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Welcome to the On Record Podcast.
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This is a podcast where we talk with professionals and subject matter experts from diverse markets that are using video and audio in innovative ways to support their organization's objectives.
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My name is Mike Anselone, and my co-host today is Kyle Shellstad.
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And our guest is Dr.
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Kelly Fuls Ramos.
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Kelly is an assistant professor and the director of simulation and innovation at the University of Buffalo.
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Welcome, Kelly.
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Thank you.
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Before we get started, you have a long list of accomplishments, and I'd like to highlight at least a couple to let our listeners really know your passion for nursing.
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And I think first and foremost, you've been nationally recognized as a leader in simulation-based education.
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You've been recently designated as a fellow in the American Academy of Nursing.
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Congratulations on that.
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Thank you.
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And then you've also been able to usher in the University of Buffalo as a statewide simulation center of excellence, which I think is one of the first times in New York State that that has been recognized.
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Yes, the first.
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The first.
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So once again, congratulations on that.
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So, Kelly, tell us a little bit about how you've been able to accomplish some of these accolades and uh a little bit more about your journey in the field of nursing.
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Sure.
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Well, I will talk about my journey first, because then I think that leads me to how I've been able to accomplish what I've been able to accomplish.
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So I have always been passionate about technology.
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Um from as young as like 10 years old, I would program video games.
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Um when I initially chose a profession, I went into health information administration.
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So I'm a second career nurse, and that's kind of like informatics.
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I was not satisfied with that profession.
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Um, I wanted to actually touch the patient, so I went back to school and became a nurse and decided that education really was what made me happy when I was precepting new nurses.
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So I took a job as a corporate nurse educator for a large hospital system.
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And my first day on that job, my new boss told me, last year we purchased two patient simulators for$80,000 a piece.
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We paid for all the training, everyone's been trained, but no one has taken them out of the box.
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So your job is to take them out of the box.
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We can't pay to train you because we already did all the training last year.
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So you have to teach yourself how to use them and then integrate them into continuing education and new higher orientation for the whole hospital system.
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So um I really taught myself, and I think in those old days, that was um like 2008, a lot of people who work in simulation and healthcare are self were self-taught because there weren't a lot of people who were doing it.
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Um so I then uh worked in that capacity for about five years, did successfully implement simulation, uh, and then I decided to uh come to the University of Buffalo where there were more opportunities for advancement.
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And I had done my family nurse practitioner degree here.
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So when I got to the University of Buffalo, I took over the clinical skills lab and really kind of revamped all the simulation that was being done here.
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At the same time, I I went to school, I got my PhD in curriculum instruction in the science of learning, and I also got an advanced certificate in educational technology and new literacies.
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Um I think having that background of educational theory is extremely important.
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Um and then kind of put everything together.
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Uh, the people I work with at UB have always supported me and my growth and my crazy ideas.
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They trust what I'm going to do.
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So it really has given me the freedom to try new things um to innovate.
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And I always say that what sets us apart, our simulation program apart from other ones, is that we try new things.
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We definitely are the first ones to try new things and to innovate, but we also do research when we try those new things so that we can provide the evidence to other schools who may need a little bit more of a push to adopt new technology or new ways of teaching and learning.
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What are some of the new ideas and things that you that you've been working with?
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So we are using virtual reality, we are using artificial intelligence.
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Virtual reality has been around for a long time now, but we didn't implement it until 2024.
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Um I I got a HERSA grant in 2023 to um fund our virtual reality program.
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Um I had been trying to find a reason to get virtual reality implemented in the curriculum for a few years, and I have the RIF, the Oculus Rift at home.
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I had um the quest.
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And so I finally found a good reason for it.
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And what we use it for is to teach our nursing students to care for patients from rural and underserved communities.
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So we are an urban campus, our students go to clinical within driving distance of our campus.
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So there aren't a lot of opportunities for them to experience health care in those types of settings.
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And they might not decide to go on and work in a rural or underserved environment, but even if they're in a hospital in a city, they're going to have patients who are going back to those environments.
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And so knowing that they're limited resources and how they might have to treat a patient differently is really important.
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That's virtual reality.
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Artificial intelligence, um, I think I don't know that there's an email or any kind of advertisement for any training that I get now that does not talk about artificial intelligence.
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I think it's kind of creeping into every single part of our lives.
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But I have definitely embraced it myself.
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Um, again, as an innovator, I did a fellowship and advanced teaching with um or advanced generative AI for teaching.
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And I learned a lot of tools, and I actually was able to create a custom GPT that will generate simulation scenarios.
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And I curated all of the important materials.
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So it has the healthcare simulation standards for best practice for nursing, it has the AACN essentials, which are very important to us.
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Um, I'm also really involved in interprofessional education, so it has the IPAC core competencies, which is what we follow in interprofessional education.
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Um, and so you can just write in a prompt, give me a simulation about this for nursing, pharmacy, PT students, and it will give you an entire simulation that you then have to read through and and edit.
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But um I call it quality quality healthcare simulations in five minutes.
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Wow.
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So um that is my personal AI, but we have also integrated AI into our simulation by using AI voices for our mannequins.
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So instead of having them voiced by a person in the control room, an actor, a student, we actually use an AI speaker.
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Um, and this helps make our simulations more standardized because everyone's getting the same programming.
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It also helps us, you know, if the patient is a 78-year-old female, we can actually make her sound like a 78-year-old female, not one of our graduate students in the control room.
