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today . Welcome

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to The Sim Cafe , a

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podcast produced by the team at

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Innovative Sim Solutions , edited

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by Shelly Houser . Join

1:00

our host , Deb Tauber , and

1:03

co-host , Je rrod Jeffries as

1:05

they sit down with subject matter experts

1:08

from across the globe to reimagine

1:11

clinical education and

1:13

the use of simulation . So

1:16

pour yourself a cup of relaxation

1:18

, sit back , tune

1:21

in and learn something new

1:23

from The Sim Cafe .

1:31

Well , welcome back to The Sim Cafe , thank

1:33

you very much . Today, Jerrod Jeffries and I are here with Dr Dan Raemer . Dr Raemer is the founding President of the Society for Simulation and Healthcare and has just so many things he's done, and we are so truly honored to have you as a guest today . today Jarrod Jeffries

1:36

and myself are here with Dr Dan

1:38

Raemer , and Dr

1:41

. Raemer is the founding President for

1:43

the Society for Simulation and Healthcare

1:45

and has just

1:48

so many things he's

1:50

done, and we are so truly

1:52

honored to have you as a guest today

1:55

. Thank you so much .

1:57

Well , thank you for inviting me . It's a pleasure .

1:59

I'll kick it off . We were chatting a little bit before we

2:01

went live , but for your

2:04

journey into simulation has been pretty

2:07

robust and quite vast , so

2:10

maybe we can try to put

2:12

some touch points on different areas around

2:14

your journey into simulation . Would you give us some

2:16

color there ?

