Simulation at Yale 2022: Adapting to the changing educational and health care landscape

January 28, 2022

Information

The panel discussion will focus on the simulation curriculum for Yale medical students from their first week of medical school until graduation as well as the role of simulation education during the COVID pandemic. Simulation fellows and Yale medical students join the panel discussion.

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00:13Welcome to simulation at Yale 2022.
00:17Adapting to the changing educational
00:19and healthcare landscape,
00:21there will be time for Q&A.
00:23At the end of the session,
00:24please use the chat feature
00:26at the bottom of your screen
00:27to submit any questions.
00:29This session is being recorded.
00:35Hello and welcome to the second
00:37webinar in our inaugural innovation
00:39in Medical Education series.
00:41As you just heard,
00:43today's topic is simulation at Yale in 2022.
00:46Adapting to the changing educational and
00:49healthcare landscape I am Jessica Lucy,
00:51the deputy Dean for education at
00:53the School of Medicine and I want
00:55to thank you for taking time out
00:56of your day to join us for an in
00:59depth presentation and discussion
01:00of how innovations and stimulation
01:02are being used in our curriculum.
01:04To enhance learning.
01:06With health care and educational technology
01:09changing at such a rapid pace, we are.
01:13We are prioritizing our
01:15investment in our faculty,
01:16students and curriculum to ensure Yale School
01:19of Medicine is a leader in this space,
01:22I'd now like to introduce Michael Schwartz,
01:24our associate Dean,
01:26for the curriculum and newly appointed
01:28Director of Innovation in Medical Education.
01:31Mike is leading our efforts to re
01:33Envision and expand how we use
01:35technology and other tools to meet the
01:38needs of our changing learners in an
01:40ever evolving healthcare landscape.
01:42With that I'll turn it over to Mike.
01:45Thanks, Mike.
01:46Thank you Jessica and thank you to
01:48all of you for joining us tonight.
01:50I'm I'm very excited to be able to
01:53introduce this second session in our series,
01:55which will focus, as Jessica mentioned
01:58on simulation and medical education.
02:01Tonight you will hear and experience how
02:03simulation has been integrated across
02:05all phases of our medical educational
02:07programs and you'll hear about the
02:10creativity and the leadership that
02:11the simulation team has brought not
02:14only to medical education at Yale,
02:16but also across the country and
02:18even to our community in New Haven.
02:20Through innovative outreach programs.
02:22To lead us on this journey of
02:25innovation and creativity,
02:27it is my great pleasure
02:29to introduce Lee Evans.
02:31Doctor Lee Evans is the inaugural director
02:33of the Yale Center for Medical Simulation,
02:36which he founded in 2015.
02:38Lee is an associate professor.
02:41In simulation section,
02:42chief and emergency medicine at Yale
02:45School of Medicine and she's been the
02:47executive director of the Yale Center
02:49for Medical Education since its inception.
02:52She has been the recipient
02:53of multiple teaching awards,
02:54including the Banfa Teaching Award,
02:57the Alvan,
02:58Feinstein Teaching Award,
02:59and she is currently the principal
03:02investigator of an AHRQ grant
03:05focused on adaptive simulation
03:07interventions to reduce COVID induced
03:09stress on health care workers.
03:12So it's not to take away from this great
03:14the time of this great presentation,
03:16Lee.
03:16I'm going to turn the baton over to you.
03:20OK, thanks Mike.
03:21I'm going to share my screen.
03:36So thank you for joining us for
03:38the 2nd innovations in Medical
03:40Education Webinar tonight.
03:41The faculty at the Yale Center
03:43for Medical Simulation and three
03:45medical students plan to expose you
03:47to all of the innovative simulation
03:49opportunities we offer for our students.
03:52In 2009, Chesley Sullenberger was able
03:54to do an emergency landing of his US
03:57Airways plane on the Hudson River,
03:59saving the lives of many of his passengers.
04:02He attributed his success to his extensive
04:05previous simulated flight training.
04:07Similarly, we at the Yale Center for
04:10Medical Simulation use simulation
04:11education to train students to primarily
04:14manage acute clinical problems in a
04:17patient safe environment that they
04:19would never have the opportunity
04:21to do in the hospital setting.
04:23The mission of the Yale Center for
04:25Medical Simulation is to provide
04:27excellent patient care and health
04:29care delivery through innovative
04:30medical education assessment,
04:32research and outreach.
04:35Earlier this month we received
04:37notification that Yale Center for
04:39Medical Simulation has received
04:41full accreditation from the Society
04:43for Simulation and Health Care.
04:44In all, 5 program Areas,
04:47Assessment fellowship,
04:48research systems integration and teaching,
04:52and education.
04:55The Yale Center for Medical Simulation
04:57is located at 728 Howard Ave,
04:59one block away from both the
05:01Sterling Hall of Medicine and the
05:02York Street campus of Yale,
05:04New Haven Hospital.
05:05This provides an ideal location
05:07for easy access to the Center
05:09for medical students during their
05:11entire four years of medical school.
05:13Our state of the art facility
05:14opened in January of 2015.
05:18I traveled throughout the country to visit
05:20multiple different simulation centers.
05:21When we're in the process
05:23of developing our plan,
05:24we eventually chose to hire HGA
05:26architects from Minneapolis,
05:28who also built the simulation
05:30center at the Mayo Clinic.
05:32YCMS is a 5000 square foot space.
05:34I'm not going to take you on a virtual tour.
05:39Our interest is on Howard Ave and
05:41students are able to gain access
05:43to YCMS with their Yale ID's.
05:45We have three full time staff members,
05:47Joy Grabo, our simulation supervisor
05:50Luis Cruz and Jeff Hoffman are
05:53simulation operation specialists.
05:55There are four simulation rooms
05:56in each room there is a high
05:59fidelity manikin simulator.
06:00Their computer controlled mechanical
06:02simulators that mimic human Physiology and
06:05display symptoms and disease processes.
06:08As they present in an actual patient,
06:10they can speak, blink their eyes.
06:13They have palpable pulses,
06:14lung and heart sounds.
06:16During the scenario,
06:17there is a faculty member in the control
06:20room along with a simulation specialist.
06:22Yale faculty do not require sophisticated
06:25simulation computer skills to use YCMS.
06:28We create the computer programming
06:30based on their learning objectives.
06:32We have designed over 200 scenarios with
06:35learning objectives and critical actions.
06:38Critical actions are divided into
06:40clinical management and teamwork
06:42and communication categories.
06:44We included a simulated OR scrub room
06:46for students to practice learning how
06:48to enter the OR during the pre suit
06:50precede for their surgery clerkships.
06:57Our procedure room allows students to
06:59practice a variety of invasive procedures.
07:01We have all the ultrasound machines
07:03available to students in the hospital.
07:06And students use partial task trainers.
07:09To perform slit lamp exams practice
07:13advanced airway management.
07:15Lumbar punctures central venous catheter
07:19insertions and ultrasound guided Ivs.
07:28Our pediatric simulations require
07:30the most diverse group of simulators.
07:33We have a newborn infant and
07:36child high fidelity simulators.
07:38We also have a SIM mom for
07:40obstetrical emergencies.
07:41We have all of the required equipment
07:43for management of pediatric patients.
07:51So in 2022, the key question facing medical
07:54educators is who controls medical education?
07:58It is becoming more and more clear that
08:00medical students want to control the
08:02sources of their education and be more
08:04involved in the self learning process
08:05early in their medical education.
08:08Students are outsourcing their.
08:12Formal curriculum with additional
08:13resources like boards and beyond.
