn't going to be
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good enough. Even in the simulationprogressive world. We're going to have to
figure out other innovative ways to assesspeople, to fast track their learning,
to imprint on them early, tomove out of what is really a flat
diadactic into the experiential phase in differentways, to get our learners to where
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we need them to be, toresolve our healthcare shortage that's happening, to
make a competent and confident provider becauseyou know, our society demands it,
and we have healthcare shortages across theboard that are happening not only in the
state of Tennessee, within the college, you know, within nursing, but
everywhere. So simulation gives us anopportunity to harness technology to create a better
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provider, to create a VET orprovider faster, to create a well rounded,
resilient provider so that we don't faceattrition, so that they don't become
frustrated with technology as it changes.There's a lot of opportunities in simulation to
move things forward in ways that rightnow we don't currently do in chips,
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and certainly because of how fast technologyprogresses, in five years will look totally
different. What are some of thedisciplines that use simulation, either on our
campus or across the country. Ithink if you look at all of the
healthcare professions and you start to diginto what accreditation demands each healthcare profession has,
you will find an imprint of simulationsomewhere. We have a footprint in
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all of our colleges. Across campus. We have the dentistry program that comes
here, and for example, theyhave to be able as dentists to take
a blood pressure, have an interventionalplan if somebody has an elevated blood pressure,
to acknowledge when somebody with an elevatedblood pressure could not go under a
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local anesthetic or a procedure because ofthat underlying number. So even dentistry is
in our building using standardized patients andinterfacing with people and procuring information at the
communication stage of things. Our pharmacists, certainly whose scope of practice has expanded
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over the last five to seven years, are constantly within our space collaborating with
us, from taking blood pressures tocommunication to hybrid simulations or high fidelity simulations.
As you know ACLS providers, certainlythe College of Medicine, the College
of Nursing both at the accelerated andtraditional programs for BSN, the Doctorate of
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Nurse Practitioner programs, our CRNA programsthere ptot. Everyone that interfaces on this
campus has a touch point within ourbuilding, and I would say for simulation
that is mirrored across the country fromcoast to coast. If you are a
health care provider in an undergraduate orgraduate education experience, you are using simulation
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as part of your experiential learning,moved out of flat diadactics, moved out
of the classroom into a hands onthree dimensional learning opportunity. For you give
us some examples of interprofessional healthcare simulations. Interprofessional simulations has a large spectrum that
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we see summit chips and certainly acrossthe country and simulation centers. So for
example, currently on our radar iswe have College of Medicine Fourth Theore medical
students and College of Pharmacy Fourth Theoremedical students who need to be able to
do the hands on the physical workof running a cardiac arrest. So a
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good example of interprofessional simulation. Ina real world, there are not six
medical students or six physicians are goingthrough a cardiac arrest without nursing and pharmacy
and medicine and the other individuals onthat team that are providing care to that
patient. So in the simulation experience, you can join those two or three
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cohort groups together at the learner levelthat they're currently at to go through that
process of walking in a room,identifying that a patients under a cardiac arrest,
getting into your roles, maybe thephysician or the College of Medicine student
being as the team leader, thepharmacist getting to their code card, getting
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their drugs ready, the bedside nursewho's going to deliver those drugs. So
that is a really salient example ofinner professional simulations that are largely based on
the technical skills of leading the code, delivering medications, drawing up medications.
There's another deeper layer to that whenwe get a little bit further along into
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that experience, and that is howwe communicate how do we at the College
of medicine or medical student level acknowledgethat our partners in nursing have a very
specific, high end skill set todo the things that they need to do
to save that patient's life, justlike the pharmacist on our right hand side
carries a level of content expertise thatwe as physician providers or young physician learners
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do not have that we have torely on to take care of a patient.
Well, are there opportunities for otheragencies outside the UT system to partner
with CHIPS to provide some of thesesimulation experiences to say people who are already
physicians and nurses and nurse practitioners andrespiratory therapists and so on. I certainly
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think so, And in fact,when this building was imagined, there was
the design of this building, inthe design of this space to think about.
We have multiple healthcare institutions that liearound us, and the ultimate goal
is not just to provide simulation basededucation for our undergraduate learners, for our
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people in the College of Medicine andthe College of Nursing, but also to
people who are already in a postlicensure phase to use this facility as a
place where they do enter professional trainingand education that is simulation focused. Is
they're always going to be the needfor those individuals to become technically sophisticated in
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terms of putting in an ivy orputting in an artline or a central line
or an airway. Probably not.They probably already have that technical skill set
that they've honed as licensed providers.But what we do have here and what
the opportunity is really is start todeveloping the communication and the team work and
sort of that formula one team forpeople inside of this space, because in
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our real day to day environment,because healthcare is moving so quickly and there's
so many demands, it's really hardto slow down in that real clinical space
and think about how do we communicate, how do we lead, where are
our pressure points, how do wesort of round out our teams as interprofessional
providers. And this is a spacewhere that can certainly be done, whether
(35:16):
that's in an operating room, becausewe have that facility within our space that
looks like a real operating room,whether that's in our L and D suite,
whether that's in our one of ouracute care er trauma patient room experiences.
