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today . Welcome

0:50

to The Sim Cafe , a

0:52

podcast produced by the team at

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Innovative Sim Solutions , edited

0:57

by Shelly Houser .

1:00

hos De Taube a c Jer Join

1:07

our host , Deb Tauber , and co-host Jerrod Jeffries as they sit down with subject

1:09

matter experts from across the globe to reimagine clinical education

1:11

and the use of simulation

1:13

. So pour

1:16

yourself a cup of relaxation , sit

1:19

back , tune in and

1:21

learn something new from The Sim

1:23

Cafe . Tune in and learn something

1:27

new from The Sim Cafe

1:29

.

1:29

Welcome to another episode of The Sim Cafe

1:31

, and today we are so fortunate

1:34

to have Dr Jenny Rudolph with us . Welcome

1:36

, Dr Rudolph , and you mentioned we could call you

1:38

Jenny , so we will do that .

1:41

Glad to be here . Deb and Jerrod thanks

1:43

for inviting me .

1:46

Thank you so much , and why don't you ? For any of our listeners who may not

1:48

be familiar with you , why don't you tell

1:50

us about your journey into simulation

1:52

and about yourself ?

1:54

Sure , I am a lifelong

1:56

athlete and that brought me into simulation

1:59

. I love practicing

2:01

, learning from both my

2:03

successes and mistakes and getting better

2:05

. And so when I was

2:07

a young

2:10

recent college grad , I

2:12

rode crew on

2:14

the US team and we would

2:16

practice on the water and we would simulate

2:19

rowing on rowing ergometers

2:21

and in a tank indoors and we'd video

2:24

it . And we'd look at our videos

2:26

just like you do with basketball games and

2:28

analyze them . And when

2:30

I wrapped up that process

2:32

I thought , wow , it would be so cool if

2:34

I could actually do something like that that

2:37

really had an impact in the world and

2:39

really made a difference beyond

2:41

sports . And so

2:44

I started looking around for things

2:46

and , fortunately , when

2:49

I started my doctoral dissertation

2:51

studies 10 years later , I

2:54

fell into clinical

2:56

simulation because I was interested in

2:58

learning from accident and error

3:00

.

3:01

And how did you actually fall into it ? Why

3:03

don't you just walk us a little bit closer

3:05

to how you started the program

3:08

and where you are now ?

3:10

Sure . So I started

3:12

with an interest in industrial

3:14

safety . Actually , I had

3:17

been doing research with one of my mentors

3:19

on learning from accident

3:21

and error in nuclear power and

3:24

chemical processing and

3:26

he knew that I really wanted

3:28

to study clinicians

3:31

and medical error . And fortunately

3:33

healthcare is

3:35

pretty safe overall and so error

3:37

is pretty rare . And one day

3:39

when I was hanging out with him in

3:42

his office at MIT

3:44

, when

3:48

I was hanging out with him in his office at MIT , he tossed a proposal across the table

3:51

to me and he said hey , this guy , David Gaba , sent me this proposal

3:53

. It's about something called medical simulation

3:56

. Why don't you take a look at it ? And

3:58

I looked at it and I thought

4:00

, oh , this is so cool . And , as

4:03

luck would have it , I was able to visit David

4:05

Gaba's lab . He showed me what he

4:07

was doing . I discovered that

4:10

Jeffrey Cooper and Dan Raymer

4:12

had a similar lab in Boston , which

4:14

is where I was working , and in

4:16

those days pretty much everybody referred to simulation

4:19

centers as simulation labs . I'm dating

4:21

myself and I

4:23

went over and I chatted with Dan

4:25

Raymer and I said , hey , I'm really interested in this

4:27

thing called fixation error , where

4:29

you decided on a diagnosis but then you cling

4:32

to it despite mounting cues that you're on

4:34

the wrong track . Could we study that in

4:36

simulation ? And he immediately

4:38

started laughing and he said , oh my gosh

4:40

, yes , we have several situations like

4:42

that . And so I was

4:44

able to write a dissertation proposal

4:46

to study fixation error during

4:48

surgical emergencies and

4:51

I looked at how did anesthesiologists

4:53

either get stuck

4:55

or get unstuck trying to solve problems

4:58

in their decision-making Fascinating

5:01

.