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So um, yeah, that is one of our newest initiatives.
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From all the guests that we've had so far, it sounds like you are really on the cutting edge of technology and how you are implementing some of these new technologies.
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That sounds really cool.
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How do your um how do your students respond to some of this new technology that you're incorporating into the simulation?
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Well, our students are great.
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Because remember, I said every time that we introduce something new, we also do research.
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And sometimes that research will be kind of mandatory part of their coursework just because whatever we're implementing is part of that simulation.
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But there are also studies that we do that require volunteers, and I never have a problem getting volunteers to come and help.
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I think that they they are eager for anything that's new, they're eager for anything that's active.
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Um, and they always say that they want more simulations.
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When I was doing my homework before our interview today, I was going through some of your published research.
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And there's a lot that involves technology, there's even some that involve escape rooms to develop communication skills, things like that.
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It's super interesting.
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Curious if there's anything currently that you're working on.
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Sure.
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Um, I think I said interprofessional education is something that's really important to me.
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Teamwork and communication are really, really key to ensuring patient safety.
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So one of the newest studies that I'm working on with um colleagues from the School of Engineering, um, systems and industrial engineering here at UB, it's called the Shared Mental Model Project.
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So we are actually using um a whole bunch of data streams.
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So we are looking at video from inside the room, so captured from two different angles.
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We are looking at uh brain activity using an EEG cap, and we're looking at eye tracking using Toby glasses.
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We also capture headset video because we are doing the study in virtual reality.
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So we put two participants into the same virtual room.
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We have different scenarios that we put them through that have triggers that would make them work together.
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And what we're doing is training a model that will be able to predict when these participants have a shared mental model and also when they don't have a shared mental model.
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So uh the end goal is to have a real-time feedback system that will alert students when a breakdown in communication or teamwork is predicted.
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Give them a little reminder, okay, stop and do a huddle, something like that.
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It's um a lot of data, but I think in the end it's going to be very rewarding.
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And we're starting with nursing students, but this definitely is something that would work with every healthcare team.
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Kelly, you mentioned a number of terms like shared mental model, the HUDLE.
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I know those are terms I'm familiar with from team steps level of communication.
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Could could you expand on what a shared mental model is?
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Seems kind of obvious, but I know there's more behind it.
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Yes.
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So I the most simple way that I can explain it, it's being on the same page.
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So having a shared mental model is having the same idea of what roles are, what the situation is, what changes are going on.
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Um, so it's really getting on the same page.
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And if I say a huddle is needed, a huddle is kind of like putting your heads together to get back on the same page if you're not currently on the same page.
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And yes, Team Steps is um something that we kind of weave throughout our curriculum.
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And they're they're basically communication and conflict resolution tools.
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They were um developed in response to the to Air's Human report from a while back that said a large percentage of um medical errors are due to communication.
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So this group of tools is a way for healthcare professionals to speak the same language.
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So if we all learn team steps, we know a huddle.
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We know that anyone can ask for a huddle if we think that there's a a breakdown in communication.
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We know how to respond to conflict when it might be, you know, there might be hierarchical issues by using a cuss.
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As soon as you say I'm concerned, if you've been trained in team steps, the other person knows, okay, something important is going on.
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I need to stop what I'm doing and figure out what the problem is.
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That's a different cuss than I use in communication breakdowns.
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So when you're when you're kind of researching some of those communication skills, teamwork skills, tell us a little bit about how you've been able to incorporate video and the types of things that you're looking for in video.
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Sure.
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I think video and simulation kind of go hand in hand.
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Um for our any of our simulations, if they're uniprofessional or interprofessional, we use it for pre-briefing, for preparing our students for simulation, we use it during simulation so that our facilitators can watch what's happening, but we also have other students who are observing.
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And then we use it in debriefing as a way to help students see something they may not have noticed during the scenario.
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Um in our interprofessional um simulations, it's usually about communication.
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That's usually what those scenarios are about.
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So sometimes it's it's seeing like, okay, you're from two different professions, you're standing at two different sides of the room and kind of like taking turns talking to the patient instead of integrating what you're doing and working together.
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And so the benefit of the video then is to be able to watch the simulation live and then to use it for reflection afterwards.
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And then again, I keep harping on research, but for us, we probably are doing research on that simulation scenario, and that gives us the ability to have observer rating of performance, which makes the research much stronger than if we were just taking a survey from a participant.
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So when you mention observer rating, are you doing like interrater reliability studies and the collected data?
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Yeah, so we definitely can do that.
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If we have the recording, we can have as many people watch and rate to make sure that we're we have inner rater reliability.
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I know there's been uh a fair amount of work on um and research.
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Well, maybe not a lot of research, but um, where the observers can gain just as much learning experience as participants in the so-called hot seat, right, in the simulation.
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What's your what's been your experience from that perspective?
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Sure.
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So we actually have done research on that here at the University of Buffalo, and both of our studies have shown that our observers have equal um knowledge gain and satisfaction and self-confidence and learning as the students who were active in the simulation.
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I think part of it is probably um cognitive load.
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So there is some anxiety going into a simulation when you're kind of you said in the hot seat.
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Um, I think you kind of get at it right, like that.
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There is um some increase in cognitive load, which means that your brain cannot take in as much new information as the observer who's sitting there watching, they can take everything in.
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So we really think that that's part of the reasoning for that.
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And that's why we kind of do a balance.
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When we bring students in for simulation, we will bring in um a group of eight and we will do three different simulation scenarios and have them take turns being active or observing.