I think that the long shot lookat this building was that people would
(35:36):
show up at all levels of educationand training, no matter where they were
in their licensure and use this spaceas the capacity to become better healthcare providers,
better healthcare teams, and certainly providesafer patient care to the people that
we serve here in the community.It's certainly impressive, as I mentioned before,
(35:58):
very impressive. Earlier, when youtalked about debriefing after a simulation being,
I think you said something like theheart of it or the meat of
it, or I can't remember theterm that you used. I would like
to see a lot more real lifedebriefing, even though it was a maybe
something that occurred in whatever setting,and acute care setting, a clinic space
(36:20):
or whatever. I would like tosee a lot more real life debriefing.
What's out there on that being discussednow? I think it depends on where
you're working, what facility you're in. I certainly came from a facility where
debriefing either hot debriefing so right aftersomething had happened in the moment, or
cold debriefing when people needed to takethat time in space to separate from it
(36:42):
could be emotionally charged, it couldbe something that people really needed to take
a step back and be able tosee with some great transparency. The cold
debriefing process certainly happens depending on whatinstitution you're in. I think one of
the things that comes out of simulationin you are trained to debrief or when
you see this debriefing process as eithera young learner or somebody in the post
(37:06):
licensure phase, the whole goal isthat maybe you will take that forward,
you will use that skill set that'sbeing emulated for you into your real life,
real world practice. Debriefing and theart of debriefing in the skill of
debriefing is a whole nother subset ofsimulation where you get additional training, you
have to have practice on it.Their psychological safety around how we do debriefing
(37:30):
in real events that may look differentthan simulated based events, but I really
think that the whole point of thatexercise is to show people how we communicate,
ways that we could do that betterand give them a part of a
tool set that they don't have beforewalking into the door. And part of
(37:50):
that debriefing process when you're looking atpeople in the post licensure phase who we're
working on a day to day basiswith each other, is really to get
to the root of how they movedtogether as a team, how to take
up their skill set of communication,another notch that they didn't have when they
walked through the door, to createsome empathy around the stressors that each individual
(38:13):
role may be feeling in the realworld experience that bubbles out to the surface
in the simulation experience. And Ican give you a real good example of
that. As an attending physician inan ICU, I had a lot of
expectations in terms of how long thingstook. It wasn't until I had people
(38:34):
at the level of nursing and pharmacywho could show me, yes, we
understand that you asked for epenefrin,but let me tell you what has to
happen in order to get epinefrin froma code cart out of a drawer into
a syringe. Right, there's allof these steps that have to happen in
the physician myopic brain of mind.At the time before I had a really
(38:57):
deep imprint of my colleagues who changesort of my outlook on how I practice
was that things were instantaneous. Theyare not, in fact instantaneous. And
more importantly, I don't have theskill set to do the things that those
individuals are doing that are part ofsaving the life or taking care of a
patient, and I think the simulationexperience in the debriefing process can pull that
(39:20):
out of people. We know thatyou want X, Y or Z.
Let me tell you the fifteen stepsit takes to get that. Why that
delay that you are becoming impatient overis happening because when you start to do
that work, you start to understandyour colleagues in medicine, nursing, pharmacy,
PTOT, what their additional demands areon them as providers, and how
(39:45):
you have to sort of march forwardknowing what that looks like. And it
wasn't probably until the five or sixyears into my career did I realize that
my team of people was as crucialas any other element that was happening in
that moment, and my sort ofhonoring and respecting what their skills had had
(40:06):
to be really changed how I approachedpatient care. And I think in that
debriefing process that's where some of thatcomes out, and it's really why we
should be doing in a professional simulationat the early stages of people's career.
It's fantastic to bring in people whoare in the post licensure phase and do
that level of work, But ifwe imprint early and people people who are
(40:30):
who are in the healthcare educational realm, the experiences the level of expertise that
each individual cohort group has. Ithink it changes the lens of how you
see the team of people that youinterface with, and that will always be
my passion. The ICU naturally breedsthat, but I think that if I
(40:52):
could give that one thing to everyhealthcare provider, it is that anchor of
every person here has their own levelof expertise. We should honor that,
respect that and interface with that individualand exactly that framework, and that way
we can take care of patients farbetter than if we develop some uneven hierarchical
(41:14):
model that creates communication barriers and gapsand how we take care of our patient.
I really appreciate you saying that,I really do, and this has
been such a great conversation. Doyou before we go, do you have
any last thoughts or last words ofwisdom you'd like to share with us today?
I think that parting words will bethe center for healthcare improvement and patient
(41:36):
Simulation has a tremendous capacity to changehealthcare, be innovative, and within its
walls contains some of the expertise insimulation that is unparalleled. I certainly look
forward to be able to do innovativeprojects with our colleges across campus, and
certainly with healthcare providers and some ofour clinical partnerships moving forward. Absolutely again,
(42:00):
my guest today has been doctor TeraLemoine, the executive director of the
Center for Healthcare Improvement and Patient Simulation. I really do appreciate your time today,
Thanks so much. Thank you.You've been listening to the That's Helpful
podcast with your host, doctor LisaBeasley, a family nurse practitioner and healthcare
advocate. Views expressed on this podcastor the views and opinions of the hosts
(42:24):
and guests and are not affiliated withany facility or institution that may have been
mentioned in this episode. That's Helpfuldot com. For more information or to
hear prior episodes, follow at NowHelpful on Twitter, and That's Helpful on
Facebook and Instagram. Like or commenton an episode wherever you listen or stream
(42:45):
your favorite podcasts. Music for thisepisode it's provided by local Memphisinger musician and
songwriter Devin Yennik. For more ofDevon's music, visit Devin Music Dot Weekly, dot com
Welcome to That's Healthful, a podcastabout health and advocacy with a special focus
on rural and vulnerable populations. Nowhere's your host, family nurse practitioner and
health advocate, doctor Lisa Beasley.Hello. I'm Lisa Beasley, and this
is That's Helpful today. My guestis doctor Tara Lemoyne. She's the executive
(00:21):
director of the Center for Healthcare Improvementand Patient Simulation or CHIPS, which you
will be hearing us referred to thiscenter as doctor Lemoine. Welcome. Thank
you Lisa for having me. I'mexcited to be here today. I'm very
happy to have you here today forthis discussion. We're going to be talking
about simulation, just for those ofyou listening to warm me up a bit.