08:15Lectures, Anki, flash cards, etc.
08:19Simulation training offers students
08:21unique educational opportunities not
08:23available online yet still designed
08:25and taught by Yale faculty both in
08:27the pre clerkship curriculum and
08:29while on the clinical services.
08:34The COVID pandemic posed a
08:36challenge to Yale Medical School,
08:38and Weiss EMS responded to this
08:40challenge in March of 2020,
08:42medical schools across the country
08:44needed to temporarily suspend hospital
08:46based clerkship rotations due to
08:48both the potential shortage of PPE
08:50and the need for social distancing.
08:52Yale Medical School responded by offering
08:55electives to the clerkship students.
08:58We created a six week course for 48
09:02students while YCMS was closed to in person.
09:04Learning.
09:05The course immediately fill.
09:09We converted our high fidelity manikin
09:11simulation into a fully online
09:13virtual Tele simulation format.
09:15We were able to provide an immersive
09:18Tele simulation curriculum
09:19for widely dispersed students.
09:21Some of the students in this.
09:24Simulation encounter we're in New Haven,
09:26others were in Los Angeles,
09:27and some were in New York City.
09:29We used a zoom platform and the
09:32students communicated with each
09:34other and the nurse using the
09:35chat box as seen on the right.
09:38Students participated in 12
09:40scenarios over these six weeks.
09:42We use scenarios from our scenario
09:44banks so that we didn't disrupt
09:46the curriculum for students when
09:47they returned to their clerkships.
09:49We determined that the maximum
09:51number of students participating
09:53in a virtual simulation was three.
09:56We were able to disseminate
09:57our virtual program.
09:58During the course,
10:00we invited medical educators
10:01from the 13 school consortium
10:04to observe a Tele simulation.
10:06We presented the program at the
10:09international webinar organized
10:10through Cornell Weill Medical School.
10:12And we offered a workshop on medical
10:15student to stimulation during
10:16last year's international meeting
10:18for stimulation and health care.
10:20We published our program as an
10:22innovative report in academic
10:24medicine in October of 2021.
10:27So we'd like to spend the remainder
10:29of this evening highlighting how YCMS
10:32meets its missions in the areas of education,
10:34research, and outreach.
10:38Yale School of Medicine has the largest
10:41high fidelity manikin simulation
10:43curriculum of any US medical school.
10:46All medical students matriculate ING this
10:48year in 2021 will care for at least 39
10:52stimulated patients prior to graduation.
10:55These acutely ill patients have diagnosis,
10:57ranging from an acute MI ruptured
11:00abdominal aortic aneurysm gunshot
11:02wound to the chest and eclampsia.
11:05They not only need to manage the patient,
11:07but they also must consult the
11:09appropriate inpatient service and
11:11explain to the patient and family
11:13members the diagnosis and plan.
11:15Because of the acuity of illness,
11:17students would never be able to primarily
11:19manage these patients in the hospital.
11:21If they choose to do a simulation elective
11:24during the final 18 months of medical school,
11:26they will participate in an
11:28additional 25 scenarios.
11:32During the first two weeks of medical school,
11:34all of the students take care
11:36of their first patient at YCMS.
11:40Nancy Angoff, the prior Dean of students,
11:43initially approached me about including
11:44a simulation in I Pro in order to
11:47instill a sense of professionalism
11:48in the students by taking care of a
11:50quote patient early in their career.
11:52We weren't certain how it would be received,
11:54or if they would have the skills
11:56necessary to care for a patient.
11:58The students have been consistently
12:00outstanding in their empathy
12:01and bedside manner,
12:03so that now the simulation is
12:05an integral part of the course.
12:07Just a few of the comments by
12:10medical students this year.
12:11This was one of the highlights of a I pro.
12:14It was an incredibly uncomfortable
12:15initially being thrown in as the
12:18simulated patients physicians,
12:19but it was incredibly meaningful.
12:21It was an emotional experience
12:22that helped me understand what it's
12:24like to not know the answers and
12:26still be able to respond to the
12:27patient the needs of the patients.
12:2910 out of 10 recommend for future
12:32I Pro courses. This was amazing.
12:34It was the moment that made medical school
12:37really feel most real for me so far.
12:39I absolutely loved the ability to get
12:41started to start getting experience
12:44within the clinical typesetting,
12:45receive personalized and helpful feedback,
12:48and work to try to apply what we already
12:50started learning over the past two weeks.
12:52I can't wait to get back in there.
12:57Consistent feedback from students has been
12:59that they want more stimulation during the
13:02pre clerkship portion of medical school.
13:04This year we have started a pre clerkship
13:07curriculum led by Doctor Sam Buck,
13:09a new member of the YCMS faculty who just
13:12completed a Sam simulation faculty Dr
13:14Bucks not able to be here tonight because
13:17he's at Disney World with his family.
13:19And the students are going to be
13:22participating in eight cases throughout
13:24the pre clerkship curriculum.
13:266 cases during their first year
13:28and two during the second year.
13:30They have been integrated into
13:32the master courses.
13:34Doctor Buck and I have collaborated with
13:36the Master course directors to determine
13:38educational goals and objectives.
13:40The Scientifics Foundation master course
13:43held its first simulation in the fall,
13:46where students manage an infant with
13:49an inboard error of metabolism.
13:52The cases are designed to illustrate clinical
13:55presentations of recent course material.
13:57It has integrated Physiology and
13:59pharmacology built into each scenario.
14:02The communication objectives can
14:03include anything from addressing.
14:05Challenging social interactions,
14:06can fresh,
14:07confronting inequities in medicine
14:09and health counseling for patients
14:12during the debriefing session,
14:13all of the relevant Physiology and
14:16pathology for each case or distance
14:18guest as well as communication,
14:20critical thinking,
14:21teamwork and professionalism.
14:27We needed to advise us we needed to
14:29devise a format to be able to have
14:32the entire class participate in
14:33these scenarios and one afternoon
14:35we devised a format where in which
14:38we simultaneously run 4 rooms with
14:41four students in each room in the
14:43clinical evaluation group at YCMS
14:46and the remaining 12 students in
14:48a virtual clinical reasoning group
14:49led by a faculty facilitator.
14:51This has allows us to have
14:53the entire class go through.
14:55A simulation in one afternoon
14:56in proximity to what they're
14:57learning in the classroom.
15:01This is a video clip from our first
15:04simulation session last fall.
15:05In the background is a mother with
15:08her newborn baby who presents with
15:10lethargy and poor peel intake.
15:12Students are reviewing the lab
15:14results and are about to realize the
15:16baby has an elevated ammonia level.
15:20So somewhat normal, yeah.
15:22Open any changes.
15:24Is there some reactive?
15:29Lactic acid Tony.
15:35We're gonna notice that they all pull out
15:37their iPhones to interpret these results.
15:39We encourage them to use the electronic
15:42resources that they have available to them.
15:58Yeah, yeah. Top six so yeah.
16:13The majority of the simulation sessions
16:14occur on the clinical clerkships.
16:17Doctor Melissa Joseph,
16:18who is our director of resident simulation
16:20at YCMS and Doctor Ambrose Wong,
16:23director of Simulation Research,
16:24will discuss our clerkship
16:26simulation program.
16:32Alright, so first we're gonna
16:34start off with a video of one
16:36of the simulation scenarios that
16:38the students participated in.
16:41I don't think we'll play the whole thing,
16:43but just to give you an idea.
16:49Oh, you know what? We're not
16:50going to have audio because.
16:54Lee, do you wanna unmute yourself?
