MedBiquitous Community Connection: February 16 Webinar Q&A

Note: Some questions and answers from the webinar transcription have been paraphrased to be more succinct.

Presentation: A Discussion with MedBiquitous Luminary Dr. Rosalyn Scott
Speaker: Rosalyn Scott, MD, MSHA, Charles R. Drew University of Medicine and Science

The recorded presentation may be viewed here.

Q: (Julianna Cole) 
Are there any thoughts regarding the repository for portable MedBiquitous information? A single repository? Multiple repositories?

A: (Johmarx Patton) 
When considering data portability for the health professions education (HPE) learner or the patient as a learner, we usually think about it in a federated sense. In this option, one requests the data from where it was originally entered. We don’t often see single repositories.

Health information exchange is a good analogy. At the state level there are health information exchanges that allow health systems and individual practitioners to use this hub for their EHR (electronic health record) data to be shared. In a similar model, no one actually has that original data on hand. They need to request whenever it is needed.

A: (Rosalyn Scott) 
Ideally, we hope there would be a system that can pull data from different sources. In Canada, a system linked medical schools and simulation centers together whereby one simulation center could direct activities in a remote simulation center and pull training information across multiple systems across Canada. This was an exciting way where educational resources were actively shared.

In terms of the data capturing an individual’s career objectives and experiences, a CV is carried around. What would be ideal is to have a truly electronic CV that could pull information from around the country and around the world. This would be something to look forward to.

In Denmark, people carry an electronic card with their entire medical record. In an emergency room, the card is inserted into a computer and all their information is there. That is a system we need to strive toward for our educational achievements.

Q: (Marcelle Willock) 
How did you train the trainers for the Simulation Center?

A: (Rosalyn Scott) 
Marcelle Willock, who is asking the question, is the Marcelle Willock who introduced me to simulation and also sponsored me for ELAM (Executive Leadership in Academic Medicine). During the pandemic, I started the virtual salon, The Excellent Ladies’ Salon, which has about 12 women from various fields in medicine. Marcelle was invited to be one of the Excellent Ladies. This is a true example of a lifelong relationship between a mentor/outstanding dean and an excellent lady.

To answer Marcelle’s question, we had two different strategies for training the trainers. 1.) When the simulation was developed, we invited the local simulation staff to help facilitate. 2.) Then, each year in Dayton, we held two to three professional development programs to which simulation staff from different network sites were invited. Some trainings offered included an introduction to simulation, and a moulage class that had an invited artist train how to develop moulage.

So, we had the experience of working with a simulation expert, as well as formal didactic experiences for the simulation staff.

Q: (Johmarx Patton) 
How did you go about getting funding for such an interesting project? And, were there any follow-up projects?

A: (Rosalyn Scott) 
At the VA, I initially applied for a $25,000 grant in women’s health. We bought some female pelvic trainers and did a small program. The VA then announced competitive funding for other projects in women’s health, so we proposed a mobile project what would utilize an unused mobile patient care clinic. The following year, we did a rotation around the women’s health network, which expanded into doing general work through the VA’s national simulation program.

The network was impressed with what we had done, so they funded the remodeling of that 17,000 square foot space. I created a spreadsheet detailing what funding each hospital should have for simulation equipment, as well as funding for a nicer mobile van. It ended up being about the same cost. We spent about a half million dollars on our mobile van, which was built from scratch. We bought high-end equipment from a simulation center, and some lower-end equipment for each facility. Our notion was that a team of highly trained simulation specialists would be the best way to provide consistent education, including all individual hospital staff so they could improve their own skills. We started out with $25,000 and built it up to several millions of dollars.

Q: (John Rice) 
What mechanisms exist or are needed to gain compliance to what I assume ANSI considers voluntary standards?

A: (Johmarx Patton) 
ANSI has a set of essential requirements, which is how those mechanisms are set forth. They have a set of criteria for how due process and other methods should work within a standards development organization to allow for voluntary standards.

Q: (Johmarx Patton) 
When I reflect on our conversations over the past few months, we’ve talked about spaces in nursing education, physician’s assistant education, and physician education. Looking ahead to 2030 and the amount of simulation we have in classrooms or in health professions curricula, where do you think we are going in terms of the volume and types of simulation offered? Paint us a picture.

A: (Rosalyn Scott) 
Nurses have been ahead of physicians in terms of using simulation in their training. There are many nursing schools around the country that do not have the ideal number of patients available to them for training. Each state has different licensing requirements. Up to 50% or more of their training could be simulation-based. Medical schools are a bit different in that the LCME (Liaison Committee on Medical Education) will state that, if you are not able to provide a key clinical experience in a particular disease, you can use a simulated experience.

One of the most valuable ways simulation is used today is in multi-disciplinary activities. Medicine is no longer a cottage industry as it was in the past; it truly is now a team sport. Understanding how all the different members of the team contribute to patient care is something I did not learn in medical school. I was exposed to it in residency. In medical school I didn’t know how team members really contributed to the care - I’m talking about nutritionists, physical therapists, occupational therapists. I think there is a real opportunity to use simulation to integrate those disciplines, both in school and then after training.

Charles R. Drew University of Medicine and Science is working on their curriculum for a new, expanded medical school. I have been an advocate for looking at the curriculum of their PA school, nursing school, and their other technical schools. Throw it up in the air, put it on a white board (just as I did with flipping diabetes education for the virtual medical center) and say, how can we take the didactic pieces of each of those disciplines, teach them together, and then branch off into the discipline-specific courses and components that are needed. This is a very challenging exercise, but it does open the possibility for much more efficient education. By using simulation early and later in their career, we certainly demonstrated that fully trained providers practicing medicine every day benefited from the simulation that was provided them, and made them better practitioners. Lifelong learning can use simulation throughout the career of any individual.

A: (Johmarx Patton) 
Before joining the AAMC, I worked with a university who, back then, was trying to create interprofessional activities. They were starting to look at simulation. The lifelong learning part is interesting – thinking about how space can be provided for all these current providers to continue their education in simulation spaces across the country and around the world. It’s something we really need to think about.

Q: (Liesel Tavenner and Johmarx Patton) 
In recent weeks, we have had announcements from the USMLE (United States Medical Licensing Examination) about the Step 2 CS being suspended. Would you like to share your thoughts on the future of simulation on board exams and assessments?

A: (Rosalyn Scott) 
For a number of years, I have been on various committees that develop questions and review questions for the National Board of Medical Examiners. They do have an area that is supposed to be simulated patient experience. I think that this can definitely be further expanded. Virtual patient cases can be developed integrating more virtual reality, which is certainly a possibility.

The unfortunate part of Covid-19 is that we’ve lost the ability to do things face-to-face, so looking at what virtual technologies can do in terms of simulating clinical experiences is important. The ACLS (Advanced Cardiac Life Support) exam is now really a number of simulations along with the practical part of resuscitation on a manikin.

In one exercise we looked at the ACLS components to see how we could put those within the MedBiquitous Competency Framework, and then develop a system to track what competencies people were actually doing in their clinical practice. Continuous performance renewals are now required as a part of ACLS. I think the MedBiquitous competency and performance standards could be uniquely applied to that, and be supported by simulation efforts.