(00:42):
But before we get started, Iwould like for doctor Lemoinne to please
tell us a little bit about yourself. Yes, Lisa, well, I,
as you stated, I am thecurrent medical and executive director for the
Center for Healthcare Improvement and Patient Simulationhere on the campus of UTHSC. My
clinical background is in pediatric critical caremedicine. I was trained as a pediatrician
(01:06):
and then as a critical care specialistand then subsequently received an additional fellowship training
in simulation medicine. I've spent thelast almost twenty years of my life inside
of a ICU taking care of criticallyill and injured children, and then the
last fifteen years of my life buildingsimulation inside of healthcare facilities before onboarding to
(01:29):
the UTHSC system. As healthcare professionals, we're fairly familiar with simulation. But
I don't know that healthcare professionals areas familiar with simulation as they think they
are. I don't think that weunderstand the vastness of simulation, and a
lot of providers today that were trainedand educated early on, they didn't have
(01:49):
a lot of simulation. And Iwant you to expand on that and tell
us what is healthcare simulation? Well, I think you're a correct Lisa.
Even in my era, simulation wasn'tas prominent as it is today, And
certainly depending on where you trained inthe health professions career path back in the
late nineties in the early two thousands, really decided on whether you were influenced
(02:14):
by simulation in your career or not. I will say that simulation simply is
the recreation of real life events sothat we have the opportunity to practice and
train in an environment where we canlearn to be safe for our patients.
Simulation could be basic skills training thatwe're learning to put an IV in a
(02:36):
mannequin, so that we have aprocedural skill set that we're acquiring. So
that's starting an IV, intubating apatient, putting in a Foley catheter,
and in G tube practicing CPR.Those are the very basic struts of simulation.
It can be as advanced as goingthrough a cardiac arrest situation with our
(02:59):
interprofessional team of nursing, medicine pharmacy. It can be identifying a room full
of errors so that we anchor downinto what our patient safety mechanisms need to
look like. Simulation can take placemuch like it does at the Center for
Healthcare Improvement and Patient Simulation on theUTSC campus and a very lab situation setting
(03:20):
separate from a healthcare institution or Simulationcan take place in the language that we
use as in situ actually inside ofa healthcare facility, an operating room,
a acute care patient clinic. Itcan be in an emergency department. It
could be on the street with adeployment of EMS and firefighters moving senter a
(03:45):
simulated patient into an er setting,all the way up to an operating room
and backdown. There's also simulation thatis done that's really focused on communication.
We do that with standardized patients orpaid actors who are coached into a series
of history and physical series of complaints. The ability to teach people how to
(04:05):
be empathetic, how to be greatcommunicators, no matter what their healthcare profession
background is medicine, nursing, pharmacy, ptot. It really is the ability
to practice, hone your skill andmove away from what I think the old
era was, which was c one, do one, teach one. Now
(04:27):
we have the opportunity to scale back, slow down, understand with faculty and
people who are area experts in ourfield to show us how we should be
doing something on or with our patients. I would say simulation really has its
roots in the field of nursing.If you look all the way back to
the early nineteen hundreds, there areimages of mannequins that were essentially straw mannequins
(04:54):
that were built had clothing placed onthem, and that's how some of the
nursing community of healthcare provider started withsome of their skills that if you fast
forward to today, it's a muchmore technologically advanced I would say the biggest
imprint of simulation started in the latenineteen nineties with a book that was published
(05:15):
called to Er as Human and thatreally looked at what does the healthcare system
need in order to provide safe patientcare. I think it was our first
really transparent open awareness that some ofthe patient harm that was happening inside of
our medical healthcare systems was due tocommunication errors, the lack of streamlined processes,
(05:41):
etc. And out of that reallybore this idea of simulation medicine hyper
focused on crisis resource management, situationalawareness of what was happening, and most
importantly, really communication that happens betweenthe entire healthcare team, because no one
of us is more important than theother. We may have different roles in
(06:01):
different responsibilities, but as we marchforward in healthcare, whether we're in a
clinic, an operating room, anemergency department, an ICU, everything that
we do involves a large team ofpeople that are touching this patient or interfacing
with this patient in different ways,and those breakdowns and communication and mutual respect
(06:25):
is where patient harm occurs, andsimulation is there to mitigate that, not
only to make you technically good atwhat you do before you interface with a
patient, but to bring up yournon technical skill set of communication, mutual
respect, and how to work asa team to keep our patients safe and
care for appropriately. You mentioned somethingthat made me think about when amputations occur
(06:51):
and from the beginning of the patientsin their room at the hospital and you
as that point of cares the nurse, You're communicating no, it's the right
leg, yes? Or which legis it that you're having amputated, and
it just keeps getting carried on.And the reason that that was occurring is
(07:11):
because there were wrong limbs being removed. So that communication piece among the healthcare
the whole team is extremely important andgetting that education early and getting that education
while you can still practice. AndI would look at it as rehearsal for
the performance. And I don't meanto minimize it, but that's how I
(07:34):
kind of look at it. Thisis where you get a chance to mess
up because the performance. No,you need to be spot on. I
mean everybody does make mistakes, butyou need to be spot on with the
performance. Yeah, that's correct.I think when we look at simulation and
we take our nod from aeronautics andaviation, that's really where this came from.