17:06I think we lost the video audio just
17:08because Doctor Evans was on mute,
17:09but that was gonna try again.
17:16There's a video clip of the
17:18group of students managing
17:20me. There we go.
17:27I'm not moving. Like
17:32that's an STL. Yeah. We talked.
17:38We'll give him aspirin. Oh God.
17:45I'll, I'll check to see if it's happening.
17:47Computer aspirin, Nitro and.
17:51Listen to this. That is called.
17:56OK, I think we can go to the next slide.
18:00So the students participate in
18:02simulation every Friday while they're on
18:04their twelve week combined
18:06M and surgery clerkship,
18:07and then additionally they participate
18:09on Tuesdays during the emergency
18:11medicine portion of their rotation.
18:13The participating groups are limited
18:14to about four to five students,
18:16so you'll typically run 2 simultaneous
18:18simulation sessions and then we'll
18:19debrief them together and it gives
18:21us an opportunity to compare what
18:22happened between the two rooms.
18:24Next slide.
18:27SIM allows the students to practice
18:30application analysis and evaluation,
18:32furthering the knowledge that
18:34they've gathered on their pre
18:35clerkship years and rotations.
18:37Beyond just understanding and remembering
18:39like they may encounter on their exams.
18:43This allows them to practice
18:44leading a patient care team before
18:46having to do so at the bedside.
18:48Next slide.
18:50In addition to application
18:51of clinical knowledge,
18:52simulation allows us to practice and
18:54debrief challenging team dynamics,
18:56important interpersonal interactions,
18:57and conversations with patients and family,
19:00and conflict resolution strategies.
19:03Students also practice consulting
19:05other services and get direct
19:07feedback and guidance on these
19:09conversations during the debrief.
19:11Next line.
19:13We can also utilize simulation
19:15to practice interprofessional E
19:16across departments and roles,
19:18and to practice theory and strategies
19:21on how to effectively lead a team.
19:23Next slide.
19:27A few example cases from their clerkships
19:29include amazing trick ischaemia case
19:31where the ideal treatment plan is for
19:33comfort care and the students must
19:35counsel the patient and her daughter.
19:36A gunshot wound to the chest that
19:38requires a chest tube and a case of
19:41interpersonal violence where they must
19:43manage an escalating significant other.
19:45They also have a case of managing atrial
19:48fibrillation with rapid ventricular
19:50response and many other scenarios.
19:52Next slide.
19:54In order to push to the next
19:56level of knowledge and to manage
19:57these challenging scenarios,
19:58we're asking the students to really
20:00step outside their comfort zone and to
20:02make mistakes and to do so in front of
20:04their peers and their teaching faculty.
20:06Thus, a sense of physiologic of
20:08psychological safety is imperative to
20:10the success of the simulation session,
20:12and we spend a dedicated session
20:14before the rotation,
20:15and then a briefer reminder before
20:17each session to discuss some
20:19of the important ground rules.
20:20The first is the basic assumption that
20:22we believe everyone participating
20:24in our activities is intelligent,
20:26capable,
20:26and cares about doing their best
20:28and wanting to improve.
20:30The second is that the sessions
20:31are all formative.
20:32They're really purely for
20:33the students growth,
20:34and they're not evaluated
20:36during these sessions.
20:37We subscribe to the Vegas
20:39Rules of Simulation.
20:40We don't discuss things that happen
20:43within the simulation outside
20:44of the group that participated.
20:46This psychological safety really allows
20:48the students to put themselves out there to,
20:51you know,
20:52make mistakes,
20:52and to really step up to the
20:55next performance level.
20:57The psychological safety is also
20:59dependent on a very skilled debrief,
21:01which is arguably the most
21:02important part of the session,
21:04and I'm going to turn it over to
21:05Doctor Wong to talk about that.
21:09Thanks Doctor Joseph,
21:10pleasure to be here and really
21:12excited to talk to you all.
21:14I'm like Doctor Joseph said debriefing is
21:16sort of our counterpart to simulation,
21:19to the immersive simulation experience
21:20and we as wise seems really feel that
21:23debriefing is in some ways even more
21:25important than the actual simulation
21:27experience itself as a way to really
21:29consolidate knowledge and a way for us
21:31to really get our future students to
21:33understand the complexity of what it's
21:35like to manage these patients in real life.
21:37And what the implications might be for them
21:39when they're actually in clinical practice.
21:42Here's an example of Doctor Barnes here,
21:43debriefing our learner group
21:45and thinking about our critical
21:48resuscitation as an example.
21:49Next slide, please.
21:51And what we really think about with
21:54debriefing is actually fundamentally
21:56driven by experiential learning,
21:59which was developed by David Cole,
22:00who was one of the pioneering educational
22:02psychologists David Cope really
22:04talked about the cycle of learning
22:06which you see here in the middle,
22:07talking about sort of the four
22:09phases of education and how that
22:11really consolidate's knowledge
22:12on the left hand side.
22:14If Doctor Evans would click once for me,
22:16is the active experimentation side.
22:18So that's really the part that's exciting
22:20when the collector students are.
22:22In that experience immersed in
22:24that psychological realism of what
22:26it's like to talk to a patient,
22:28gather a history,
22:29perform an exam,
22:31and they come up with a differential
22:32in a plan.
22:33Live in front of their peers
22:35like Doctor Joseph said,
22:36and having to discuss that with the patient,
22:39and that really generates a lot of
22:41really good excitement and emotions
22:43that we really want to consolidate.
22:45So on the left hand side is the
22:47concrete experience and the time for
22:49them to experiment in a controlled
22:50and safe way on the right hand side.
22:52Is also just as important,
22:54if not more important what we do
22:56afterwards is we take our learner
22:58groups into a safe and controlled
23:00setting in a debriefing room and what
23:03we do there is now we do some deep
23:05dive using reflective observation
23:07and also thinking conceptually
23:08about how that might extract into
23:10clinical practice in real life or
23:12when they're in their clerkships to
23:14really reflect on the experience and
23:16the emotions they have and how that
23:19actually will apply in real life.
23:21And so if we Click to the next slide.
23:24What we really want to get at are
23:26things that are not necessarily
23:27observable in in the day-to-day setting.
23:31As you're working with your country,
23:32students in the clinical realm,
23:34you can really observe what they're
23:36doing live and give them feedback
23:37about what is actually happening,
23:39but that's really what we say.
23:40The tip of the iceberg.
23:42What's really more important are
23:43the drivers underneath that we can't
23:46necessarily observe or understand,
23:47though these motivations and cognitive
23:49frames that drive behavior and
23:51the really beautiful thing about
23:53debriefing is that we get a chance
23:54to sit down with small groups.
23:56Of students and get into those
23:58mental models and really change the
24:00motivations behind their behavior so
24:02that they have an understanding of
24:05really deeper understanding of the
24:06complexity of how they make decisions
24:09and how we make decisions as faculty
24:11members to help conceptualize and sort
24:14of make those decisions concrete.
24:16So we have a video to sort of.
24:17Give an example of what debriefing
24:19would look like if Doctor Evans
24:21would mind pressing the next slide.
24:23This is actually an example
24:26of doctor teaching.
24:27Students.
24:30I've been work forward by the way
24:32very early on and I can see like
24:34like who who came up with that
24:36and why did where did that come?
24:41There was no who said that.
24:45We know that. Like
24:50collectively speaking,
24:51I think we should only eat.
24:54That's actually very sophisticated, right?
24:58It does hypoglycemia can
24:59cause someone to faint.
25:01OK, so that's something university
25:03department that every single
25:04person that comes in and fades
25:05gets that as a screening test.