5:02

Now you wrote the

5:05

article led the charge on . There's no

5:07

such thing as nonjudgmental debriefing

5:09

. Why don't you tell us a little bit

5:11

about how you guys came

5:13

about starting that work and

5:16

about that ?

5:24

I think one of the biggest

5:26

problems that we all struggle with

5:28

is how do I give straightforward

5:31

feedback or how do I share

5:33

a critical insight without

5:35

ruining the relationship

5:38

with the other person ? And

5:40

let me just ask you a little bit , because

5:42

I know you've been an educator for a long time

5:44

you're a podcast interviewer what

5:46

are some of the things that you kind of either

5:48

struggle with when you have feedback conversations

5:51

or enjoy when you have feedback

5:53

conversations , and then maybe we can build

5:56

on that together .

5:57

Yeah , thank you . What I enjoy

5:59

when I'm having conversations with

6:01

people is being sure

6:04

that I've understood what

6:06

they're trying to communicate to me .

6:08

So the words they say may

6:10

or may not reveal their underlying

6:13

feelings or their thought processes , or tell

6:15

me a little more about what makes you feel unsure

6:17

.

6:17

Just to make sure that they're comfortable enough to speak

6:19

up .

6:21

So it's the psychological safety

6:23

part , the feeling like it's safe

6:25

for them to let you know what

6:27

they're really thinking Correct

6:29

. How do you know what

6:31

are sort of the signs and symptoms that you've gotten

6:34

there ? What lets you know when you feel like you

6:36

can trust that you've created

6:39

or co-created that environment with people

6:41

? And I'm asking because I

6:43

feel like if we can sort of get these ideas

6:45

on the table , then you and I can kick

6:48

them around a little more and I can talk about debriefing

6:50

with good judgment in relation to challenges

6:53

that I think you would recognize and

6:55

other people would recognize .

6:57

I think , generally when they say something vulnerable

7:00

, if they say something that

7:02

is vulnerable to me , then

7:04

I will know that they feel

7:06

comfortable to tell

7:09

me more and

7:11

help me , to help

7:13

them clarify what they

7:15

might be thinking , so that we're all on the

7:17

same page and we can make some

7:19

good decisions .

7:26

Okay , thank you , Deb , that's so helpful . So , circling back to there's no such thing as a nonjudgmental

7:29

debriefing and debriefing with good judgment . I

7:31

think the heart of

7:33

what we were trying to accomplish

7:36

with the debriefing with good judgment was how

7:39

do you create an environment that is

7:41

simultaneously psychologically

7:44

safe enough for people to

7:46

either admit mistakes , talk

7:49

about something they're not entirely proud

7:51

of , share their true feelings

7:54

, and also for the

7:56

feedback conversation leader or

7:58

the debriefing conversation leader to

8:01

take the risk to be

8:04

open and honest about their

8:06

insights , about the other

8:08

person's actions or performance

8:10

. And the problem

8:13

that we were kind of trying to solve

8:15

with debriefing with good judgment was exactly

8:18

this , which is most of us so

8:20

value relationships that

8:23

we kind of sugarcoat bad

8:25

news because we don't want to hurt the other person's

8:28

feelings or , even

8:30

more , we don't want to hurt the relationship between

8:32

us . But when I sugarcoat

8:34

or I'm indirect about my insights

8:37

, then it's harder for you to learn

8:39

my conversation partner , to learn

8:41

from the things that you

8:43

might have a blind spot on that I

8:46

actually saw . On the other hand

8:48

, though , I think we

8:50

really want to be able

8:52

to help our colleagues in , especially

8:55

, health professions and maybe

8:57

people who are direct reports and even

8:59

people we report to be

9:01

the best that they can be at their jobs

9:03

, and so we have standards

9:06

that we want people to meet . We have insights

9:09

that can help them do better , and so

9:11

we need a way to be straightforward while

9:14

also maintaining the relationship .