2:18

Sure . So I

2:20

was an engineer by training . I

2:23

have a PhD in bioengineering

2:25

and my specialty was feedback

2:28

control systems . And

2:30

with feedback control systems and

2:32

the mathematics behind it one

2:34

does a lot of modeling , and

2:37

modeling is a form of simulation

2:40

, and so I

2:42

saw myself from a very early

2:44

time I think they were covered wagons

2:46

back when I did my PhD

2:49

for a very long time I saw

2:51

myself as a simulationist

2:53

and I wound

2:55

up working for the anesthesia

2:58

department at Brigham and Women's Hospital

3:01

in Boston in the early 1980s

3:03

, and in that job

3:06

I was a device inventor

3:08

type person . They gave me a

3:10

job to kind of have

3:12

free reign in the clinical environment

3:14

and to try to develop things

3:17

to improve anesthesia care , and

3:19

so I did do that , and

3:22

in the course of doing that I did lots

3:24

of simulations to

3:26

prove my devices effective

3:29

. So one you might be

3:31

familiar with I have a patent on the

3:33

chemistry for a

3:35

colorometric CO2 indicator

3:38

, the device that you put on

3:40

the end of an endotracheal tube to tell

3:42

you that you're in the right tube

3:44

the trachea and

3:46

so for that I had to come

3:49

up with simulations of CO2

3:51

expirations in order to make

3:54

the colorometric indicator turn

3:56

color , and so

3:58

I saw myself really very much

4:01

on the technical side of simulation

4:03

when mannequin simulators

4:06

first came to be , my

4:08

colleague at Massachusetts

4:11

General Hospital , jeff Cooper

4:13

who , by the way , just received

4:15

the Society for Simulation

4:18

Pioneer Award this past year

4:20

he had undertaken this project

4:23

to fund efforts

4:25

to develop mannequin simulators

4:27

, and that was in

4:29

the early 1990s , 1991

4:31

or 1992 . And just

4:34

because I was invited , I went

4:36

on a field trip with him

4:38

and several other anesthesia

4:41

providers to look at the

4:43

simulation efforts

4:45

in Gainesville , florida , the

4:47

work that was done by

4:50

Nick Ravenstein Sr . That

4:52

eventually led to the

4:54

METI company being

4:56

formed , and that was the

4:58

genesis of that . And I

5:01

thought what they were doing was kind of cool

5:04

and it was actually

5:06

pretty technical at the time . So

5:09

interesting fact

5:12

is that they were interested

5:14

in teaching anesthesia residents

5:17

how to maintain

5:20

and debug problems with an

5:22

anesthesia machine , and

5:25

so they wanted to build a little device

5:27

that they could attach to the anesthesia

5:29

machine that would breathe . And

5:32

so they did that . They put a test

5:34

lung on an anesthesia machine and

5:37

they wanted it to respond

5:39

in various other ways , and so

5:41

eventually a simulator

5:44

, a mannequin , grew out of

5:46

the test lungs in order

5:48

for them to simulate various

5:50

things that could happen in anesthesia

5:52

, and so you know , that was sort

5:54

of right up my alley and thought

5:57

it was interesting . But I kind of decided

5:59

that they were doing a great job with that

6:01

. I had other things to work on and so

6:04

I set it down . And

6:06

then in the early 1993

6:08

, I think it was Massachusetts

6:11

General Hospital and Brigham and Warman's

6:13

Hospital merged , and

6:15

Jeff Cooper and I had

6:18

the same job at that point

6:20

in our respective institutions we

6:23

were both the directors of

6:25

biomedical engineering , and

6:27

so when the news hit

6:30

that the two hospitals had merged

6:32

this was unthinkable we

6:35

called each other up and I called

6:37

him and I said Jeff , do I work for you

6:39

or do you work for me ? And

6:42

he said I don't know what happened

6:44

. And I said we've merged and

6:46

we're one department now . And

6:48

so we got together and we

6:50

plotted for how we would make

6:53

this transition . And so

6:55

when Jeff tells the story , he says

6:57

he had just started the

6:59

simulation program in Boston

7:01

which was to be really

7:03

the first anesthesia oriented

7:06

training center based

7:08

on work of David Gaba at Stanford

7:11

. And he thought to himself

7:13

this is great , dan

7:15

will take over the biomedical

7:17

engineering department and I

7:19

can now devote my time to the

7:22

simulation program . Well

7:24

, things turned out

7:26

the opposite and

7:28

I wound up running the simulation

7:31

program and he became the head of both

7:34

biomedical engineering departments

7:36

and ultimately that

7:38

worked into a great partnership

7:40

where Jeff kind of served

7:43

as the CEO

7:45

. He was the person

7:47

who interacted with the outside

7:50

world of the simulation program

7:52

and I was the person inside

7:55

developing the cases and the scenarios

7:58

and the courses and the mannequins

8:01

and props and all of those sorts

8:03

of things which were all pretty

8:05

much brand new . It was a clean

8:08

slate . We were able to

8:10

make things and do things

8:12

that hadn't been done before

8:14

.

8:15

And , during the time , were you creating everything in-house

8:17

by yourself , because there's no suppliers

8:19

for this equipment at this time

8:21

.

8:22

Correct , except for the mannequins . So

8:25

one thing that Jeff did in

8:27

those years up until

8:29

1993 is

8:32

he felt that

8:34

for simulation to be successful it

8:36

would have to become commercial

8:39

. The two simulation

8:41

efforts that he funded

8:43

were one at Gainesville and one at

8:45

Stanford . There were a couple

8:47

of others , there was one in Toronto

8:50

, Canada , and there was one

8:52

in Pittsburgh , and so he

8:55

felt they needed a commercial

8:57

mannequin instead of their homemade

9:00

mannequins that were

9:02

, you know , he was funding and that were

9:04

evolving . So he went

9:06

to the companies , went to several

9:09

companies with his

9:11

colleagues from those institutions

9:13

and tried to get them to get

9:16

into the simulator business

9:18

, and he was successful at

9:20

that , and so the METI

9:22

company came out of the Florida

9:24

effort . It turned out that the Florida

9:26

people and the Stanford people didn't

9:29

get along CIDI

9:31

completely , and so the

9:34

Lockheed Martin Aerospace

9:36

Company developed a simulator

9:39

as well , and

9:41

so , yeah , so that

9:43

became the what was

9:46

it called the Eagle Simulator

9:49

, and it got bought out

9:51

. It is now the Canadian

9:53

company that makes it . It

9:56

became CAE . Actually

9:59

they switched corporations

10:01

at one point , so it became the original

10:04

CAE mannequin , and

10:08

so METI and CAE were the

10:10

two available mannequins

10:12

in the early 1990s

10:15

.