25:07OK, and then this is a bit jillion
25:09times and I would say maybe three
25:11times people have checked a finger.
25:13Stick with posts without being
25:15prompted Peso that was outstanding
25:16that he came up with that.
25:24OK, thank you Doctor Wong and Doctor Joseph.
25:29The next portion I'd like
25:30to talk have be presented.
25:33Is that the Department of Pediatrics
25:36plays a significant role in education
25:38at YCMS from involvement in the
25:41pre clerkship simulation program
25:42to the response that we had with
25:45the COVID tell simulation elective.
25:47Doctor Mark Auerbach is the director
25:49of pediatric simulation at YCMS.
25:56Hi, thank you for the opportunity
25:57to share our work in Pediatrics.
25:59So I just wanted to give some experience
26:02that we have with our clerkship students
26:04during their pediatric rotation and
26:06we've been speaking a lot about other
26:08aspects of the medical school experience.
26:11So while they have exposure to Pediatrics
26:13in the preclinical and some of the other
26:16experiences that Lee had mentioned,
26:18they are able to get 8 hours of
26:20simulation in the pediatric clerkship.
26:22So four of those sessions are at the
26:24SIM Center for students only where
26:25they are in a safe environment without.
26:27Residents or interprofessional staff,
26:29such as nurses and then they do
26:31get 4 experiences where they are
26:33interprofessional over at the hospital
26:35depending upon if they're rotating
26:37on the floor or on the nick.
26:39You or in the pic you get to participate in
26:42simulation alongside residents and nurses.
26:44The cases that we cover really
26:46range the spectrum and we do have
26:48a need and have been very fortunate
26:50to be provided simulators across
26:52that developmental spectrum.
26:53So as pediatricians were always
26:55thinking about growth and development,
26:57we're fortunate to have a newborn
26:58infant sized simulator so we can do
27:01cases that range from congenital heart
27:03disease and critically ill newborn
27:04that's just delivered up through a
27:06toddler sized mannequin that can
27:08represent things like child abuse,
27:10sepsis, anaphylaxis,
27:11myocarditis and then a child sized mannequin.
27:14That's about a school age child
27:16that can represent some of those
27:17other conditions and do things like.
27:19Talking interact with the patients.
27:21We're very fortunate to have a family
27:23member present in joy who's a trained
27:25actor and really helps to bring in many
27:27of the family centered care objectives
27:28that are really critical to Pediatrics.
27:33So the learning objectives for
27:34all of our pediatric simulations
27:36do include many that doctor,
27:37Evans and others mentioned.
27:39So we have clinical decision making.
27:41Those psycho motor skills.
27:42So being able to touch and feel
27:44and do procedures,
27:45teamwork and communication,
27:46we had a simulation this afternoon with
27:48the student incident fascinating to
27:50see over the course of four sessions
27:52these were students that it really
27:54started clerkships this block and have
27:56not been in the hospital too long,
27:59but to see how they've gone from,
28:00you know,
28:01not really understanding what a team.
28:02Peter does to really starting to apply
28:04some of the tenets of teamwork and
28:06communication and then the family
28:08centered care aspects and embedding
28:09discussions with the parents that
28:11involve both empathy and the importance
28:14of ascertaining information from the parents.
28:16Please advance a element that we
28:19put in which is quite innovative in
28:22the simulation world,
28:24but something of vital importance
28:26is enhancing the diversity,
28:27equity and inclusion in the whole
28:29patient aspect of our simulations.
28:31So as an example, in today's case,
28:33when we conducted an.
28:34Asthma simulation the patient was
28:36homeless and have some discussions
28:38in our debriefing about not only the
28:41asthma and how to manage status asthmaticus,
28:44but how to integrate that patient
28:45within some of the
28:47support systems related to homelessness
28:48and legal action in New Haven. Next slide.
28:51We've also been very fortunate that the
28:54Med school this past year helped us
28:56to actually diversify our mannequins,
28:59so we were able to purchase a
29:02number of darker skin mannequins.
29:04We had an adult that have been
29:06purchased in the past,
29:07but now have a variety of pediatric
29:09mannequins that are of different skin color.
29:11Obviously that's necessary,
29:13but not sufficient.
29:14There's still more work that
29:15we have to do there,
29:17but we've integrated these objectives.
29:19As I mentioned,
29:20homelessness dealing with uninsured,
29:21dealing with racism and bias, and.
29:23Having a name that is stated in the
29:26wrong way and seeing how you can
29:28call in or call out related to that,
29:30the challenge for this and we're learning
29:32as we go along is how you integrate
29:34this with into the existing curriculum,
29:36because obviously this is a very
29:38important topic but can be really quite
29:41sensitive and needs the appropriate
29:43time to have the discussions and
29:45we're really excited that some of
29:47the leading members at the medical
29:49school that are working in this
29:50area have provided us really focused
29:52tricks and tips and teaching points.
29:54Just as we would work with a cardiologist,
29:56we've worked with the DI team to get
29:58some of those important teaching points.
30:00Next, slide.
30:02So, as was mentioned by Doctor Evans,
30:04one of the things that we did do
30:06during the pandemic was innovate.
30:07So this is a picture of my son
30:09actually overlaid and he was having a
30:11seizure during one of those clerkship
30:12simulations that we mentioned.
30:14I mean,
30:14elective simulations that we mentioned
30:16where we have parents facilitators.
30:18We did shift down to having only
30:20three students,
30:21but most of what those individuals
30:23were doing was listening,
30:24speaking and typing into zoom next slide.
30:28And during that time we were very
30:30fortunate to learn through really
30:32what is a small community like
30:34in many subspecialties?
30:36Within simulation of an innovative
30:38platform leveraging Google Slides
30:40and we're able to work with our
30:42technicians and our actors at the
30:45SIM center to allow for doing so.
30:47Looking at this slide and Lee will advance.
30:50You can actually have the sick
30:52patient come in as you would in a
30:54real experience and using Google
30:56Slides can work as a team to move
30:58equipment to conduct procedures
30:59in that virtual environment.
31:01And then move on to debriefing
31:04during the zoom session.
31:05So all our students needed and they
31:07were able to do this and have been
31:08able to do this in different places.
31:10Today we had to go back to this on
31:13the fly because of the Omicron surge
31:15and students really just need their laptop.
31:18A Google slide room and zoom so
31:20they all have that available and
31:22can do this from their home or
31:24wherever they're traveling.
31:26And that's really the setup so they're
31:28seeing their fellow students on the
31:29right side in the zoom window and on the.
31:31Left side seeing this virtual
31:34simulation experience.
31:35Next slide. So they get set up,
31:38we divide them into roles just
31:39like we would at the SIM center.
31:41And again, this was something we're
31:42pretty proud of in terms of innovation,
31:44where they still were able to go
31:46through running this case now,
31:47instead of just seeing and typing,
31:51but actually doing so,
31:52we have a little example
31:54of that in the next slide.
31:55So they divide up into teams we've
31:57come up with six rolls to try to
31:59give them all something to do.
32:00We've even put in this liquor
32:01upper role where they're going
32:02to look things up on the Internet
32:04and start to talk about what is
32:06a reliable source of information,
32:07or perhaps a less reliable source.
32:09And it's been really interesting
32:10to see them struggling through
32:12documentation and functioning in some
32:14of those more traditional nurse roles.
32:16Next slide.
32:19So again, you can simultaneously
32:21edit as you go through.
32:22We can easily cut and paste in.
32:24Our technicians have helped us with
32:27this and put things like in newborn.
32:29A newborn cart with a
32:31newborn ventilator in there.