There is high risk every time somebodygets in a plane or every time
(08:00):
astronaut was going to board a spaceshuttle. So's that industry very early on,
prior to the healthcare sector adopting simulationnew we have got to have a
streamline set of processes where we getit right. We have a checklist system
in place that we deploy every timewe do something so that there is this
(08:20):
cockpit mentality. Everybody's on the samepage. We're listening for those verbal cues
of our step by step process becauseit opens up the door for anyone to
say time that process isn't going theway that it's supposed to. Is very
transparent. So we took what aviationand aeronautics was doing, which had created
(08:41):
a very high safety profile for ahigh risk industry, and overlaid it into
the healthcare sector. So it tookit away from each individual to decide how
am I going to do X,Y or Z, and said, this
system has these guardrails around it sothat we approach each individual with the basic
set of constructs to keep them safe. There's always the art of healthcare,
(09:05):
the art of medicine that comes intothat, but the things that keep every
single human being safe are really rootedin how aviation and aeronautics changed a safety
profile and gave us an opportunity toreplicate that. And when you mentioned these
never ever events right, this wrongleg amputation, those things were happening because
(09:26):
of a Swiss cheese model effect wherea series of things could potentially go wrong
that led to a catastrophic event ora catastrophic injury. And I think what
we have all looked back and reflectedon and healthcare in general, is there
were opportunities for us to have peoplespeak up to change that, but we
(09:46):
hadn't enculturated in people into this ideaquite yet that although we have different roles,
we are all on the equal playingfield of the opportunity to step up
and stand for patient safety. AndI think that's what we coach to or
teach to in the simulation space herecertainly is yes, you have to be
(10:07):
technically good at what you do,you have to have the skill set and
understand your equipment, but you alsohave to have the ability to communicate effectively
and respectfully to all of the peoplethat are part of that care team for
that patient. So tell us aboutthe Center for Healthcare Improvement and Patient Simulation,
(10:28):
or CHIPS as we've been referring toit as the Center for Healthcare Improvement
and Patient Simulation on the UTHSSE campus. Is one of the largest simulation centers,
certainly in the South, the biggestone in the mid South, and
there is nothing like it in thestate of Tennessee. We rival some of
the largest healthcare center simulation spaces inthe country. It was built in two
(10:52):
thousand and eighteen and has been inoperation for the last five years. We
provide simulation base collaborative services with allof our healthcare profession programs on the campus
of UTHSC and some of the externalpartners here within the Memphis community. It
was borne out of this idea thatalthough there was simulation happening years ago within
(11:16):
the College of Nursing and within theCollege of Medicine, to unifocalize that experience,
for the lack of better word,and have a central place where people
could come and work through simulation basedexercises, either in silo, which is
important at certain phases in people's healthcareeducation or as an inner professional team,
(11:37):
which we are in our real experienceson a day to day basis. We
provide procedural based simulation that things wetalked about at the beginning of this in
terms of being able to put inan IV, a central line, an
airway, etc. All the waythrough immersive experiences where we use high fidelity
mannequins that have the capacity to blink, talk through these mannequins, they have
(12:01):
the ability to be intubated. Wecan do almost any procedure that you do
with a real human being on thesemannequins. A fleet of from premature infants
all the way to a geriatric agemannequin that we have for our learners to
interface with mannequins that can go throughthe full birthing process. As we train
people in obstruct trics and gynecology forlabor and delivery services, whether that's in
(12:26):
our nurse midwiffery program or that's withinthe College of Medicine, Obeguide residency,
etc. We also provide standardized patientlevel work, which is the capacity to
be able to start that interface withpatients, how to communicate effectively, how
to show empathy, how to deliverbad news, all of the things that
(12:48):
make us healthcare providers, and everysingle healthcare professions on the campus of UTSC
collaborates within our program and utilizes ourservices across that entire spectrum. We do
somewhere north of about thirty five thousandlearner hours a year of simulation based activity,
(13:09):
all the way from the procedural tostandardized patient to the hybrid simulation that
we talk about with mannequin based technology. So you made me think about during
the pandemic, and I think healthcareproviders and healthcare education is the educators are
so creative. So during the pandemic, a lot of shift was focused to
(13:31):
telehealth. I know that we innursing did a lot of telehealth. We
had to have a quick or rapidresponse to what was occurring out in the
real world. You want to talkabout that a little absolutely, And I
think one of the things that wewill find with simulationists across the country,
and simulationists are really defined as anyonewho is developing or executing simulation based exercises.
(13:56):
You can be a PhD faculty,you can have a master degree in
healthcare education, you can be aperson who has been an EMS or a
paramedic background. Anyone who is engagedin delivering simulation activities is considered a simulationist.