9:16

Yes , yes , and Jenny , I

9:18

think that a lot of that really resonates with

9:21

me , because I mean , to your thing of

9:23

sugarcoating , you always want to

9:25

be their friend but also make

9:27

sure that you're the leader and coaching them , but

9:29

then at the same time , you don't know how direct

9:32

or deep to go on certain situations

9:34

. So I think what you're getting

9:36

at is so it hits

9:39

me hard . But I also think that a

9:41

lot of our listeners can really relate to it in regards

9:43

to saying I've been in that same situation

9:45

, either being the person who's

9:47

actually leading the debriefing , or the learner

9:49

or the participant within it , Because

9:51

I think there's just so many times that we're

9:54

faced with that , you know you almost I don't

9:56

want to say daily , but definitely weekly even

9:58

in personal relationships , not only just

10:00

within the simulation training .

10:02

Yeah and

10:05

Jerrod , I don't know if it's something that comes to mind for you like an example

10:08

or a feeling , or I was really

10:10

struck by your phrase . It hits you hard , what

10:12

hits you hard , or what is that about

10:14

?

10:15

Well . So I think that you sugarcoat

10:17

it and I think there's a lot

10:20

of situations or times

10:22

, you know , even in my relationship

10:25

with my wife . We have a fantastic relationship , but we

10:27

have a young child , you know , who's just

10:29

under a year and a half , and it's like handling

10:32

logistics around a small child

10:34

, of course , is just , it's almost

10:36

elementary of who's going to pick her up , who's

10:39

going to make sure that that backs . But whatever it may

10:41

be right , very minute , just easy things . But

10:43

sometimes I think , when we are communicating

10:45

, if the communication is too direct or

10:48

if it's not led with appreciation

10:50

, sometimes because of all

10:52

the other things that everybody's doing , you sometimes

10:55

can overlook or it seems like you're overlooking

10:57

all the good things I've done . So

11:00

back to you know the simulation practices . It's

11:02

all the learning objectives or the scope of practice

11:04

. They hit eight out of 10 . And

11:07

there's no mention of them doing a great job

11:10

of those eight out of 10 , but it's just like those

11:12

two that you did were . They weren't severe

11:14

, they were not critical errors , but those two

11:16

learning directions they did not hit . If you

11:18

just dive right into those and be like , well , this

11:21

is just . Your teamwork was horrible

11:23

. You guys didn't communicate . You skipped over

11:25

this , I think the team or

11:28

I'll put it in my personal experience I

11:30

would think maybe , oh , that's the biggest

11:32

focus , and they didn't see any of the good . So

11:34

actually , my confidence was lowered and

11:37

I don't feel as good going into

11:39

the next sim or actually going into practice

11:41

now . So it actually did the opposite

11:43

of what it was intended .