32:32Put things like a intraosseous line
32:34and take photos of that next slide.
32:37And then here's a little bit
32:38about what it looks like,
32:40so you can press play Doctor Evans
32:41and you'll see here that the students
32:43at the blood pressure O2 SAT temp
32:45heart rate, and I'd also like to add
32:47up to move the clothes,
32:49examine the patient. The middle
32:51signs come up on the monitor,
32:52can click on the stethoscope to hear heart
32:55and lungs. Could you please don't
32:57interact and do many of the
32:59things that they would do during
33:00a real simulation
33:01center, which we're hoping to get back to. So
33:04if I take a look at his face
33:06and airway, what do I see?
33:08If you go to Slide 4,
33:10you can see a picture of what his
33:12face and upper area looks like,
33:14and if you press play you can hear
33:15an audio of his upper airway sounds.
33:18Thank you so Marley, I see a
33:20little boy who is awake and alert,
33:22is some obvious swelling around
33:23his mouth and a rash on his cheeks.
33:25This is what I hear.
33:32So so as you see, there were able to
33:34integrate some real patient videos,
33:36and during the pandemic some of these
33:38things that we've learned and using
33:39some of these videos during our in
33:41person simulations have actually been
33:43quite powerful and quite helpful.
33:44But I I think that this was really,
33:47you know, a great testament to the
33:49entirety of our team and innovating and
33:51responding to feedback from the students
33:53because the feedback from the students was,
33:56we want more pediatric simulation.
33:57We want more virtual simulation.
33:59But is there a way to do it that
34:01we can actually do more instead
34:03of just looking and speaking?
34:05So thank you for that opportunity
34:07to share that.
34:10Hey thanks mark.
34:11So as I've already mentioned,
34:13we've incorporated simulation into
34:15the first week of medical school,
34:17and now our hope is to incorporate a
34:20simulation into the end of medical school.
34:23So I've already been in discussions
34:25with Doctor Lucy about potentially
34:27incorporating a simulation
34:28curriculum into the Capstone course,
34:30and we'd like to offer it in the
34:33spring to 4th year students that
34:35have matched into clinical residency,
34:37and it will be similar to a
34:39boot camp type scenarios where
34:41these are scenarios where the.
34:43Student would be the first person called
34:45to the bedside as an intern and they
34:47would manage things like hyperkalemia,
34:49change in mental status,
34:50shortness of breath and chest pain.
34:53We're hoping to actually pilot that
34:55this spring in 2022 and add it to
34:58our curriculum in 2023 and one of our
35:00simulation fellows for next year is
35:02particularly interested in this curriculum.
35:07OK, now Doctor Wong and Doctor
35:09Joseph are going to discuss some
35:11of our research and introduce some
35:13of our students scholars that have
35:15participated in simulation research.
35:19Thanks doctor Evans.
35:20As you can imagine research and
35:23scholarship is one of the core tenants
35:25and missions of YCMS and tonight we
35:27really wanted the chance to highlight
35:29some of our students scholars.
35:31We've been very proud and excited to
35:33work with some really bright minds
35:35and some of the best students that
35:37we have at Yale School of Medicine
35:39and we wanted to highlight them with
35:41their experiences working with YCMS
35:42in some of their ongoing projects.
35:44So we'll start with Jiangsu Jiangsu started
35:47with us very early right from day one,
35:50is currently doing a fifth year project in
35:53dermatology and has interest in dermatology,
35:55but we were able to work with her earlier
35:57on and she worked with a number of our
36:00faculty members and number of projects.
36:02John see you want to get us started about
36:04your experiences doing research with
36:06us? Yeah, thank
36:07you for that introduction.
36:08My name is Gen Z as Doctor Long mentioned
36:11and I'm currently a researcher medical
36:13student in my chronological 4th year.
36:15I became interested in the YCMS work
36:17as I wanted to become involved in
36:19research that introduced sector,
36:20technology, engineering,
36:21and medical education during my
36:23first year of medical school.
36:25I first reached out and worked with
36:27Doctor Mark Arbach regarding his
36:29pediatric simulation studies and he
36:31connected me with Doctor Melissa Joseph
36:33for work and using Hexa Skin which
36:36is a wearable bio suit and we use
36:37that to measure biofeedback metrics
36:39during resident simulation sessions to
36:42determine if inoculation training has
36:44an effect on physician trainee burnout.
36:47As a medical student researcher and I
36:49was able to participate in the trial
36:51of wearable biometric shirts learned
36:53about the collaboration work with
36:55other labs and also the simulation
36:57spaces and other schools and just
37:00learn medicine and decision making.
37:02From watching the residents and simulation
37:04cases themselves when I conducted the
37:06study day today at in the simulation space.
37:09In addition to learning them,
37:11these,
37:12the cases themselves and learning
37:14research methods they today,
37:16whether it be in presenting an
37:18academic meetings or learning
37:19how to balance the surveys,
37:21I was also given the opportunity
37:22to become a coauthor in three
37:25accepted and published papers
37:26from the works with White EMS.
37:28I want to emphasize that
37:29throughout the process,
37:30I felt strongly supported by
37:32Doctor Joseph and other members
37:34and faculty of the YC&S space who
37:35treated me just like a colleague
37:37and appreciated the research and
37:38work I brought into this space.
37:40And their mentorship and support is
37:42truly the reason how we were able to get
37:45abstracts and presentations accepted
37:46at both the regional and national
37:48academic emergency medicine meetings.
37:56Thanks Jung Soo so next we are
37:59going to invite August to speak.
38:01August is currently one of our second
38:05year medical students and has been
38:07working with us very closely on HHR
38:10funded study and has been a great
38:14help to us and we're really excited
38:17to continue working with him as he
38:19just entered his clerkship years.
38:21I'm going to hand it over to you I guess.
38:24Thanks so much Melissa.
38:25Super excited to be here.
38:27Thank you all for letting me speak tonight.
38:30As was mentioned I'm a
38:31second year medical student.
38:32Very very interested in emergency
38:34medicine in the future.
38:37In terms of how I came
38:38to YCMS. So actually about five years
38:40ago I was working as an ER tech in
38:43Stamford and one day Mark Auerbach
38:45brought his pediatric simulation
38:47show on the road down to Stanford
38:49Hospital and I thought this was
38:51amazing because I'd been an EMT for
38:53years at that point and I learned.
38:55More about pediatric emergencies and how
38:57to handle them in that one day session.
39:00Then in my past years of training,
39:03I thought this is fantastic.
39:04I grabbed his business card and
39:06five years later when I ended
39:08up at Yale School of Medicine,
39:09I gave him a call and here I am and it
39:12was one of the best choices I've made.
39:15The project I'm on now is junk.
39:18You mentioned there's really exciting
39:20work happening with the hexa skins and
39:22the live biometrics and physicians,
39:24and so we've brought that actually
39:26into the emergency department and
39:27so we have a working attendings and
39:29residents wearing these hexa skins
39:31measuring their levels of stress
39:33throughout the shift and then letting
39:35them go through a simulation curriculum
39:37and then going through another few
39:39shifts of those shirts on and seeing
39:41how do their levels of stress change,
39:43particularly in the context.
39:45Of kovid and these rapidly
39:47changing guidelines,
39:48and I think we have a really exciting
39:50project that kind of lets us see
39:52how are we able to adapt and how is
39:55simulation a really powerful tool to
39:57adapting to these changing circumstances
40:00that can be very, very stressful.
40:03I think the mentor ship that I've
40:05received at YCMS is second to none.