Those individuals are very flexible, innovativepeople that can pivot on a dom
(14:22):
and make something happen. The individualswithin this building, the simulationists that are
the employees within CHIPS, were ableto take what was typically an in person
only done physically format and quickly turnthat into a virtual experience for people so
(14:43):
that they were still able to getthe education that they needed. But we're
doing it in a melieu that notonly developed a skill set that they had
to have, but also that additionallayer of Yes, as healthcare providers now
we do tell a health work,so you have to be technologically savvy and
trained at on both realms of howdo you interface within the technological limitations or
(15:05):
adaptations that we have to have tobe healthcare providers, as well as the
core stuff that they needed for communication, being able to obtain a history and
physical with standardized patients. None ofthat ever stops. So I think this
building and some of the work theydid inside of the pandemic shows the creativity
of simulation and the growth and changeof simulation that it will continue to happen
(15:28):
over time because there are ongoing demandsof how we deliver education, how fast
I will need to be, howquickly things change, how quickly technology adapts
as well well. On CHIPS isa pretty impressive building. And it's not
just the building, it's the peoplewithin the building, and it's all the
different areas of simulation or different disciplinesthat can use CHIPS. And I know
(15:54):
you've touched on it. If youwant to elaborate further on how CHIPS is
used to teach students and talked aboutwhy it's important, but if you have
any further thoughts on that, pleasego ahead and elaborate on that. Yeah.
Absolutely so. I think with whenwe talk about the technical skill,
the procedural piece of it, wehave things that are just task trainers.
So if you're learning to place anIV, you literally are looking at what
(16:18):
is a replica of a human being'sarm. There's the capacity to learn how
to clean an arm in order tostart an IV, how to hold your
pieces of equipment. When you goin to be a start that IV,
you get an immediate flash of blood, just like if you were putting it
in a real life patient. Youhave hands on instruction on how to secure
(16:40):
that IV, how to tape thatIV, the dressings that go on that
IV, and a very similar experiencethat happens if you're learning to put in
a central line in our arterial line. There are task trainers that are done
and design that look and feel asmuch like a human being as humanly possible.
There's also the piece that goes withit of you know, even the
(17:00):
beds that we have our replicas,real life replicas of either a patient journey
or a true patient bed when we'reworking with our physical therapist or occupational therapist.
Even being in that space that lookslike a clinical bedspace with the equipment,
learning how to reposition a patient,how to move a patient off of
(17:22):
a bed to prevent falls, understandingwhy we do certain things within a patient's
bed to prevent pressure ulcers, orall of the other pieces that get overlaid
into our healthcare that aren't done inisolation. They're done for a reason so
people have that real experience to gothrough those movements before they move out into
(17:44):
their experience. There's the upper levelpiece of it, where you're interfacing with
that mannequin where you have to walkin, you have to acknowledge that there
is a patient monitor there. Youhave to pull from your didactic education some
of those critical thinking skills and thenhave to act on those critical thinking skills.
(18:04):
It's not just seeing it, butit's seeing and then what do we
do next? And having these highfidelity mannequins that can be anywhere from sixty
to three hundred thousand dollars each onethat we purchase, having to go through
the step by step process of criticalthinking, intervention communication for whatever scenario has
(18:26):
been built by the faculty or educationalistthat works within CHIPS, sort of merging
the flat work that we do aswe learn our trade and then actually implementing
what that looks like. And simulationcan be so real. And I recall
showing instructing in a skills lab anddemonstrating how to start an IV, and
(18:48):
all the students were kind of gatheredaround and you stick the the IV the
needle in, you get that flashbackof blood and I hear a plot behind
me, and one of the studentshad passed out because it appeared so real
for her that I was actually startingan IV. A person's arm or in
(19:10):
their vein, in their arm andshe fainted. Yeah, it can just
be so real on that. I'llnever forget that story. There is great
evidence based research and literature that supportsthe feelings that you feel in a simulation
based experience or exactly what happens inthe real world. They've gone down to
do the biometrics of that and measuredcortisol levels out of people's saliva who are
(19:34):
in an experience that simulation based andthey have the same stress markers as if
they were experiencing a real life event. And I think simulation also does that
in terms of it builds some ofthe resiliency. You essentially are able to
see the things or experience the thingsthat you're going to see in the real
(19:55):
world, and it allows you towork through some of those emotions, some
of those stressors in that space beforeyou actually are doing it in real life
or where you're maybe you're on clinicaland your back here and you're doing it
as an adjunct. That help adds, that helps add to the entire experience
as we become healthcare providers. Socan you talk about the steps of a
simulation. There's the prebrief, youknow, the actual simulation, and then
(20:21):
what are the actual steps of asimulation. The CHIP Center is an accredited
program for the Society of Simulation andHealthcare, so we hold that designation much
just like the College of Nursing inthe College of Medicine and graduate medical education
programs do they have the seal ofaccreditation that says you are the gold standard.
You meet the requirements in order toprovide healthcare profession education on your campus.
(20:48):
Simulation has a mirror image of that. When we are an accredited center.