10:16

So in early 90s of course there's

10:18

Gainesville and the Florida activity

10:20

, and then even on the California side

10:23

there's the Lockheed with Eagle Simulator , CAE

10:26

comes in , and this is the mid 90s , even before

10:28

other larger corporations or other corporations

10:30

are involved .

10:32

Yes , absolutely . It's

10:34

sort of a funny story . The

10:36

Laurdal people became

10:39

interested in a kind

10:41

of backdoor way , and

10:44

so what happened was neither

10:46

company knew how

10:48

to make the plastic

10:50

body . The CAE

10:53

corporation was both

10:55

companies . Actually both companies were

10:58

. Their engineering base was flight

11:00

simulators , and

11:02

so they could make all the electronics

11:04

and the gears and the whistles and arms

11:07

that moved and eyes

11:09

that blinked and all of those kinds of things . But

11:12

they didn't know how to make the body . And

11:14

it turned out that there was a company in

11:17

Plano , Texas , called

11:19

Medical Plastics , that

11:22

made a full body

11:24

mannequin that was hollow

11:26

, and both companies

11:28

bought the same mannequin

11:30

and put their simulator

11:33

in it , and so the

11:35

two competitive mannequins in 1994

11:39

or so were identical looking

11:41

. So

11:44

then one year , at one of the conferences

11:47

it was a few years later Medical

11:50

Plastics hired an engineer

11:52

who said , gee , this isn't so

11:55

complicated , and he wrote a software

11:57

program to operate

12:00

their very own mannequin

12:02

. Well , this

12:04

did not sit well with the two

12:06

companies who were buying

12:08

their body from them , and

12:11

there was this great fight

12:14

that happened at the meeting that I was

12:16

witness to , with lots of yelling

12:18

at each other , and

12:20

so medical plastics agreed not

12:22

to compete with the two

12:24

companies that they supplied the body to

12:27

Gore . Lairdall was there

12:29

, and he was visiting to see

12:31

what this was all about , and

12:34

so he wound up buying

12:36

medical plastics and

12:38

their software , and so it

12:40

became the Lairdall mannequin

12:42

. This frightened

12:45

both the CAE

12:47

and the METI people , and they

12:49

had to come up with their own body

12:51

now , because they didn't want to be competing

12:54

with the company that was

12:56

about to undersell them , and

12:59

so they went out and they got mannequins

13:01

made from other companies

13:04

, some of which didn't

13:06

look that good , and

13:10

so , anyways , La

13:12

came along and instead

13:14

of costing $200,000

13:17

, which was the price for the original

13:19

METI and CAE mannequins the

13:21

price dropped to the $20,000

13:24

, $30,000 range , and

13:27

that changed the whole business . Mannequins

13:31

became affordable to everyone , and

13:33

the technology improved , and it

13:35

took us a long time , but

13:38

we're starting to get there

13:40

where the mannequins , at least

13:42

, are somewhat human-like and

13:44

actually work .

13:46

Certainly , and I'm with the advancements of technology

13:49

, the cost is coming down even more so . Absolutely

13:52

To that point , though , Dan , so

13:54

and I want to respond by

13:56

some organizational stuff too . But what

13:59

have you seen ? Some of the biggest challenges

14:01

in terms of simulation

14:03

, growth throughout the decades , meaning

14:06

one such example you just mentioned

14:09

right , $200,000 down to $30,000 , for

14:11

example .