40:07Ambrose has been working with me very,
40:09very closely.
40:10He has been amazing.
40:11He has taught me,
40:12you know,
40:13the I had absolutely no idea how
40:15to conduct this type of research.
40:17I've also involved in the qualitative
40:19research side of things.
40:20I didn't even know qualitative
40:22research existed before I came here
40:24and with the guidance I've had from
40:26him and Melissa and Doctor Evans.
40:28It's just been a really fantastic experience.
40:30I felt I feel like I've built my skills.
40:33Now I feel like I've had some unique
40:35insight into the stresses that our
40:38emergency physicians experience,
40:39and I think that's prepared me
40:41well for clerkships,
40:42and I'm just so excited to continue
40:45working with them and get to that
40:47point where I can take my fifth year of
40:49research and work even more closely with.
40:51Thanks so much.
40:54Thank you so much August.
40:56I promise I didn't pay him in advance.
40:58This so came directly from August Spring.
41:02And last but not least, Muriel,
41:04if you wouldn't mind talking a little bit
41:05about your experience working with us,
41:07Muriel is currently a fourth year student
41:09who just completed her thesis with us.
41:11Looking at some of our existing
41:13datasets at our central venous
41:15catheter training program.
41:16Take it away mural.
41:18Hi everyone, happy to be here.
41:22So as Doctor Wong mentioned,
41:24I'm a fourth year medical student.
41:25I am applying into emergency medicine
41:28residency this year and I have to say that
41:30I had not seen this presentation before.
41:32I wrote my little thing about how
41:34I became interested in simulation,
41:35but the eye procession that I went through
41:38in my first week at Yale Medical School.
41:41I thought it was the coolest thing
41:43ever and I just like from that moment.
41:46Totally loved simulation and thought
41:48it was such an amazing way to learn.
41:50I found that I integrated.
41:52Doing so well and really just gained
41:55so much from my simulation session
41:57so I was so excited about it.
41:59And as I entered the second half of my
42:02clerkship year I knew I wanted to pursue
42:04emergency medicine as my clinical specialty,
42:07so I was hoping to do my thesis
42:09research in the area of simulation
42:12and connecting medical education.
42:14I got in contact with Doctor Wong,
42:16who the research structure and I was very
42:18shortly set up with meeting with both
42:20Doctor Wong and Doctor Ray to discuss.
42:23Potential projects the faculty were
42:25so welcoming and thoughtful and
42:27they asked me detailed questions
42:29about what I was interested in,
42:30what I needed to accomplish.
42:32Because,
42:32like Doctor Wang mentioned,
42:33I did my thesis research so I had
42:35certain deadlines that needed to be met.
42:37Certain formalities Doctor Evans
42:39and doctor Bonds came on board
42:42and we decided that I would.
42:44Together I was interested in
42:45pursuing my thesis project,
42:47centering on the central venous
42:49catheter insertion training program,
42:51which is a hospital wide training
42:53program that the simulation.
42:54Center runs for incoming residents.
42:56And as Doctor Wong mentioned,
42:58there was a lot of existing
42:59data that had been previously
43:01collected for educational purposes,
43:03so it was great for my thesis project
43:05because I didn't have a ton of time to
43:07go through the data collection process.
43:08But we wrote up an IRB to do
43:11secondary data analysis of this data,
43:14and we looked at the association
43:16of trainee characteristics with
43:18outcomes in the simulation training,
43:20such as the number of like cannulation
43:22attempts to insert the catheter and like
43:25a global assessment rating of the trainees.
43:28I'm happy to say that I have
43:29successfully submitted my thesis
43:31on this topic with Doctor Evans as
43:32my faculty mentor and lots of help
43:35throughout the process from Doctor Wong,
43:37Dr Bonds and Doctor Ray.
43:39I have to say that the access to
43:42faculty mentorship guidance throughout
43:43this process has been unparalleled
43:45to anything else in my medical
43:48school experience.
43:49And we're also now in the process of
43:51writing some of this work up for to
43:54submit for peer reviewed publications.
43:56So I've had a fantastic.
43:58Experience with the Simcenter
43:59and I'm happy to be here tonight.
44:02Thank you so much Maria.
44:04I have to say we really appreciate
44:06the the strong recommendations
44:07from our student scholars,
44:09but we also feel like a lot of our
44:11research could not have happened without
44:12all of your support and hard work.
44:14So just really a big round of
44:15applause for all your students,
44:17scholars and your accomplishments.
44:21OK, thank you so much.
44:23So we want to come up now discuss
44:25our final aspect of the mission of
44:28Yale Center for Medical Simulation,
44:30which is outreach. And we are very
44:33committed to community outreach.
44:35Doctor Jay Bonds, who is the
44:37director of procedural simulation,
44:39runs the Yale Simulation Academy
44:40for New Haven High School students.
44:43So doctor bonds. She.
44:46Thank you Doctor Evans,
44:47so thank you all for being here and it's
44:50gonna be hard to top the the students.
44:53The enthusiasm that was that was terrific,
44:56but I would like to take a few more
44:58minutes of your time before we conclude
45:00and have some questions to discuss
45:02a little bit about our outreach.
45:06So we run a very robust outreach program
45:10for New Haven High School students.
45:14Doctor Richard Doesburg,
45:15who some of you probably know fairly well,
45:18was the person who initially recognized
45:20the potential of the new simulation center
45:23as a vehicle for community outreach,
45:27and he initially conceptualized it as
45:29as a mentor ship program and partnered
45:32with a former Yale College grad,
45:35Terrance Mctague, who is a local
45:38science teacher at career high school.
45:41And then he reached out to me as well.
45:44Our curriculum development and to try
45:46to put this plan in place and so we all
45:50work together and brought our first
45:53class in now about seven years ago.
45:56The population right now is career
45:58high school,
45:59which is located within walking
46:02distance of the simulation center
46:04and the hospital career high school.
46:06For those of you who don't know,
46:08is the population 91% minority?
46:1370% of the population at career qualify
46:16for free lunch and the percentage of
46:19the student body that goes on to either
46:23two or four year colleges is right above 50.
46:27Percent and so we really were hoping
46:31to select within this population a
46:33particular sort of sub population,
46:35and that was with the help of Mr Mctee,
46:39as he is affectionately known
46:40by his high school students,
46:42he was able to help us identify some
46:45of the students, not the top tier.
46:48Students at the school,
46:50because those students actually do
46:53have several advantages that are
46:55offered through other programs.
46:57But we really sort of seized on that.
46:59That middle tier student and really
47:01wanted to give them an opportunity.
47:04For this program,
47:06and so that's.
47:07Of the population that we've grabbed.
47:10Next slide.
47:14So the curriculum spans the academic year and
47:18takes place in the afternoons once per week,
47:22and the sessions last approximately
47:24a little less than two hours.
47:26About an hour and 45 minutes each session,
47:29we teach a different advanced
47:31medical procedure, such as direct
47:33laryngoscopy video, laryngoscopy,
47:35fiber optic and division suturing,
47:38central venous catheter insertion,
47:40lumbar punctures,
47:41I mean very advanced things.
47:43You know, things that.
47:45That many of these high school students
47:48will likely never perform again.
47:50But each topic is tide in
47:53with several STEM concepts.
47:55So for instance,
47:56when we're talking about intubating,
47:58this helps us explore acid base.
48:03We can talk about pressure gradients etc.
48:09And so all of these.
48:12Concepts are rooted in something else,
48:14and this I think, makes these these
48:18principles matter to the students and
48:21all of a sudden there's some relevance
48:23to some of these abstract concepts.