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Do you find from an observer perspective, is there more to be gained from watching a recorded video versus watching a live scenario?
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I would say that the difference would be in what happens afterwards.
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So if you're watching a recording, are you going to debrief right afterwards?
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Because that's where like the learning occurs.
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Usually, if you're watching it live, the students are going to come right back out and you're all going to debrief together.
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And so you get that whole experience.
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Um, if you're watching it recorded, I'm wondering if that means it's more of like an asynchronous thing and you might not get that same experience.
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Are you familiar?
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I've I've heard the term you observe what you focus on.
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And there was this famous video where there's three or four people that are tossing a ball around, and there's a gorilla, a man in a gorilla suit that walks behind them.
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Well, the observer is is basically instructed to watch how they pass the ball around.
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And so they're focused on those individuals, and they never realize they never see the gorilla behind them.
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And but when you are watching the video, you have the opportunity to you have the element of time because you can stop the video, you can review the video, you can see things that you may not see in the moment because of what you're focused in on.
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And I'm kind of curious what your thoughts are on that something like that.
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Yeah, I think that there probably is some truth to that, but we also think uh we also use the terminology focused observer in a different way that might make a difference.
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Um, we will actually, like thinking about our team step simulations with an interprofessional audience, we will have five students in the room and um ten watching.
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Those 10 students who are watching, we give an observer tool too with the team steps tools, asking them if they see any of them used or if they see a situation where one could have been used but wasn't.
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So we kind of are focusing them in on what we want them to be looking at.
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What was your um I'm kind of curious, Kelly, your involvement when the when you started using video at University of Buffalo, I'm sure you were very instrumental in the design of the system.
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What were some of the thoughts, thought processes that uh you had in terms of designing that system?
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Well, I will tell you uh when I got to the University of Buffalo, they were using a casino security system for video and simulation and um and burning DVDs.
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So everything recorded 24 hours a day in our health assessment lab in our simulation rooms, and then if you wanted to keep something, you would actually have to pull it off and burn it onto a DVD, which then later we were upgrading to a flash drive.
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But if we wanted to go back and look at something, it is like hitting the rewind.
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Um it was really time intensive, it was not easy to use.
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And when there was a power outage, sometimes it would um it would break and things would have to be replaced.
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Um, so when we were looking for a new video system, obviously I wanted something that was updated, but my biggest um need, the one thing that I was looking for is the ability to annotate.
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So when we're watching a simulation, we can put the marker in and then easily use that video during debriefing to show, like, okay, what were you thinking in this spot of the simulation?
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Um, having that ability just really, really, really helps.
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Do you do you record all the simulations?
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No, we do not.
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What's the reasoning for that?
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What makes you decide whether to record or not record?
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So it really depends on the purpose of the simulation.
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Um we will almost always be streaming the video.
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If we're not using it for research purposes or if it's not something that's being graded summatively, we don't necessarily always record it.
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And a lot of our simulation is done um with formative evaluation.
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So we aren't we aren't grading them.
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We're looking at at how they perform and how they really react during debriefing.
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When you mentioned formative evaluation, can you define that a little bit more for our listeners?
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Sure.
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So formative and summative would be the two different types of evaluation.
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And summative is where you are giving someone a grade.
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So it can be used as when you think of high-stakes testing, so like at end of the course exam, head-to-toe assessment, that's summative evaluation.
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Formative is more of looking at overall quality.
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And in our in our um context, we do it more as like a participation than participating.
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Um, but that's really the difference between formative and summative.
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We're not giving them a grade in formative.
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So the formative assessment is building skills towards that summative assessment.
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In some cases, we actually don't use summative at the end of every course.
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So it might not be.
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Um, but we definitely do scaffolding.
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So what that means is we kind of start smaller with more um kind of beginning, easier skills, and then kind of put them together and make our simulations more complex as uh time goes on as our students move through the program.
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Um so we don't always need a summative assessment as long as they're progressing through those different stages.
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As you've kind of modernized your video system from the old DVD kind of technology, what challenges have you experienced?
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I mean, there's definitely challenges with people getting to know the system, um, which you're gonna have whenever you implement something new.
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Um I don't think anyone knew how to use the casino security system, but when we got when we got Vault, um people wanted to use it, so we had more people who we had to kind of get up to speed on how to use it.
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Um other than that, I mean we have kind of some of the same challenges.
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Not everyone wants to be recorded, it does, you know, cause some anxiety sometimes, but beyond that, um nothing that's really stands out.
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This kind of pulling back to the observer versus participant, where you were saying, you know, stress of being the participant could impact their learning.
00:25:53.119 --> 00:25:57.599
Is the observation there simply to supplement that?
00:25:58.960 --> 00:25:59.279
No.
00:25:59.519 --> 00:26:05.359
So the observation for us is a way to get more students through simulation.
00:26:05.599 --> 00:26:08.960
So I'm sure that you've heard that there's a nursing shortage.
00:26:10.160 --> 00:26:16.319
I feel like there's always been a nursing shortage, but there's really a nursing shortage right now.
00:26:16.480 --> 00:26:23.519
And we really need to increase enrollment and get some more nurses out there into the workforce.
00:26:23.839 --> 00:26:31.920
But the big thing that is keeping that enrollment down is the lack of clinical sites, the lack of faculty.
00:26:32.319 --> 00:26:45.039
And um, here in New York State in 2023, we passed legislation to allow for one-third of clinical hours to be done through simulation in New York State.