11:45

Yeah . So what I'm hearing

11:47

us talk about now

11:49

is the relational context

11:52

of our debriefing

11:55

conversations or our feedback conversations

11:57

or our collaboration conversations

11:59

with our partners or our spouses or our

12:01

colleagues , and what

12:04

I'm thinking about is essentially

12:07

what is the culture that we want to create

12:09

via these conversations ? And

12:13

I want to talk for a second maybe

12:15

about the value of being valued

12:17

, and then maybe we could pivot

12:19

back to talk a little bit about

12:21

the more critical insight conversations

12:25

that often we also

12:27

have to have . So Rick

12:29

Hansen , who does research around

12:31

resilience and learning

12:33

, says our brains are

12:36

like Teflon for

12:38

good things that we have done and

12:40

or good things that other people do , and Velcro

12:42

for our mistakes and other

12:44

people's mistakes . And

12:47

part of what interested me

12:49

so much and got me into the

12:51

concept of debriefing with good judgment

12:53

was what is the culture

12:55

that we want to create ? Going

12:58

back to that history of studying

13:00

nuclear power plants , what

13:03

John Carroll , my mentor , and I

13:05

discovered studying plants

13:07

over five years was

13:09

that plants who

13:12

were too harsh and too

13:14

controlling created

13:16

a culture that was kind of punitive and

13:19

nobody wanted to talk about their

13:21

mistakes , and

13:24

plants where people had

13:27

learned from that and decided they were

13:29

going to be more open and kind

13:32

. That succeeded

13:34

. People were less afraid

13:36

, but they weren't able to

13:38

really dig into the

13:40

mistakes that had been made because

13:43

they didn't have the muscles

13:45

to dig in in a way that

13:47

was non-punitive and non-threatening . So they

13:49

either had this sort of control what

13:52

we've now come to call harsh judgment

13:54

approach or they had kind of a fake nicey what we've

13:56

now come to call harsh judgment approach or they had kind of a fake nicey what

13:58

we've now come to call hidden judgment approach

14:00

. And what

14:03

the plants who learned the most did

14:05

was what we in those studies

14:07

called deep learning , which is where they

14:09

were open and honest about what were the mistakes

14:11

that had been made , but they assumed

14:14

the best of other people . And

14:17

what we would now call

14:19

that for debriefing and feedback conversations

14:21

a good judgment approach , where you hold

14:23

a high standard and yet

14:25

you also assume the best , or you hold

14:27

the learner or the employee

14:29

in high regard . And

14:32

the thing that you've directed

14:34

us to Jerrod e , here , is

14:36

the high regard piece . The

14:40

team not only did

14:42

eight things right and

14:45

we need to recognize that . They need to kind

14:47

of quote unquote get credit for that , because

14:49

we humans like to get credit for doing

14:51

things right , but as

14:53

the feedback conversation leader

14:56

or the debriefer , I'm creating a culture

14:58

of appreciation and

15:00

valuing the other people

15:02

by acknowledging those things

15:05

and what we can learn from that positive

15:07

performance . So why

15:09

I'm so passionate about debriefing with good

15:11

judgment is not

15:13

only the immediate conversation that

15:15

we're having , that I'm being fair

15:18

and caring and challenging

15:20

, but that in the future

15:23

you'll feel that the

15:25

culture that we've co-created is

15:27

one where you can be open and honest about

15:29

mistakes , but also open

15:31

and honest about successes , and

15:34

you won't be afraid to bring up things in

15:36

the future .

15:37

This is wonderful . I'm loving this , Jenny . But one

15:39

question about this is do you find

15:41

the frequency of , say

15:43

, hidden judgment or another

15:46

, like we want to get to deep learning

15:48

, we want to get to the best deep learning

15:50

possible ? Is the frequency of not

15:52

getting there more prominent in any area

15:55

that you see more likely , or even

15:57

within the study ?

15:59

That's a great question . So we only

16:01

looked at five plants in

16:03

that particular study , jared but

16:05

we looked at tens of

16:07

accident and error reports

16:09

and corrective

16:12

300 reports

16:14

, and so

16:17

I can answer more about

16:20

the stance of the people who

16:22

were formally charged

16:24

with causing learning

16:27

from that event , and I've

16:29

never actually thought about this before . So

16:31

, as debriefers or

16:33

feedback conversation leaders're the

16:35

people charged with supporting

16:38

learning in our organization

16:40

. And

16:49

so you asked me about the

16:51

frequency simulation leader and

16:53

instructor programs that we've done .

16:56

I would say , well , more

16:58

than half come into the program

17:00

with a hidden judgment approach , because

17:02

that's what we're all socialized to

17:07

do Sure , and so just when you socialize to do , do you think

17:09

that's specifically within the United States or do you

17:11

see that even globally ?