There is a set of best practicesand standards that have evolved over time
and simulation that probably weren't there fifteenyears ago, but now we're anchoring and
tethering down into those that set thegold standard of how you set up a
simulation in terms of making sure thatthe learner cohort group understands the reasoning behind
(21:14):
the simulation, that we enter intosome of these contractual things mentally of suspending
disbelief, understanding that this is apsychologically safe place for you to practice,
that this is a confidential experience,especially when we have learners who have their
faculty that are standing there as anovice healthcare provider you have the sense of
(21:37):
worry or consternation that somebody is judgingyou where they're looking at what you're doing
in simulation and making some assessment thatyou're not going to be able to do
that necessarily in real life. Sowe establish the boundaries of simulation about what
we're going to do, and that'swhat we talk about when we say prebrief
essentially, and then we go throughthe process of actually doing the simulation,
(22:00):
whether that's in silo with just ourown cohort group with our healthcare profession or
that's interprofessional in nature. We movethrough the simulation and then we get to
what really is the meat of simulation, and that is debriefing it. It
is sitting down or standing back andhaving an open, transparent dialogue to try
to peel back and to dig intowhy were we making the decisions that we
(22:23):
made, What potential impacts does thathave on our patient? Are there other
things that we should have done orcould have done to get to the root
of how we're thinking and moving ashealthcare providers, so that you walk away
from the simulation experience one have learningsomething. There's none of us who no
(22:45):
matter where you are in your careertrajectory. We're always going to learn something
in that experience in the simulation environment, but also how are we going to
change our behaviors that may positively impactour patients. There are high stake simulation
experiences you have alluded to in thepast, when people come in and they
(23:06):
interface with standardized patients. Sometimes thatis actually an exam. It is as
equal to taking a test that youhave to pass in order to matriculate further
into your program. We're just doingit with a patient interface. So there
are places where simulation you may makea mistake, and that mistake could potentially
(23:29):
mean that you don't matriculate forward.But that's really a safety net to make
sure we are producing healthcare professionals thatare going to meet the standard of safety,
education, and care moving forward inour space. There's always the opportunity
to duplicate that experience to get anotherattempt to come back so that we are
(23:52):
able to make sure that everyone isable to matriculate in the program. But
there's low stakes work or formative workwhere're really just helping people educate in a
different experiential learning milieu, which issimulation, and then the high stakes summitive
work where you've got to show competencyin this in order to move forward in
your education. It's important to getthem to think about this is a this
(24:18):
is greater than you. It's there'sa bigger picture out there, and we're
responsible to the public, or elsewe would not have a license. What
are some simulation modalities and technologies thatare being used today? Right you hear
me talk about how the root ofsimulation started with a straw mannequin and the
nursing realm pushed forward to today andyou have mannequins that literally are animatronic so
(24:42):
that they can cry salty tears,they can bleed from their finger, they
can turn and look at you,they can have facial expressions, they are
as fidel as Shining a light intheir eyes will change their pupillary response.
A mannequin that we have that canfully birth a human being, a baby
(25:03):
mannequin. The place we say wheremannequins come to have baby mannequins. All
of that technology currently exists within thisbuilding, and you can even take it
a step further where there is moreand more utilization of virtual reality, the
ability to see things in almost thisfour dimensional space, not to just see
a flat heart on a drawn Netterdiagram, but actually to stand physically inside
(25:30):
of a heart in virtual reality,to be able to turn around and look
at all of the vessels that comefrom the heart. Same thing with the
brain. There's virtual reality that allowsus to be interfacing with a patient where
we're walking essentially into a room,making clinical decisions from the information we see
(25:51):
in that virtual reality space, havingan algorithm that we have to follow,
having not just us in that virtualreality space, but having multiple people in
that virtual reality space. So you'redoing it in an inner professional way,
in a format that you could doover and over and over again, whether
you're at a simulation lab, whetheryou're at your house in your study.
(26:12):
All of that technology is growing andadvancing. We have mannequins now that in
my era, if you wanted tohear an abnormal heart rhythm, you literally
had to wait until that abnormal heartrhythm showed up in your physical world of
seeing patients do that anymore. Nowwe have the capacity for people to hear
(26:34):
normal and abnormal start that imprint anddownload in their brain of knowing this is
what I should be hearing, andwhen I hear something different here the potential
things that are out there, sothat you're already cued. It's not the
late game that probably you and Itrained in and a lot of the healthcare
providers that are coming out of theirera in the late nineties and early two
(26:57):
thousands. So we have the technologythat continues to change over time, and
every year there is something new thatis moving the needle of how sophisticated our
simulation experience is. It's amazing.And when you were speaking, it was
reminding me of this latest conversation ofAI. And I don't know with folks
(27:19):
out there and know this, butwith some of the healthcare AI, these
types of modalities, some of themget smarter and smarter with the interaction that
they have with the person that's usingthem, and it's great in so many
ways, and then other ways,to me, it's just a little it's
a little scary. Yeah. Ithink our in healthcare is going to be,
(27:44):
especially at the educational level, isgoing to be to adapt to some
of those technological demands that are outthere and to teach our learners how to
navigate through that. You look atthe College of Nursing and some of the
ACN requirements that are going to comeup competency by a design, and we
have to acknowledge the way that weused to train people isn't going to be
(28:07):
good enough. Even in the simulationprogressive world. We're going to have to
figure out other innovative ways to assesspeople, to fast track their learning,
to imprint on them early, tomove out of what is really a flat
diadactic into the experiential phase in differentways, to get our learners to where
(28:27):
we need them to be, toresolve our healthcare shortage that's happening, to
make a competent and confident provider becauseyou know, our society demands it,
and we have healthcare shortages across theboard that are happening not only in the
state of Tennessee, within the college, you know, within nursing, but
everywhere. So simulation gives us anopportunity to harness technology to create a better
(28:52):
provider, to create a VET orprovider faster, to create a well rounded,
resilient provider so that we don't faceattrition, so that they don't become
frustrated with technology as it changes.There's a lot of opportunities in simulation to
move things forward in ways that rightnow we don't currently do in chips,
(29:14):
and certainly because of how fast technologyprogresses, in five years will look totally
different. What are some of thedisciplines that use simulation, either on our
campus or across the country. Ithink if you look at all of the
healthcare professions and you start to diginto what accreditation demands each healthcare profession has,
you will find an imprint of simulationsomewhere. We have a footprint in
(29:37):
all of our colleges. Across campus. We have the dentistry program that comes
here, and for example, theyhave to be able as dentists to take
a blood pressure, have an interventionalplan if somebody has an elevated blood pressure,
to acknowledge when somebody with an elevatedblood pressure could not go under a
(29:57):
local anesthetic or a procedure because ofthat underlying number. So even dentistry is
in our building using standardized patients andinterfacing with people and procuring information at the
communication stage of things. Our pharmacists, certainly whose scope of practice has expanded
(30:18):
over the last five to seven years, are constantly within our space collaborating with
us, from taking blood pressures tocommunication to hybrid simulations or high fidelity simulations.