00:26:45.359 --> 00:27:00.559
And that simulation counts if you're in the active or the observer role, as long as it's part of you have the whole process of pre-briefing, the simulation scenario, debriefing.
00:27:00.960 --> 00:27:16.480
Um, so for us to be able to get eight students through one session of simulation versus the two to three who would go in at one time, that is really why we have the observer role.
00:27:16.559 --> 00:27:23.359
And then we make them focus to make sure that they're um getting everything that they need out of it.
00:27:23.519 --> 00:27:25.920
And of course, we debrief everyone together.
00:27:26.079 --> 00:27:33.599
But for us, it has allowed us to increase our numbers of students in simulation.
00:27:34.799 --> 00:27:55.519
That actually is an interesting comment because I was going to ask you a question in terms of uh a lot of the folks that we speak with have had challenges in terms of convincing stakeholders in universities to invest in some of these video systems, which it can represent a significant investment.
00:27:56.000 --> 00:28:02.240
Um but with the legislation I know in New York and and other states, um as well.
00:28:02.400 --> 00:28:16.240
What what are some of your thoughts on helping clients that are having challenges convincing their stakeholders that video is a valuable and integral component of simulation?
00:28:17.119 --> 00:28:26.880
I think in the current environment, telling them that they can get more students in using video is probably the biggest selling point.
00:28:27.119 --> 00:28:39.039
I mean, we can talk about the numbers that we put through before having observers compared to the number that we have now, and that's like a a really clear metric to show.
00:28:39.200 --> 00:28:45.200
Um, I mean, we can definitely show the value from the research that we've done.
00:28:45.359 --> 00:28:57.279
We can show the value in our student evaluations, but being able to show them that ability to get more students through kind of is more important than anything else.
00:28:57.680 --> 00:29:15.680
Before we wrap up, one one question I'd like to ask is if our listeners are in a position where they're involved with either designing a new video system or or evaluating a new video system, what kind of guidance would you provide them?
00:29:16.160 --> 00:29:29.119
I think with any any new system that you're implementing, start with a needs assessment, looking at what your objectives are, what you're going to be using it for.
00:29:29.599 --> 00:29:56.480
Um and I I think in the simulation world, having a system that has functions that are specific to simulation is really important because you can get A V systems for casino that will work fine, but they're not going to have those extra features that really make your simulation special and much better.
00:29:56.720 --> 00:30:11.119
Um, and then I also like to talk to other people who maybe have just implemented their systems to see um what advice they have and how they like whatever they chose.
00:30:11.680 --> 00:30:26.160
Well, Kelly, you've really brought to the podcast today not only a wealth of technical expertise and nursing expertise, but the ability to kind of tie both of those together, which is I think a very unique position.
00:30:26.480 --> 00:30:35.440
If any of our listeners were interested in getting in touch with you, any follow-up questions kind of based on what we talked about, um, is there a good way for them to do that?
00:30:35.839 --> 00:30:43.839
Yes, probably my email is the the best way, and that's Folts F O L T Z at Buffalo.edu.
00:30:44.400 --> 00:30:45.759
Well, thank you very much, Kelly.
00:30:45.839 --> 00:30:48.880
This has been an awesome conversation.
00:30:50.720 --> 00:30:58.400
OnRecord is a podcast presented by Intelligent Video Solutions, hosted by Mike Anzolone and Carmen Hawk, and produced by Kyle Shellstead.
00:30:58.559 --> 00:31:05.680
Find us online at ipivs.com slash on record and on social media at Intelligent Video Solutions.
00:00:01.919 --> 00:00:04.719
Welcome to the On Record Podcast.
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This is a podcast where we talk with professionals and subject matter experts from diverse markets that are using video and audio in innovative ways to support their organization's objectives.
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My name is Mike Anselone, and my co-host today is Kyle Shellstad.
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And our guest is Dr.
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Kelly Fuls Ramos.
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Kelly is an assistant professor and the director of simulation and innovation at the University of Buffalo.
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Welcome, Kelly.
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Thank you.
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Before we get started, you have a long list of accomplishments, and I'd like to highlight at least a couple to let our listeners really know your passion for nursing.
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And I think first and foremost, you've been nationally recognized as a leader in simulation-based education.
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You've been recently designated as a fellow in the American Academy of Nursing.
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Congratulations on that.
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Thank you.
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And then you've also been able to usher in the University of Buffalo as a statewide simulation center of excellence, which I think is one of the first times in New York State that that has been recognized.
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Yes, the first.
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The first.
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So once again, congratulations on that.
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So, Kelly, tell us a little bit about how you've been able to accomplish some of these accolades and uh a little bit more about your journey in the field of nursing.
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Sure.
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Well, I will talk about my journey first, because then I think that leads me to how I've been able to accomplish what I've been able to accomplish.
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So I have always been passionate about technology.
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Um from as young as like 10 years old, I would program video games.
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Um when I initially chose a profession, I went into health information administration.
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So I'm a second career nurse, and that's kind of like informatics.
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I was not satisfied with that profession.
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Um, I wanted to actually touch the patient, so I went back to school and became a nurse and decided that education really was what made me happy when I was precepting new nurses.
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So I took a job as a corporate nurse educator for a large hospital system.
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And my first day on that job, my new boss told me, last year we purchased two patient simulators for$80,000 a piece.
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We paid for all the training, everyone's been trained, but no one has taken them out of the box.
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So your job is to take them out of the box.
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We can't pay to train you because we already did all the training last year.