17:13

I'm not an expert on this interculturally

17:15

that

17:18

even globally . I'm not an expert on this interculturally

17:20

, but when I was taught in Hong Kong , germany , australia , spain , most

17:23

people , and especially

17:25

in most Western countries , certainly prefer

17:28

the polite , hidden judgment

17:30

approach and in

17:32

collectivist cultures

17:34

that and many Asian cultures

17:36

tend to be more collectivist there's a big

17:39

emphasis on preserving face . But

17:42

recent research I've read on this Jared

17:45

and is interesting which is if

17:47

you care about the collectivity more

17:49

than you care about the individual , there's a huge

17:52

interest in learning from

17:54

accident and error . Yeah , it's

17:56

possible that there might be some factors

17:58

that make it easier for people to use

18:01

good judgment rather than hidden

18:03

, but again , this is not my

18:05

area of expertise , so I'm speculating

18:08

.

18:08

No , I think that we could probably spend a whole hour just

18:10

on this . And I'm blanking on the name

18:13

. I don't want to say it's called the cultural war , but

18:15

it's some sort of culture map that

18:17

highlights different countries . And

18:20

back to the collectivism versus individualism

18:22

. It's a slew of I'm making

18:24

this number up 79 other

18:27

traits around the

18:29

norm , cultural norms . So

18:33

that was my question with the US

18:35

, first Global . But from your first-hand perspective of teaching

18:37

in so many different areas as well , I think that's fascinating

18:40

.

18:40

For myself and others listening . I was

18:43

just thinking you know how you kind of recap

18:45

during a resuscitation like what have we

18:47

done ? Where are we ? I think Deb

18:49

asked a question , then you asked a question . I'm just trying

18:51

to remind myself the topic area we're

18:53

in . Was it creating culture

18:56

via conversation ? Was it the value

18:58

of being valued ? We've

19:00

been over some interesting things . Anyway , I'm

19:02

happy to follow you guys .

19:04

I have one last question , maybe to wrap up . This

19:06

one is what do

19:08

you feel or what do you see as the

19:10

most common errors ? Is there

19:12

any sort of pattern that has emerged that says this

19:15

is what I anticipate , the probability of

19:17

something going wrong ? It's going to be X . And

19:20

what would that X be ?

19:26

You mean in feedback conversation skills

19:28

or debriefing conversation skills ? Yes

19:33

, I definitely can answer that . I would say the most common thing that people like to skip is sharing

