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>>SINGER: Hi, my name is Steve Singer, I'm the Vice President for Education and Outreach at the Accreditation Council for Continuing Medical Education. My guest is Clara Schroedl. She's a pulmonary and critical care physician, at the Northwestern University Feinberg School of Medicine, where she is the Medical Director for CME. We're going to talk today about simulation as a great educational opportunity to address all sorts of different clinical issues. Hi, Clara, how are you?

>>SCHROEDL: I'm great, thanks.

>>SINGER: Thanks for being here.

>>SCHROEDL: Of course.

>>SINGER: Let's start by talking about the role that you have at Northwestern.

>>SCHROEDL: Sure. For about the last year, I've been the medical director for CME. It's a new position for me. I've always been very interested in medical education as I went through my medical training. I also am a pulmonary and critical care physician. So in my role as the Medical Director for CME, I've taken on a lot of things that I think are interesting moving forward. One of them is trying to improve the educational impact of some of our CME activities, and one way that we're hoping to do that is through the use of simulation.

>>SINGER: Okay. So when you say simulation, I think of some specific things, but your... The world of things that you do with simulation at Northwestern. Tell us about the medium, what is it, how does it work, what are some of the constructs of it?

>>SCHROEDL: Sure. So it can be anything from very low tech to very high-tech. And at Northwestern we have a really wonderful simulation laboratory, where we have all kinds of different scenarios that we are able to simulate or create. And we train everyone from medical students through attending physicians, respiratory therapists, nurses, everyone really within...

>>SINGER: So the whole healthcare team can be involved.

>>SCHROEDL: Absolutely, and really it's limitless as far as the things that you could simulate. The really easy and straightforward things are going to be a procedure. So, a surgeon who has to learn how to do a laparoscopic procedure, for example, they can come into the simulation lab, have tools that are exactly the same as they would use in the operating room, and really go through every single step that is required for them to be able to be competent to perform a surgery on an actual patient.

>>SINGER: Okay.

>>SCHROEDL: But you could also envision other types of scenarios. For example, what about team training? So maybe taking in a nurse and a respiratory therapist and a physician into a room and working on a critically ill patient, and simulating the critical illness and how the team members all interact with each other, or providing feedback between a patient actor and maybe a physician and how they're communicating with each other. So you can simulate a scenario, then provide feedback to the physician, whoever it is that's in that scenario, such that they can change their behavior, reach some level of learning that you would deem to be appropriate for them to then be able to take back into the clinical practice.

>>SINGER: Okay. You mentioned the laboratory in sort of the classical sense. You're taking something sort of out of practice, and you're working it like a muscle in the laboratory. And you mentioned a couple things about the methodology, which I think are very interesting for people who might not be familiar with simulation. So that physically in the space, there's a theater of sorts where you... Where the action is taking place but behind the scenes, there's a control room, right?

>>SCHROEDL: Yeah, so let's take an example. So, maybe we teach ACLS or advanced cardiac life support for example. So we have a simulated environment with a mannequin, monitors. Just like it would be, maybe if you were in the emergency room and somebody was having a cardiac arrest. And you have your team members there performing life support on this patient. And then behind the scenes, you have people who are controlling the actual patient and what's happening. So their vital signs, whether or not they have a pulse. What type of a heart rhythm maybe they have, as well as being able to provide things such as maybe it's important to know if a certain laboratory value was coming back during the process of this cardiac arrest.

>>SINGER: So all that information.

>>SCHROEDL: All the information, really anything that you could imagine happening in a real scenario, we're creating in a laboratory or simulated environment, all the data, all the monitoring, all the feedback related to the patient, everything that's happening.

>>SINGER: Who plans this? Because it sounds like you have to have sort of a plan or a script to go. So how does that work?

>>SCHROEDL: So it's done in combination. You need somebody who's a content expert. So if you're planning to do a scenario that is very specific to neurosurgery, you're going to need somebody from neurosurgery, who has the expertise with the exact problem that you're trying to solve, or a situation that you're trying to help your learners get better at. But they work very closely with some of our technicians within the simulation lab, because they're the ones that really have the expertise with the equipment, what is possible, what type of additional equipment do we need to bring in or how do we make this as high-fidelity as we need it to be, to really simulate what the real environment is like.

>>SINGER: Wow, okay. So then in addition, because I've visited your center. You have microphones, and cameras. The place where this simulation is taking place is also being recorded?

>>SCHROEDL: Correct.

>>SINGER: And then you have other rooms. Can you tell us about what happens after the simulation is over?

>>SCHROEDL: Yeah. So one of the most important things about simulation is going to be the debriefing period. And so going through a scenario is not really enough to reach the academic mark that we would like to reach to say that somebody is really good or competent at a certain skill. What you really need is the debriefing afterwards, so that you can allow the learner to see what they did, mistakes they made, and then really receive directed feedback about those specific situations, so that they can improve their performance. So you can go back into that simulated environment and let them try again.

>>SINGER: To see if, did you do it better? Did you do it differently?

>>SCHROEDL: Exactly. Based on the feedback that they got. And it really means something to see yourself and see yourself stumbling or making mistakes in a very safe environment, where you feel okay to make a mistake, because it's not in a patient scenario. Maybe you're not being judged by your peers necessarily, it's really directed specifically towards your learning and then you can go back and fix the things that you really want to work on so that you're better when you go back into the real environment.

>>SINGER: Great. I'm sure that that in the community of educators, the community of accredited CME providers, there are institutions that have very mature and well-developed, well-resourced simulation centers and tools, and I'm sure that there are those that maybe don't. So, can you, just to close out this video, can you give some suggestions about sort of where to start or... because I would imagine that the high fidelity and the high-tech simulation is wonderful, but it's not necessarily required. There are other things that you could do, so where would you start if you were?

>>SCHROEDL: Yeah. I think one of two things, it depends if you have a scenario that you think would really lend itself well to a simulation. You may reach out to simulation centers like our own. We are often putting on simulations for people that are not part of our institution.

>>SINGER: Okay, so people can collaborate.

>>SCHROEDL: Absolutely.

>>SINGER: That's one opportunity, okay.

>>SCHROEDL: The Chicago Fire Department, for example, has used our simulation lab to simulate some of the things required for the EMS, bringing people into the hospital. And so that's always an option, and we can help walk through and help you create the scenario that you want for your learners. But then the thinking about the use of simulation is really just a very active learning strategy. It doesn't have to be this high fidelity, expensive environment that you're in with cameras and mics and all of that. It's really just the idea that you can use an active learning strategy hands-on, give feedback to people as they're actually doing some sort of a demonstration or a simulated conversation. What about just a difficult conversation? Physicians can struggle having conversations with patients, for example, delivering bad news. So could you envision a scenario- It doesn't require anything more than people and time and space, to sit down and simulate a physician providing a bad news diagnosis to a patient, and have somebody in that environment who's really good at communication, maybe one of our palliative care physicians, and then providing feedback to that physician or whatever learner you have about that interaction and what worked well.

>>SINGER: So the same methodology...

>>SCHROEDL: Same methodology.

>>SINGER: Just with a different approach.

>>SCHROEDL: Exactly. You don't need all the high-tech things for certain environments. Obviously, if you want to simulate a very high-tech robotic surgery, you're going to need the equipment to be able to do that.

>>SINGER: Of course, of course. Thank you very much.

>>SCHROEDL: Of course