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So you have to teach yourself how to use them and then integrate them into continuing education and new higher orientation for the whole hospital system.
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So um I really taught myself, and I think in those old days, that was um like 2008, a lot of people who work in simulation and healthcare are self were self-taught because there weren't a lot of people who were doing it.
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Um so I then uh worked in that capacity for about five years, did successfully implement simulation, uh, and then I decided to uh come to the University of Buffalo where there were more opportunities for advancement.
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And I had done my family nurse practitioner degree here.
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So when I got to the University of Buffalo, I took over the clinical skills lab and really kind of revamped all the simulation that was being done here.
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At the same time, I I went to school, I got my PhD in curriculum instruction in the science of learning, and I also got an advanced certificate in educational technology and new literacies.
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Um I think having that background of educational theory is extremely important.
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Um and then kind of put everything together.
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Uh, the people I work with at UB have always supported me and my growth and my crazy ideas.
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They trust what I'm going to do.
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So it really has given me the freedom to try new things um to innovate.
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And I always say that what sets us apart, our simulation program apart from other ones, is that we try new things.
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We definitely are the first ones to try new things and to innovate, but we also do research when we try those new things so that we can provide the evidence to other schools who may need a little bit more of a push to adopt new technology or new ways of teaching and learning.
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What are some of the new ideas and things that you that you've been working with?
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So we are using virtual reality, we are using artificial intelligence.
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Virtual reality has been around for a long time now, but we didn't implement it until 2024.
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Um I I got a HERSA grant in 2023 to um fund our virtual reality program.
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Um I had been trying to find a reason to get virtual reality implemented in the curriculum for a few years, and I have the RIF, the Oculus Rift at home.
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I had um the quest.
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And so I finally found a good reason for it.
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And what we use it for is to teach our nursing students to care for patients from rural and underserved communities.
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So we are an urban campus, our students go to clinical within driving distance of our campus.
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So there aren't a lot of opportunities for them to experience health care in those types of settings.
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And they might not decide to go on and work in a rural or underserved environment, but even if they're in a hospital in a city, they're going to have patients who are going back to those environments.
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And so knowing that they're limited resources and how they might have to treat a patient differently is really important.
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That's virtual reality.
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Artificial intelligence, um, I think I don't know that there's an email or any kind of advertisement for any training that I get now that does not talk about artificial intelligence.
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I think it's kind of creeping into every single part of our lives.
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But I have definitely embraced it myself.
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Um, again, as an innovator, I did a fellowship and advanced teaching with um or advanced generative AI for teaching.
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And I learned a lot of tools, and I actually was able to create a custom GPT that will generate simulation scenarios.
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And I curated all of the important materials.
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So it has the healthcare simulation standards for best practice for nursing, it has the AACN essentials, which are very important to us.
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Um, I'm also really involved in interprofessional education, so it has the IPAC core competencies, which is what we follow in interprofessional education.
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Um, and so you can just write in a prompt, give me a simulation about this for nursing, pharmacy, PT students, and it will give you an entire simulation that you then have to read through and and edit.
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But um I call it quality quality healthcare simulations in five minutes.
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Wow.
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So um that is my personal AI, but we have also integrated AI into our simulation by using AI voices for our mannequins.
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So instead of having them voiced by a person in the control room, an actor, a student, we actually use an AI speaker.
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Um, and this helps make our simulations more standardized because everyone's getting the same programming.
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It also helps us, you know, if the patient is a 78-year-old female, we can actually make her sound like a 78-year-old female, not one of our graduate students in the control room.
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So um, yeah, that is one of our newest initiatives.
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From all the guests that we've had so far, it sounds like you are really on the cutting edge of technology and how you are implementing some of these new technologies.
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That sounds really cool.
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How do your um how do your students respond to some of this new technology that you're incorporating into the simulation?
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Well, our students are great.
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Because remember, I said every time that we introduce something new, we also do research.
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And sometimes that research will be kind of mandatory part of their coursework just because whatever we're implementing is part of that simulation.
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But there are also studies that we do that require volunteers, and I never have a problem getting volunteers to come and help.
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I think that they they are eager for anything that's new, they're eager for anything that's active.
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Um, and they always say that they want more simulations.
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When I was doing my homework before our interview today, I was going through some of your published research.
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And there's a lot that involves technology, there's even some that involve escape rooms to develop communication skills, things like that.
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It's super interesting.
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Curious if there's anything currently that you're working on.
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Sure.
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Um, I think I said interprofessional education is something that's really important to me.
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Teamwork and communication are really, really key to ensuring patient safety.
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So one of the newest studies that I'm working on with um colleagues from the School of Engineering, um, systems and industrial engineering here at UB, it's called the Shared Mental Model Project.
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So we are actually using um a whole bunch of data streams.
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So we are looking at video from inside the room, so captured from two different angles.
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We are looking at uh brain activity using an EEG cap, and we're looking at eye tracking using Toby glasses.
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We also capture headset video because we are doing the study in virtual reality.
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So we put two participants into the same virtual room.
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We have different scenarios that we put them through that have triggers that would make them work together.
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And what we're doing is training a model that will be able to predict when these participants have a shared mental model and also when they don't have a shared mental model.
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So uh the end goal is to have a real-time feedback system that will alert students when a breakdown in communication or teamwork is predicted.
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Give them a little reminder, okay, stop and do a huddle, something like that.
00:12:04.480 --> 00:12:10.799
It's um a lot of data, but I think in the end it's going to be very rewarding.