19:35

their point of view . So

19:38

, for instance , if we are helping people

19:40

learn to preview what

19:42

is the topic , let the learner

19:45

or the other person know what they saw

19:47

that was important about it and

19:49

then share why it was important to them

19:51

. It's that third piece that

19:53

people tend to want to leave

19:55

out , because it's the part that's

19:58

the spiciest and they're worried that's

20:00

going to land badly so

20:02

often . The

20:04

corrective thing that we offer

20:06

there . And I'm just going to give an example . Let's

20:14

say we were in a debriefing in a healthcare situation and the situation

20:16

was learning to manage parent presence during a pediatric

20:18

procedure . And so in the

20:20

debriefing , let's say

20:22

the debriefer said something like this hey

20:24

, I want to talk about the importance of managing parent

20:27

presence during a procedure . I

20:29

noticed that you turned your back on the mom

20:31

in the middle before you placed

20:33

the intraosseous line , and I'm

20:36

worried about that because I think turning

20:38

her back on her might've contributed to her

20:40

becoming more anxious . How

20:43

do you see it ? So , right

20:45

, there , I'm modeling one of the

20:47

kind of conversational molecules that

20:49

we use in debriefing with good judgment , which is

20:51

preview , I saw , I think I wonder , and

20:54

then I would listen for their answer

20:56

. The part about I'm worried

20:58

about that because I think it might've caused

21:00

the mom to become more anxious , is what people

21:03

tend to leave out . And

21:05

when we're working with people , there's

21:07

a really important reframe

21:09

that we have to help them with to be able

21:12

to share their point

21:14

of view directly and kindly

21:16

, and that is to make

21:18

it about something outside

21:21

the person they're talking to

21:23

. So it's the clinical consequence

21:26

, or the social consequence , is

21:29

usually not nearly as spicy as

21:31

what they're thinking , which is something

21:33

like hey , uh , student

21:37

, I've taught you five times you

21:39

can't ignore mom during the procedure . Of

21:41

course she's going to become more anxious . What are you stupid

21:43

? So they

21:46

are feeling bad or angry or something

21:48

. I'm exaggerating a little bit . What

21:51

they're really thinking is hey , what's the matter with you ? Why'd

21:53

you turn your back on mom ? So

21:56

the reframe that

21:58

lets people share their

22:01

point of view , which is so valuable

22:03

to the other person , is

22:05

shifting it from their emotional

22:07

point of view , like I feel upset

22:09

or I feel threatened that you X , y , z

22:12

, which could be important for another conversation

22:14

, but for right

22:16

now , the learning conversation needs to focus

22:18

on those external factors . Right

22:22

now , the learning conversation needs to focus on those external factors

22:24

. So that's the piece , that two-step of like hey , your emotions are important

22:26

, we'll come back to those , but for now

22:28

, share your point of view about what was the consequence

22:31

that dials down the heat

22:33

for people so much that they're often

22:35

able then to practice

22:38

that and get better at it .

22:40

And that one was preview , I think I

22:42

saw . I wonder yeah

22:44

, preview .

22:45

I saw , I think , I wonder , and we've often

22:47

also talked about that as preview

22:49

advocacy , inquiry . So

22:52

it's what I see , what I think

22:54

about it , and then I'm interested in

22:56

what you think about it , or what's your perspective

22:58

. What was going on with you , what ?

23:00

you think about it or what's your perspective , what was

23:02

going on with you ? And

23:07

I think that the reason that this particular debriefing model has had such an impact

23:09

on me is that I worked for 25 years in the emergency department prior

23:11

to any types of debriefing

23:13

, where it was just the hierarchy

23:16

of who's who in

23:18

the pack and who's going to do

23:20

what and say what , and you never really

23:22

had an opportunity to speak up . So

23:25

being exposed to your work early

23:27

on in my simulation career just opened

23:30

my eyes to some

23:32

of the things that we were doing that weren't so wonderful

23:35

.

23:36

Yeah , I'm a student

23:39

and follower of the work

23:41

of Amy Edmondson and I

23:43

know so many of us probably are . Do

24:02

organizational cultures in our clinical context move from a sort of personalities before principles

24:04

or focusing on who's right more than what's right

24:07

, creating a context

24:09

where we can share what we

24:11

need help with ? And one of the things

24:13

I wanted to connect to

24:15

what you're saying , deb , and back to

24:17

Jared's question about kind

24:20

of essentially fairness , like

24:22

when you're coordinating with your spouse to get out

24:24

the door with your young child and who has the diaper

24:26

bag and how could you have forgotten

24:28

X , y , z ? A piece

24:31

of work that I'm actually very

24:34

proud of and I think is undervalued

24:37

by all of us is a blog

24:39

post called the Value of being Valued

24:42

, and in that blog

24:45

post we connected the debriefing

24:47

skill that we all use of saying

24:50

something that we might have seen and then exploring

24:52

it with the other person , but having it focus

24:55

explicitly on things you're doing

24:57

. That helped me , like I

24:59

so appreciated , you know

25:01

, appreciated before we went live , deb , you and me having

25:04

a chance to connect more

25:06

personally and learn a little bit

25:08

about each other . And

25:10

using that value of being

25:12

valued algorithm , essentially

25:15

, I tell you what we did and then I say

25:17

and I really appreciated it , deb , because

25:19

it relaxed me and it made

25:21

me feel like you and Jared and I were really

25:23

going to be able to have a comfortable

25:25

conversation . So instead

25:28

of the external impact , the

25:30

value of being valued conversations

25:33

can really focus on . Hey , I want

25:35

to talk about how you helped me relax . Before the podcast

25:37

, I noticed you helped

25:40

us . We kind of chit-chatted . The

25:42

impact on me was to relax me and

25:44

allow me to be more authentic while

25:46

I was here , thank you , and

25:48

we do that so little for

25:50

each other , and I think that's another thing we

25:52

can do to really warm up

25:54

and create an appreciative culture

25:57

around ourselves .