As you know ACLS providers, certainlythe College of Medicine, the College
of Nursing both at the accelerated andtraditional programs for BSN, the Doctorate of
(30:41):
Nurse Practitioner programs, our CRNA programsthere ptot. Everyone that interfaces on this
campus has a touch point within ourbuilding, and I would say for simulation
that is mirrored across the country fromcoast to coast. If you are a
health care provider in an undergraduate orgraduate education experience, you are using simulation
(31:06):
as part of your experiential learning,moved out of flat diadactics, moved out
of the classroom into a hands onthree dimensional learning opportunity. For you give
us some examples of interprofessional healthcare simulations. Interprofessional simulations has a large spectrum that
(31:26):
we see summit chips and certainly acrossthe country and simulation centers. So for
example, currently on our radar iswe have College of Medicine Fourth Theore medical
students and College of Pharmacy Fourth Theoremedical students who need to be able to
do the hands on the physical workof running a cardiac arrest. So a
(31:52):
good example of interprofessional simulation. Ina real world, there are not six
medical students or six physicians are goingthrough a cardiac arrest without nursing and pharmacy
and medicine and the other individuals onthat team that are providing care to that
patient. So in the simulation experience, you can join those two or three
(32:15):
cohort groups together at the learner levelthat they're currently at to go through that
process of walking in a room,identifying that a patients under a cardiac arrest,
getting into your roles, maybe thephysician or the College of Medicine student
being as the team leader, thepharmacist getting to their code card, getting
(32:36):
their drugs ready, the bedside nursewho's going to deliver those drugs. So
that is a really salient example ofinner professional simulations that are largely based on
the technical skills of leading the code, delivering medications, drawing up medications.
There's another deeper layer to that whenwe get a little bit further along into
(32:59):
that experience, and that is howwe communicate how do we at the College
of medicine or medical student level acknowledgethat our partners in nursing have a very
specific, high end skill set todo the things that they need to do
to save that patient's life, justlike the pharmacist on our right hand side
carries a level of content expertise thatwe as physician providers or young physician learners
(33:22):
do not have that we have torely on to take care of a patient.
Well, are there opportunities for otheragencies outside the UT system to partner
with CHIPS to provide some of thesesimulation experiences to say people who are already
physicians and nurses and nurse practitioners andrespiratory therapists and so on. I certainly
(33:44):
think so, And in fact,when this building was imagined, there was
the design of this building, inthe design of this space to think about.
We have multiple healthcare institutions that liearound us, and the ultimate goal
is not just to provide simulation basededucation for our undergraduate learners, for our
(34:06):
people in the College of Medicine andthe College of Nursing, but also to
people who are already in a postlicensure phase to use this facility as a
place where they do enter professional trainingand education that is simulation focused. Is
they're always going to be the needfor those individuals to become technically sophisticated in
(34:30):
terms of putting in an ivy orputting in an artline or a central line
or an airway. Probably not.They probably already have that technical skill set
that they've honed as licensed providers.But what we do have here and what
the opportunity is really is start todeveloping the communication and the team work and
sort of that formula one team forpeople inside of this space, because in
(34:52):
our real day to day environment,because healthcare is moving so quickly and there's
so many demands, it's really hardto slow down in that real clinical space
and think about how do we communicate, how do we lead, where are
our pressure points, how do wesort of round out our teams as interprofessional
providers. And this is a spacewhere that can certainly be done, whether
(35:16):
that's in an operating room, becausewe have that facility within our space that
looks like a real operating room,whether that's in our L and D suite,
whether that's in our one of ouracute care er trauma patient room experiences.
I think that the long shot lookat this building was that people would
(35:36):
show up at all levels of educationand training, no matter where they were
in their licensure and use this spaceas the capacity to become better healthcare providers,
better healthcare teams, and certainly providesafer patient care to the people that
we serve here in the community.It's certainly impressive, as I mentioned before,
(35:58):
very impressive. Earlier, when youtalked about debriefing after a simulation being,
I think you said something like theheart of it or the meat of
it, or I can't remember theterm that you used. I would like
to see a lot more real lifedebriefing, even though it was a maybe
something that occurred in whatever setting,and acute care setting, a clinic space
(36:20):
or whatever. I would like tosee a lot more real life debriefing.