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And we're starting with nursing students, but this definitely is something that would work with every healthcare team.
00:12:18.720 --> 00:12:24.559
Kelly, you mentioned a number of terms like shared mental model, the HUDLE.
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I know those are terms I'm familiar with from team steps level of communication.
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Could could you expand on what a shared mental model is?
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Seems kind of obvious, but I know there's more behind it.
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Yes.
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So I the most simple way that I can explain it, it's being on the same page.
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So having a shared mental model is having the same idea of what roles are, what the situation is, what changes are going on.
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Um, so it's really getting on the same page.
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And if I say a huddle is needed, a huddle is kind of like putting your heads together to get back on the same page if you're not currently on the same page.
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And yes, Team Steps is um something that we kind of weave throughout our curriculum.
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And they're they're basically communication and conflict resolution tools.
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They were um developed in response to the to Air's Human report from a while back that said a large percentage of um medical errors are due to communication.
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So this group of tools is a way for healthcare professionals to speak the same language.
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So if we all learn team steps, we know a huddle.
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We know that anyone can ask for a huddle if we think that there's a a breakdown in communication.
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We know how to respond to conflict when it might be, you know, there might be hierarchical issues by using a cuss.
00:14:03.519 --> 00:14:10.240
As soon as you say I'm concerned, if you've been trained in team steps, the other person knows, okay, something important is going on.
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I need to stop what I'm doing and figure out what the problem is.
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That's a different cuss than I use in communication breakdowns.
00:14:20.720 --> 00:14:35.919
So when you're when you're kind of researching some of those communication skills, teamwork skills, tell us a little bit about how you've been able to incorporate video and the types of things that you're looking for in video.
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Sure.
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I think video and simulation kind of go hand in hand.
00:14:45.360 --> 00:15:06.399
Um for our any of our simulations, if they're uniprofessional or interprofessional, we use it for pre-briefing, for preparing our students for simulation, we use it during simulation so that our facilitators can watch what's happening, but we also have other students who are observing.
00:15:06.639 --> 00:15:14.799
And then we use it in debriefing as a way to help students see something they may not have noticed during the scenario.
00:15:15.279 --> 00:15:23.120
Um in our interprofessional um simulations, it's usually about communication.
00:15:23.279 --> 00:15:25.600
That's usually what those scenarios are about.
00:15:25.919 --> 00:15:40.399
So sometimes it's it's seeing like, okay, you're from two different professions, you're standing at two different sides of the room and kind of like taking turns talking to the patient instead of integrating what you're doing and working together.
00:15:44.480 --> 00:15:54.159
And so the benefit of the video then is to be able to watch the simulation live and then to use it for reflection afterwards.
00:15:54.320 --> 00:16:14.559
And then again, I keep harping on research, but for us, we probably are doing research on that simulation scenario, and that gives us the ability to have observer rating of performance, which makes the research much stronger than if we were just taking a survey from a participant.
00:16:14.960 --> 00:16:22.639
So when you mention observer rating, are you doing like interrater reliability studies and the collected data?
00:16:23.120 --> 00:16:25.440
Yeah, so we definitely can do that.
00:16:25.600 --> 00:16:33.440
If we have the recording, we can have as many people watch and rate to make sure that we're we have inner rater reliability.
00:16:33.840 --> 00:16:39.039
I know there's been uh a fair amount of work on um and research.
00:16:39.200 --> 00:16:51.759
Well, maybe not a lot of research, but um, where the observers can gain just as much learning experience as participants in the so-called hot seat, right, in the simulation.
00:16:52.000 --> 00:16:55.279
What's your what's been your experience from that perspective?
00:16:55.840 --> 00:16:56.080
Sure.
00:16:56.240 --> 00:17:16.160
So we actually have done research on that here at the University of Buffalo, and both of our studies have shown that our observers have equal um knowledge gain and satisfaction and self-confidence and learning as the students who were active in the simulation.
00:17:16.640 --> 00:17:22.079
I think part of it is probably um cognitive load.
00:17:22.240 --> 00:17:28.960
So there is some anxiety going into a simulation when you're kind of you said in the hot seat.
00:17:29.839 --> 00:17:32.640
Um, I think you kind of get at it right, like that.
00:17:32.880 --> 00:17:46.559
There is um some increase in cognitive load, which means that your brain cannot take in as much new information as the observer who's sitting there watching, they can take everything in.
00:17:46.799 --> 00:17:50.319
So we really think that that's part of the reasoning for that.
00:17:50.480 --> 00:17:52.880
And that's why we kind of do a balance.
00:17:53.039 --> 00:18:06.640
When we bring students in for simulation, we will bring in um a group of eight and we will do three different simulation scenarios and have them take turns being active or observing.
00:18:06.960 --> 00:18:17.119
Do you find from an observer perspective, is there more to be gained from watching a recorded video versus watching a live scenario?
00:18:17.440 --> 00:18:22.640
I would say that the difference would be in what happens afterwards.
00:18:22.880 --> 00:18:27.359
So if you're watching a recording, are you going to debrief right afterwards?
00:18:27.599 --> 00:18:30.799
Because that's where like the learning occurs.
00:18:31.119 --> 00:18:37.279
Usually, if you're watching it live, the students are going to come right back out and you're all going to debrief together.
00:18:37.440 --> 00:18:40.720
And so you get that whole experience.