25:59

Thank you so much . We really appreciate

26:01

having you here today and

26:03

we are going to start to wrap it up , but

26:06

I would like to just ask you two more questions

26:08

. One is what are you most

26:10

proud of in your vast career

26:12

? And then , following up into

26:15

what do you see as kind of

26:17

the cutting edge for innovation as you move

26:19

into things you're doing now

26:21

?

26:22

I think I'm most proud of

26:24

the fact and

26:26

of course , others will have to attest

26:28

whether this is true . My

26:31

mission is to help

26:33

people tap into their authentic voice

26:35

and power , and

26:38

including helping my own self tap

26:40

into my authentic voice and power , and

26:43

I feel like

26:45

the formal practice

26:48

of debriefing with good judgment , practicing

26:51

getting there , learning how to

26:53

know what you did see

26:55

, learning how to know what you do

26:58

feel and think , learning

27:04

how to know what you do feel and think , learning how to consider your voice

27:06

and your insights as worthy of being shared I feel like is

27:08

a very profound , dare

27:11

I say even spiritual , journey for

27:13

many of us . How do I actually

27:15

share what I care about , how do I use my authentic

27:18

voice in a way that ? And

27:20

then the power part for me

27:22

is not power over , but

27:24

it's how do I have

27:26

a positive impact on

27:28

people around me ? How do I advocate

27:30

for myself in a fair

27:33

and caring way ? I

27:35

like to think that the journey

27:37

of learning something like

27:39

debriefing with good judgment has

27:41

helped a lot of people tap into

27:43

their authentic voice and power . Thank

27:46

you Regarding

27:48

your innovation question , deb

27:51

. So I started out the

27:53

conversation with you and Jerrod talking

27:55

about my history of being an athlete

27:58

and I think , because

28:00

of my love of athletics , I've

28:02

always had a passion

28:05

for mastery , learning Like . I love

28:07

trying and trying and making

28:09

mistakes and learning from my mistakes and then

28:11

getting better , and

28:13

so one of the things that I've enjoyed most

28:15

about getting to work with clinical

28:18

leaders and educators for so many years

28:20

is working on conversation excellence

28:22

. Whether it's feedback conversations

28:25

, goals of care , consent

28:28

, debriefing conversations . We

28:31

can treat those conversations

28:34

kind of like algorithms to

28:36

some degree , that there are steps

28:38

that we can master and ways that

28:40

we can improve our listening . So

28:43

we've been working on different ways to help people

28:45

master conversations , and our current

28:48

work is thinking

28:50

about how do we use a pre-trained

28:52

generative AI to

28:54

provide feedback

28:57

to people when they're working on a

28:59

conversation . So , for example

29:01

, if you were working on a debriefing conversation

29:04

, we could

29:06

train the and

29:08

we are working on this train

29:10

both the brains and then avatars

29:14

, if needed , to

29:16

listen to you , respond

29:18

to you as you debrief , and

29:20

we can train them using , for example , something like

29:22

the debriefing assessment for simulation and healthcare

29:25

or other rubrics for the conversation

29:28

, and then , once the conversation

29:30

is finished , almost immediately you

29:32

get feedback on what you said

29:35

. You'll be able to see a

29:37

transcript of the words you actually said and

29:39

then you'll get some feedback based on the rubric

29:41

. So back to Jerrod's question . One

29:43

of the things we're working on is training

29:46

people to be able to do preview . I saw

29:48

, I think . I wonder , because it's a powerful

29:51

molecule at the center of feedback

29:54

, debriefing , negotiation , consent

29:57

conversations , because you have to be able to say

29:59

what you think and you have to find out what the other person

30:01

thinks so that you can find a way to collaborate

30:03

. So we could train

30:06

the AI to analyze

30:08

the quality of the previous statement , quality

30:11

of the I saw statement , the quality of the

30:13

I think statement or larger

30:16

parts of the conversation , and then provide

30:18

immediate feedback .