What's out there on that being discussednow? I think it depends on where
you're working, what facility you're in. I certainly came from a facility where
debriefing either hot debriefing so right aftersomething had happened in the moment, or
cold debriefing when people needed to takethat time in space to separate from it
(36:42):
could be emotionally charged, it couldbe something that people really needed to take
a step back and be able tosee with some great transparency. The cold
debriefing process certainly happens depending on whatinstitution you're in. I think one of
the things that comes out of simulationin you are trained to debrief or when
you see this debriefing process as eithera young learner or somebody in the post
(37:06):
licensure phase, the whole goal isthat maybe you will take that forward,
you will use that skill set that'sbeing emulated for you into your real life,
real world practice. Debriefing and theart of debriefing in the skill of
debriefing is a whole nother subset ofsimulation where you get additional training, you
have to have practice on it.Their psychological safety around how we do debriefing
(37:30):
in real events that may look differentthan simulated based events, but I really
think that the whole point of thatexercise is to show people how we communicate,
ways that we could do that betterand give them a part of a
tool set that they don't have beforewalking into the door. And part of
(37:50):
that debriefing process when you're looking atpeople in the post licensure phase who we're
working on a day to day basiswith each other, is really to get
to the root of how they movedtogether as a team, how to take
up their skill set of communication,another notch that they didn't have when they
walked through the door, to createsome empathy around the stressors that each individual
(38:13):
role may be feeling in the realworld experience that bubbles out to the surface
in the simulation experience. And Ican give you a real good example of
that. As an attending physician inan ICU, I had a lot of
expectations in terms of how long thingstook. It wasn't until I had people
(38:34):
at the level of nursing and pharmacywho could show me, yes, we
understand that you asked for epenefrin,but let me tell you what has to
happen in order to get epinefrin froma code cart out of a drawer into
a syringe. Right, there's allof these steps that have to happen in
the physician myopic brain of mind.At the time before I had a really
(38:57):
deep imprint of my colleagues who changesort of my outlook on how I practice
was that things were instantaneous. Theyare not, in fact instantaneous. And
more importantly, I don't have theskill set to do the things that those
individuals are doing that are part ofsaving the life or taking care of a
patient, and I think the simulationexperience in the debriefing process can pull that
(39:20):
out of people. We know thatyou want X, Y or Z.
Let me tell you the fifteen stepsit takes to get that. Why that
delay that you are becoming impatient overis happening because when you start to do
that work, you start to understandyour colleagues in medicine, nursing, pharmacy,
PTOT, what their additional demands areon them as providers, and how
(39:45):
you have to sort of march forwardknowing what that looks like. And it
wasn't probably until the five or sixyears into my career did I realize that
my team of people was as crucialas any other element that was happening in
that moment, and my sort ofhonoring and respecting what their skills had had
(40:06):
to be really changed how I approachedpatient care. And I think in that
debriefing process that's where some of thatcomes out, and it's really why we
should be doing in a professional simulationat the early stages of people's career.
It's fantastic to bring in people whoare in the post licensure phase and do
that level of work, But ifwe imprint early and people people who are
(40:30):
who are in the healthcare educational realm, the experiences the level of expertise that
each individual cohort group has. Ithink it changes the lens of how you
see the team of people that youinterface with, and that will always be
my passion. The ICU naturally breedsthat, but I think that if I
(40:52):
could give that one thing to everyhealthcare provider, it is that anchor of
every person here has their own levelof expertise. We should honor that,
respect that and interface with that individualand exactly that framework, and that way
we can take care of patients farbetter than if we develop some uneven hierarchical
(41:14):
model that creates communication barriers and gapsand how we take care of our patient.
I really appreciate you saying that,I really do, and this has
been such a great conversation. Doyou before we go, do you have
any last thoughts or last words ofwisdom you'd like to share with us today?
I think that parting words will bethe center for healthcare improvement and patient
(41:36):
Simulation has a tremendous capacity to changehealthcare, be innovative, and within its
walls contains some of the expertise insimulation that is unparalleled. I certainly look
forward to be able to do innovativeprojects with our colleges across campus, and
certainly with healthcare providers and some ofour clinical partnerships moving forward. Absolutely again,
(42:00):
my guest today has been doctor TeraLemoine, the executive director of the
Center for Healthcare Improvement and Patient Simulation. I really do appreciate your time today,
Thanks so much. Thank you.You've been listening to the That's Helpful
podcast with your host, doctor LisaBeasley, a family nurse practitioner and healthcare
advocate. Views expressed on this podcastor the views and opinions of the hosts
(42:24):
and guests and are not affiliated withany facility or institution that may have been
mentioned in this episode. That's Helpfuldot com. For more information or to
hear prior episodes, follow at NowHelpful on Twitter, and That's Helpful on
Facebook and Instagram. Like or commenton an episode wherever you listen or stream
(42:45):
your favorite podcasts. Music for thisepisode it's provided by local Memphisinger musician and
songwriter Devin Yennik. For more ofDevon's music, visit Devin Music Dot Weekly, dot com
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