48:26Next slide, please.
48:31The Faculty act as mentors for the students,
48:34and that's how we initially conceived
48:37the program and started it.
48:39A lot of these students haven't
48:41thought about applying to college,
48:42some that are thinking about applying
48:45to college don't have any role models,
48:48direct role models who have gone through
48:51that experience and don't necessarily get a
48:53lot of help from their guidance counselors,
48:57so we've helped them with those types of.
48:59Things with career advice
49:02and professionalism.
49:03Overtime we've incorporated peer
49:05mentorship into this program,
49:08and that's actually now, I think,
49:09become a real strength of our program.
49:12Or what we have done is graduates.
49:18From a prior year or welcome to come
49:20back as mentors and then essentially
49:23join us as faculty to help teach
49:27the new crop students and so every
49:30year we hold a graduation and at
49:32the end of that graduation,
49:34ioffer to any of the students
49:36who are interested.
49:37If they would like to come back as
49:39mentors and I and I get lots of interest.
49:41And unfortunately I can only take so many,
49:44but I do think that the pure
49:46mentorship aspect of the program.
49:48Has really really improved it and and
49:53has improved the enthusiasm level as well
49:56for for those students who undergo it.
49:59And truthfully,
50:00I want to say that I think mentorship is
50:03really one of the backbones of this program.
50:05Next slide,
50:06please.
50:09Beyond just the teaching
50:11of these STEM concepts,
50:12the interesting procedures that we perform,
50:14and the mentorship that goes along with it,
50:17these students are really exposed to
50:19lots of diverse careers within the
50:21Health Sciences and this is yet again,
50:23another strength I think of our program.
50:25Our goal here is not to try to
50:27convince these students that they
50:29should apply to medical school.
50:30Some do, in fact, want to do that.
50:33But along the way
50:35they learn about so many other
50:37career paths that have really
50:40up until this point not been.
50:42Open to them. And so, for instance,
50:46when we we do an ultrasound curriculum
50:48where they learn how to use ultrasound,
50:51identify organs, etc.
50:55They learn about what it takes to apply
50:59to become an ultrasound technician.
51:02That this is a career path that
51:04doesn't need a college degree.
51:06They understand they learn
51:08about prehospital medicine,
51:10whether it's EMT or becoming a paramedic,
51:14respiratory therapy.
51:15When we go through a lot of the
51:18procedures that have to do with
51:20airway and and so the students
51:22really learn a lot and actually.
51:24And in this photo,
51:25you can see this is actually one of the
51:29one of the students former graduated program.
51:32Who is actually managing the IT while
51:35another group of students is managing
51:37a cardiac arrest in the other room?
51:40Of course,
51:41prior to managing this cardiac arrest,
51:43they did learn CPR and intubation
51:45skills and and then we threw
51:48them in with the cardiac arrest.
51:50Next slide,
51:51please.
51:58So over the years, we've expanded,
52:01you know, in our first year. Uhm?
52:03I think we had a total of 10 students,
52:07but word of mouth has really helped
52:10our program and now unfortunately
52:12every year I run it I have to turn
52:15away lots of students we fill up.
52:18I take a total of 25 students a
52:20year and I could easily just from
52:22career high school and we take 10th
52:24graders just from that alone I could.
52:26I could fill up, you know, three times
52:29what I do now so we have expanded,
52:32and that's pretty exciting.
52:34We have begun to engage younger students.
52:36I may have mentioned that
52:38we take 10th graders.
52:39We had taken Juniors initially,
52:42and then I realized after doing that for
52:45a year or so that it was better to take
52:48the younger students and then take those
52:50graduates and bring back as faculty.
52:52And again we've increased peer mentorship.
52:54Next slide, please.
52:57We have had some challenges,
52:59COVID-19 being foremost among them.
53:01This program is a really
53:03truly a hands on program.
53:05It's what makes it exciting.
53:06It's how the students learn.
53:08It's how they apply these concepts.
53:10So we have been suspended during COVID,
53:13unfortunately.
53:16Another one of our challenges is funding.
53:19Obviously we don't get any
53:21direct funding for this,
53:22and all of the task trainers we
53:24use get beat up fairly quickly.
53:27I need replacement parts.
53:29And so that is another ongoing challenge.
53:33And again,
53:34this is a volunteer program of
53:35faculty are not paid for their time.
53:37We all have academic and clinical duties,
53:40and this is extra to that.
53:44Again, a challenge.
53:44And so we try to find a like minded
53:48faculty members who who see the
53:50importance next slide please.
53:55And I'd just like to end with the future
53:58directions of where we hope this goes.
53:59We've actually been lucky enough this
54:02year to hire a second simulation faculty
54:06simulation fellow and that fellow,
54:09a native Spanish speaker,
54:10is planning on focusing on outreach,
54:12which I'm I'm very excited about,
54:14having her join us.
54:17We'd also like to have Yale
54:19medical students join us as
54:22mentors in a longitudinal setting.
54:23I would love for them to be able to be
54:26present once a week for the for the
54:28duration of the school year so they
54:30could actually build a relationship
54:32with these high school students.
54:34Additionally,
54:34we have already partnered
54:35with Yale Pathways to Science,
54:37which has increased our exposure
54:40and we think will potentially
54:42allow us to expand this program
54:45to other New Haven high schools.
54:47I appreciate your time tonight.
54:49Thank you.
54:52OK, so I feel that.
54:55This was a 50 minute opportunity for us too.
54:59Present to you the different areas
55:01and the missions of Yale Center for
55:03Medical simulation to get a sense
55:05of our commitment to education,
55:07to research and outreach.
55:08And now we'd like to take
55:10the opportunity to answer any
55:11questions that you might have.
55:15And also I'd like to remind
55:17everybody that please put your
55:19questions in the chat for Doctor
55:22Evans or any of the faculty or
55:25students that have spoken tonight.
55:28We did have some questions that
55:30came in prior to the to the evening,
55:32the evening, and so maybe we could ask
55:34you to answer some of those while we're
55:37waiting for questions in the chat.
55:39So Doctor Evans,
55:41one of the questions that came through,
55:44which is similar to some of the points that.
55:46Doctor Barnes talked about is how are these
55:49activities and initiatives supported?
55:53Well, as you can imagine,
55:54just from what you saw the the equipment and
55:58technology that we use are very expensive.
56:00The simulators that I showed you
56:03in the beginning during the tour,
56:05each one of those simulators costs
56:07about $100,000 and so we need to pray.
56:10We place them probably once every five years.
56:12Our financial support is
56:14really through four sources.
56:16We receive generous support from the central
56:19administration of the medical school.
56:21We are also supported by the
56:23Department of Emergency Medicine.
56:24We have, as you saw,
56:27we have research funding.
56:29We have some NIH funding to
56:31support some of our work,
56:33and then we also are dependent on
56:36gifts from friends as well as alumni,
56:40and that has also been an
56:42important part of support for us.
56:46Thank you, another question
56:49that came in was new residents,
56:51fellows new attendings and students
56:53feel that the simulation training
56:55that you provide for them prepares
56:57them well for the real thing and
56:59you might want to even throw some of
57:01this to some of your panel as well.
57:05I am going to pass that question on
57:08to some of our junior faculty who
57:10have done stimulation fellowships
57:11as well as to the medical students
57:13and they're they're probably the
57:14best able to answer those questions.
57:20I'll start off and then
57:22I'll nominate a student.
57:24I think I can answer this because I
57:26actually did not do any simulation
57:28during my emergency medicine
57:30residency or medical school.