30:19

So that's what we're working on right now , and

30:22

I think the thing that's so fascinating about

30:24

that is that if you get a response from

30:26

AI , there can be no feelings

30:28

associated with it .

30:30

Well , people are certainly studying that , deb

30:32

, and many of us do

30:35

feel less threatened and less

30:37

judged . A colleague

30:39

of mine , Kate Kellogg

30:41

at MIT Sloan School of Management , has

30:43

started looking at this , actually has an article

30:46

we could put in the show notes about this in

30:48

HBR . I can send you the Harvard Business

30:50

Review . Some people are like

30:52

who the hell are you AI ? What do you know

30:55

? So it kind of could vary .

30:57

One question , last question for me Do you

30:59

see the future of simulation being

31:02

seeded or with

31:04

AI and a lot of parts of within

31:06

sim , like the whole process , not just debriefing

31:08

or communication ?

31:10

What I think about on that , Jerrod

31:13

, is I'm very influenced by the

31:16

work of my colleague , Chris Rusin on

31:18

sim zones , which divides

31:21

up the learning into stages . So

31:24

zone one we're learning the basic

31:26

. Zone two we're learning them in situations

31:28

. Zone three is

31:30

a lot of what all of us in

31:33

the early part of the

31:35

modern simulation era did , which is full

31:37

field simulation with lots of a

31:40

mannequin and lots of other people . In

31:43

my opinion , Jerrod , in zone one and

31:46

zone two , when we're mastering the basics

31:48

whether it's how to put in an IV , whether

31:50

it's how to do

31:52

an LP , whether it's how to

31:54

take a history , whether it's breaking

31:57

bad news those batting

32:00

practice-oriented trainings

32:03

, in my view , will be greatly assisted

32:05

by AI . I still

32:07

think there's going to continue

32:10

to be an extremely important role

32:12

for having to interact with the other

32:14

humans in a

32:17

realistic context , because we all

32:19

tend to feel more socially awkward

32:21

and also can feel

32:23

more supported by having

32:26

to interact with the

32:28

other people and haptics

32:30

and whatever else is in that environment

32:32

. So what I see happening

32:34

is a much more efficient use of

32:37

how do we divide up our time , how

32:39

do we get up the learning curve using

32:42

that batting practice assistance

32:44

that we can get from AI and

32:46

then continuing to do the more

32:48

complex simulations with

32:50

the actual humans .

32:52

Thank , you , yeah , now

32:55

. Are there any final words that you'd like to leave

32:57

our guests , our listeners , with ?

32:59

Thank you for the opportunity for that . Deb

33:02

and Jerrod , Thank you for having me on . First

33:04

of all , I think what I'd like to say

33:06

is if we can see our work

33:09

in simulation , both

33:11

in how we pre-brief

33:13

, invite people

33:15

into the simulation space , listen

33:18

to what they want to do that day

33:20

or that session or that 20 minutes , and

33:23

in our debriefings , create

33:26

a context where people

33:28

can really reflect on

33:30

their thinking and feel psychologically

33:32

safe doing so . I

33:35

feel like we're creating a little

33:37

engine of positive culture

33:39

change when we do those things well

33:42

. So it's not just the

33:44

learning moment of that simulation

33:47

, pre-briefing or debriefing , it's what

33:49

we're modeling and showing as possible

33:52

and kind of positively

33:54

infecting other parts

33:56

of our organizations with those norms

33:59

.

33:59

Perfect , I love that

34:01

. With that , I think

34:04

that we're going to let you

34:06

get onto your athletics

34:08

.

34:09

Great .

34:10

Thank you . So thank you so

34:12

much and happy simulating

34:14

.

34:15

Thanks to Innovative Sim Solutions for sponsoring

34:18

this week's podcast . Innovative

34:20

Sim Solutions will make your plans

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34:24

. Contact Deb Tauber and

34:26

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34:35

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34:37

. We hope you enjoyed . Visit

34:41

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