00:18:41.039 --> 00:18:49.599
Um, if you're watching it recorded, I'm wondering if that means it's more of like an asynchronous thing and you might not get that same experience.
00:18:50.000 --> 00:18:51.039
Are you familiar?
00:18:51.279 --> 00:18:55.039
I've I've heard the term you observe what you focus on.
00:18:55.279 --> 00:19:07.839
And there was this famous video where there's three or four people that are tossing a ball around, and there's a gorilla, a man in a gorilla suit that walks behind them.
00:19:08.079 --> 00:19:15.359
Well, the observer is is basically instructed to watch how they pass the ball around.
00:19:15.680 --> 00:19:22.880
And so they're focused on those individuals, and they never realize they never see the gorilla behind them.
00:19:23.440 --> 00:19:38.319
And but when you are watching the video, you have the opportunity to you have the element of time because you can stop the video, you can review the video, you can see things that you may not see in the moment because of what you're focused in on.
00:19:38.400 --> 00:19:42.400
And I'm kind of curious what your thoughts are on that something like that.
00:19:42.880 --> 00:19:57.599
Yeah, I think that there probably is some truth to that, but we also think uh we also use the terminology focused observer in a different way that might make a difference.
00:19:57.839 --> 00:20:11.279
Um, we will actually, like thinking about our team step simulations with an interprofessional audience, we will have five students in the room and um ten watching.
00:20:11.440 --> 00:20:24.880
Those 10 students who are watching, we give an observer tool too with the team steps tools, asking them if they see any of them used or if they see a situation where one could have been used but wasn't.
00:20:25.039 --> 00:20:30.799
So we kind of are focusing them in on what we want them to be looking at.
00:20:31.839 --> 00:20:45.599
What was your um I'm kind of curious, Kelly, your involvement when the when you started using video at University of Buffalo, I'm sure you were very instrumental in the design of the system.
00:20:45.759 --> 00:20:52.480
What were some of the thoughts, thought processes that uh you had in terms of designing that system?
00:20:53.440 --> 00:21:08.079
Well, I will tell you uh when I got to the University of Buffalo, they were using a casino security system for video and simulation and um and burning DVDs.
00:21:09.359 --> 00:21:25.039
So everything recorded 24 hours a day in our health assessment lab in our simulation rooms, and then if you wanted to keep something, you would actually have to pull it off and burn it onto a DVD, which then later we were upgrading to a flash drive.
00:21:25.359 --> 00:21:31.119
But if we wanted to go back and look at something, it is like hitting the rewind.
00:21:31.920 --> 00:21:38.000
Um it was really time intensive, it was not easy to use.
00:21:38.480 --> 00:21:46.480
And when there was a power outage, sometimes it would um it would break and things would have to be replaced.
00:21:46.720 --> 00:21:59.759
Um, so when we were looking for a new video system, obviously I wanted something that was updated, but my biggest um need, the one thing that I was looking for is the ability to annotate.
00:22:00.559 --> 00:22:13.359
So when we're watching a simulation, we can put the marker in and then easily use that video during debriefing to show, like, okay, what were you thinking in this spot of the simulation?
00:22:13.519 --> 00:22:19.119
Um, having that ability just really, really, really helps.
00:22:22.160 --> 00:22:25.279
Do you do you record all the simulations?
00:22:25.599 --> 00:22:26.559
No, we do not.
00:22:26.880 --> 00:22:28.000
What's the reasoning for that?
00:22:28.079 --> 00:22:30.640
What makes you decide whether to record or not record?
00:22:31.039 --> 00:22:35.039
So it really depends on the purpose of the simulation.
00:22:35.519 --> 00:22:41.759
Um we will almost always be streaming the video.
00:22:42.480 --> 00:22:53.039
If we're not using it for research purposes or if it's not something that's being graded summatively, we don't necessarily always record it.
00:22:53.119 --> 00:22:58.480
And a lot of our simulation is done um with formative evaluation.
00:22:59.759 --> 00:23:01.920
So we aren't we aren't grading them.
00:23:02.000 --> 00:23:08.400
We're looking at at how they perform and how they really react during debriefing.
00:23:08.799 --> 00:23:17.119
When you mentioned formative evaluation, can you define that a little bit more for our listeners?
00:23:17.519 --> 00:23:18.000
Sure.
00:23:18.240 --> 00:23:22.720
So formative and summative would be the two different types of evaluation.
00:23:22.799 --> 00:23:26.799
And summative is where you are giving someone a grade.
00:23:26.960 --> 00:23:38.400
So it can be used as when you think of high-stakes testing, so like at end of the course exam, head-to-toe assessment, that's summative evaluation.
00:23:38.720 --> 00:23:43.119
Formative is more of looking at overall quality.
00:23:43.359 --> 00:23:51.759
And in our in our um context, we do it more as like a participation than participating.
00:23:51.839 --> 00:23:55.119
Um, but that's really the difference between formative and summative.
00:23:55.200 --> 00:23:58.079
We're not giving them a grade in formative.
00:23:58.720 --> 00:24:04.160
So the formative assessment is building skills towards that summative assessment.
00:24:04.720 --> 00:24:10.240
In some cases, we actually don't use summative at the end of every course.
00:24:10.400 --> 00:24:12.319
So it might not be.
00:24:12.559 --> 00:24:17.680
Um, but we definitely do scaffolding.
00:24:17.839 --> 00:24:35.440
So what that means is we kind of start smaller with more um kind of beginning, easier skills, and then kind of put them together and make our simulations more complex as uh time goes on as our students move through the program.