57:32I I didn't go to Yale, obviously,
57:35but I didn't have any,
57:36and when I was a resident,
57:38I really I had a lot of
57:40volume and a lot of acuity,
57:42but I never had the chance to sit down
57:44and really dissect cases in real time
57:46and have a chance to sit down and.
57:48Think about things and talk
57:50about alternative ways.
57:51It could have been managed and really get
57:54into the nitty gritty of decision making.
57:57With my faculty and I think that
57:59that's something that we spend all day,
58:01every day doing with our residents
58:04and students.
58:04And that's what makes it so valuable is
58:07you can really get at the decision making.
58:09What are the different options
58:11within standard of care,
58:13how people have approached
58:15this in their own experience,
58:17and you can really draw on all
58:19of those experiences to have
58:21a really valuable discussion.
58:22So that's my take and I don't
58:24know if you wanna chime in on your
58:26experiences that are plentiful or or
58:28if I should just nominee one of our students.
58:32I'd be curious if
58:33any of our students would be willing to
58:34talk a little bit about their experiences,
58:36and then I'd be happy to add to that.
58:41I think as I as I sort of mentioned,
58:45the initial part of what I spoke about,
58:48simulation has been hugely helpful
58:50for me in terms of feeling like I was
58:53prepared for my sub internships for
58:55my clinical experiences going forward.
58:58I think the like Doctor Joseph was
59:01saying this chance to have the debrief
59:04afterwards where you both here.
59:06The standard of care,
59:07sort of various options within that,
59:09but then also you get kind of the real
59:11world perspective from the faculty,
59:13which sometimes you're missing
59:14as a medical student,
59:15things that you need to be thinking about
59:17that aren't things that you're studying.
59:19The textbook or boards and beyond or
59:23whatever you're studying shows you,
59:23and also then the direct feedback
59:26was always which the faculty at
59:28the YCS are always very willing to
59:30provide was always super helpful.
59:32You could and there's always
59:35opportunities as well like after.
59:36Recessions.
59:37If you want more feedback like individually,
59:39obviously the degree focuses on the
59:41group and the teamwork and the case.
59:42But if you want more feedback individually,
59:45the faculty always make it clear that
59:47they're happy to set up time to like.
59:48Give some individual feedback or even
59:51review videotapes of simulations,
59:52which is really helpful.
59:58Great thank you. This next question I
01:00:01think may refer to the outreach Dr.
01:00:05Bonds was talking about and that is
01:00:08we'll participant outcomes be tracked.
01:00:10See if the program helps affect
01:00:13change in college applications and
01:00:15potential future careers in healthcare.
01:00:19Yeah, so that's a great question.
01:00:21Thank you for asking it.
01:00:22We we are in touch with our students.
01:00:25We I don't have an active list
01:00:28right now and going forward we will.
01:00:30Will try to keep tabs on on everyone
01:00:32and and where they have gone.
01:00:34But I wouldn't be able to present
01:00:36it and in sort of a formalized data
01:00:39format because it has been really
01:00:42those that like what I can say is that
01:00:44there every year there are a number
01:00:46of students who continue to stay in
01:00:48touch that this is clearly hadn't.
01:00:50Impact on them and I can't say as
01:00:53a whole how it is difficult for
01:00:56me to tell you how.
01:00:59What type of change it has made
01:01:00in in any one person's life.
01:01:02We have tried to engage.
01:01:07Some of those.
01:01:09Past students,
01:01:10but we've also run into difficulties
01:01:13because they're minors and
01:01:14have to get parental consent.
01:01:16And then sometimes it's very actually.
01:01:19It's very difficult often
01:01:20to reach the parents,
01:01:22so we we have run into
01:01:23some roadblocks that way.
01:01:25I would just like to add a
01:01:26comment on on that question,
01:01:27which is that that is part of the
01:01:29reason why we are linking ourselves
01:01:31with Yale pathway to science.
01:01:33Because all of those students are
01:01:35tracked during their entire high
01:01:37school career as well as afterwards.
01:01:39What they do in terms of going
01:01:40to college and afterward.
01:01:42So all of our students now that are
01:01:43going to be enrolled in the Yell
01:01:45Simulation Academy are also going to be
01:01:47in the Yale pathway to science program,
01:01:49so that will help us to do that.
01:01:51I can just say at a personal level,
01:01:54Doctor Gus Berg today was speaking
01:01:55to a yell some Academy graduate.
01:01:58Who is graduating from college this
01:01:59year and wants to apply to PA School
01:02:02so just at a very personal level.
01:02:04I can tell you that it there's
01:02:06evidence of significant success.
01:02:09Great this next question I
01:02:11think would be for Dina Lousy,
01:02:13which is do students who have completed
01:02:16and alternative high school such as AGV.
01:02:19Can they be accepted to the Yale
01:02:21School of Medicine as undergraduates,
01:02:23and are there any scholarships
01:02:25available for overseas students?
01:02:29Thank you Mike. You know,
01:02:31I think that we are always looking
01:02:34at ways to increase the diversity
01:02:37amongst both our undergraduates
01:02:39at the Yellow College as well
01:02:40as in the School of Medicine.
01:02:42And so you know, we do not have a
01:02:46requirement that a student has has
01:02:48attended a regular high school.
01:02:51I think we will get all of our
01:02:54applicants holistically and are
01:02:56very open to receiving applications
01:02:58from from all types of students.
01:03:02Great, thank you.
01:03:03The next question is sometimes difficult
01:03:06to answer because of modesty concerns,
01:03:09but how does our center and
01:03:11program compare to our peers and
01:03:13how do potential students learn
01:03:15about the simulation program?
01:03:19Well, as I mentioned,
01:03:20we definitely have the largest high
01:03:23fidelity manikin program in the country,
01:03:25so all of our students based on
01:03:27the addition of the pre clerkship
01:03:30curriculum and then the capstone
01:03:31program will take care of 39 patients
01:03:34at our center and that's more
01:03:36than anywhere else in the country.
01:03:38I think we haven't done enough
01:03:40probably and I I need to find out
01:03:42how to do this to to also recruit
01:03:44students to participate in a
01:03:46simulation elective during their last.
01:03:48Year of medical school.
01:03:50I don't think we we advertise that enough,
01:03:52but it's another opportunity for them
01:03:54to take care of a lot more patients and.
01:04:00I think I I'm did I miss the
01:04:01second part of the question.
01:04:05Let's see and sorry you have to
01:04:10go back and read it. They had it,
01:04:13so how do they learn about the program?
01:04:14I guess was the first part and then the
01:04:18second part rather and the first part
01:04:19you already answered, which is out of
01:04:22the other thing is that I'm hoping
01:04:24too that we can incorporate the SIM
01:04:26center into the tour of students that
01:04:28get accepted to Yale Medical School
01:04:31and that we can actually advertise the
01:04:34curriculum that they're going to be
01:04:36exposed to if they choose to come to Yale.
01:04:38So that's another area I've also
01:04:39spoken to Doctor Lucy about that.
01:04:43Great. Well, I see we're
01:04:46a little bit after seven.
01:04:47I really want to thank Doctor Evans
01:04:49and the faculty and the students
01:04:51for sharing these kind of inspiring
01:04:53vignettes and telling us about the
01:04:55advances in the use of simulation that
01:04:58you all have pioneered for medical
01:05:01education research and, importantly,
01:05:02the outreach to our community at ysm.
01:05:05So thank you very much for for doing
01:05:08this and we hope to hear more and
01:05:11have our students engaged more and
01:05:13more as we proceed on. Thank you.
01:05:16Have a good evening everybody.
01:05:19Bye.