00:24:36.000 --> 00:24:44.960
Um so we don't always need a summative assessment as long as they're progressing through those different stages.
00:24:45.440 --> 00:24:55.119
As you've kind of modernized your video system from the old DVD kind of technology, what challenges have you experienced?
00:24:55.519 --> 00:25:05.200
I mean, there's definitely challenges with people getting to know the system, um, which you're gonna have whenever you implement something new.
00:25:05.440 --> 00:25:23.759
Um I don't think anyone knew how to use the casino security system, but when we got when we got Vault, um people wanted to use it, so we had more people who we had to kind of get up to speed on how to use it.
00:25:24.160 --> 00:25:30.319
Um other than that, I mean we have kind of some of the same challenges.
00:25:30.480 --> 00:25:43.039
Not everyone wants to be recorded, it does, you know, cause some anxiety sometimes, but beyond that, um nothing that's really stands out.
00:25:43.440 --> 00:25:52.960
This kind of pulling back to the observer versus participant, where you were saying, you know, stress of being the participant could impact their learning.
00:25:53.119 --> 00:25:57.599
Is the observation there simply to supplement that?
00:25:58.960 --> 00:25:59.279
No.
00:25:59.519 --> 00:26:05.359
So the observation for us is a way to get more students through simulation.
00:26:05.599 --> 00:26:08.960
So I'm sure that you've heard that there's a nursing shortage.
00:26:10.160 --> 00:26:16.319
I feel like there's always been a nursing shortage, but there's really a nursing shortage right now.
00:26:16.480 --> 00:26:23.519
And we really need to increase enrollment and get some more nurses out there into the workforce.
00:26:23.839 --> 00:26:31.920
But the big thing that is keeping that enrollment down is the lack of clinical sites, the lack of faculty.
00:26:32.319 --> 00:26:45.039
And um, here in New York State in 2023, we passed legislation to allow for one-third of clinical hours to be done through simulation in New York State.
00:26:45.359 --> 00:27:00.559
And that simulation counts if you're in the active or the observer role, as long as it's part of you have the whole process of pre-briefing, the simulation scenario, debriefing.
00:27:00.960 --> 00:27:16.480
Um, so for us to be able to get eight students through one session of simulation versus the two to three who would go in at one time, that is really why we have the observer role.
00:27:16.559 --> 00:27:23.359
And then we make them focus to make sure that they're um getting everything that they need out of it.
00:27:23.519 --> 00:27:25.920
And of course, we debrief everyone together.
00:27:26.079 --> 00:27:33.599
But for us, it has allowed us to increase our numbers of students in simulation.
00:27:34.799 --> 00:27:55.519
That actually is an interesting comment because I was going to ask you a question in terms of uh a lot of the folks that we speak with have had challenges in terms of convincing stakeholders in universities to invest in some of these video systems, which it can represent a significant investment.
00:27:56.000 --> 00:28:02.240
Um but with the legislation I know in New York and and other states, um as well.
00:28:02.400 --> 00:28:16.240
What what are some of your thoughts on helping clients that are having challenges convincing their stakeholders that video is a valuable and integral component of simulation?
00:28:17.119 --> 00:28:26.880
I think in the current environment, telling them that they can get more students in using video is probably the biggest selling point.
00:28:27.119 --> 00:28:39.039
I mean, we can talk about the numbers that we put through before having observers compared to the number that we have now, and that's like a a really clear metric to show.
00:28:39.200 --> 00:28:45.200
Um, I mean, we can definitely show the value from the research that we've done.
00:28:45.359 --> 00:28:57.279
We can show the value in our student evaluations, but being able to show them that ability to get more students through kind of is more important than anything else.
00:28:57.680 --> 00:29:15.680
Before we wrap up, one one question I'd like to ask is if our listeners are in a position where they're involved with either designing a new video system or or evaluating a new video system, what kind of guidance would you provide them?
00:29:16.160 --> 00:29:29.119
I think with any any new system that you're implementing, start with a needs assessment, looking at what your objectives are, what you're going to be using it for.
00:29:29.599 --> 00:29:56.480
Um and I I think in the simulation world, having a system that has functions that are specific to simulation is really important because you can get A V systems for casino that will work fine, but they're not going to have those extra features that really make your simulation special and much better.
00:29:56.720 --> 00:30:11.119
Um, and then I also like to talk to other people who maybe have just implemented their systems to see um what advice they have and how they like whatever they chose.
00:30:11.680 --> 00:30:26.160
Well, Kelly, you've really brought to the podcast today not only a wealth of technical expertise and nursing expertise, but the ability to kind of tie both of those together, which is I think a very unique position.
00:30:26.480 --> 00:30:35.440
If any of our listeners were interested in getting in touch with you, any follow-up questions kind of based on what we talked about, um, is there a good way for them to do that?
00:30:35.839 --> 00:30:43.839
Yes, probably my email is the the best way, and that's Folts F O L T Z at Buffalo.edu.
00:30:44.400 --> 00:30:45.759
Well, thank you very much, Kelly.
00:30:45.839 --> 00:30:48.880
This has been an awesome conversation.
00:30:50.720 --> 00:30:58.400
OnRecord is a podcast presented by Intelligent Video Solutions, hosted by Mike Anzolone and Carmen Hawk, and produced by Kyle Shellstead.
00:30:58.559 --> 00:31:05.680
Find us online at ipivs.com slash on record and on social media at Intelligent Video Solutions.