14:12

Yeah , I think it's

14:14

. I think the biggest challenge

14:17

has been from the outset

14:19

, and continues to be , the

14:22

lack of general acceptance

14:25

of the medical community

14:27

and the hospital

14:30

system community . And

14:33

so , even though the idea

14:35

of simulation makes incredible

14:38

sense to all of us and

14:40

if you've ever talked about what you do

14:43

at a cocktail party , the layperson

14:45

thinks they don't already do that

14:47

, and so

14:49

you know it just makes all the sense

14:52

in the world but because of the

14:54

way the medical community

14:56

developed in the world

14:58

and in the United States as

15:01

an apprenticeship and one where

15:04

it's self-governed , and

15:06

lots of other reasons , I

15:09

think the notion that

15:11

physicians can

15:13

learn their craft in other

15:15

ways than the apprenticeship

15:17

is a pretty

15:20

you know there's a lot

15:22

of resistance to it , and

15:24

so you know . I think the biggest

15:27

challenge has been to get the participation

15:30

of people at

15:32

all levels . The nursing

15:34

community has been much better about

15:37

it , at least at the training

15:39

level , and

15:41

to some extent medical schools

15:43

have come around and they have some

15:46

simulation , but

15:49

extending simulation

15:51

to the crafts

15:53

themselves so that

15:55

every team practices

15:57

on a regular basis , whether

16:00

you're a newbie or an experienced

16:03

practitioner , that whole concept

16:05

hasn't really taken

16:07

hold in a widespread way

16:10

, and I think it's a tough

16:12

thing to convince the world

16:15

is cost-effective

16:17

. So I think that's

16:19

the number one challenge . It's not technology

16:23

.

16:25

No , and I think Deb and I have said on previous

16:27

episodes , it's always the default is

16:29

this is the way we've done it , and it's the way we've always done it . And

16:31

culture change , of course , is immensely

16:34

difficult , but when it comes to I

16:36

learn like this , it should be done like this

16:38

. I mean , we're seeing the same thing even with pieces

16:40

of AI , right ? It's like , oh , you can't use

16:42

AI because that's not possible . But it's like

16:44

I know it's just like the internet is coming

16:46

Right , right , it's

16:48

just changing .

16:49

Yeah , these things take a

16:51

generation almost , or

16:53

a chunk of a generation , and so

16:55

I say that that's

16:58

the most difficult problem . But

17:01

it wasn't very long ago that I started

17:03

my career in the big scope

17:05

of things and there

17:08

was only a handful of people doing simulation

17:11

in the world . And now you

17:13

go to the IMSH meeting and there

17:15

are 4,500 people there . So

17:18

it's obviously growing

17:20

in spite of those

17:22

difficulties of acceptance

17:24

and technology and training

17:26

and all sorts of other potential

17:29

limitations .

17:31

And to that , what surprises me ? Or sorry

17:33

, it doesn't surprise me . It's just incredible

17:35

to see that how many young people are at

17:37

these conferences .

17:40

And they're 20s right Like 20s yes

17:42

.

17:43

Because they're just thirsting for this type of intersection

17:45

of technology and health care , and they love

17:47

it .

17:49

It's a sexy field . When you think about

17:51

it , you can do good things

17:53

and you don't have to be

17:55

in the firing line . If you will

17:58

this thing clinically , you can

18:00

be really contributing and

18:02

have a good life . It's a very

18:04

appealing field to people .

18:06

And it's to that because I've

18:08

been in simulation now for quite a while too because

18:11

of some family history , but when it

18:13

you have the ability to help change

18:15

and help adopt that change and have

18:17

your ideas heard and actually implement

18:20

better practices and able to help

18:22

save lives , I mean that's lack of it , yep

18:25

absolutely Absolutely

18:28

.

18:29

Dr Raemer , can you tell us a little bit about the CMS

18:31

, what you did there ? You

18:34

were there for a long time . You've created

18:36

a legacy . Other guests

18:38

have mentioned you during podcasts

18:41

.

18:41

Yeah , sure . So

18:44

it's really odd I'm such

18:46

an odd duck , I guess . So

18:48

I'm trained as an engineer . I

18:51

mean , I'm a bioengineer . I've

18:53

had a keen interest in physiology

18:56

and in medicine . I did

18:58

spend a little bit of time

19:00

clinically . At the beginning of my

19:02

career I worked on a heart surgery team

19:04

and I ran the intraortic

19:07

balloon pump . So I spent a couple

19:09

of years kind of practicing clinically

19:12

. But that's the extent of my

19:14

clinical certification

19:16

. So when I came to CMS , all

19:19

of the courses were taught by anesthesiologists

19:22

. And one day one

19:24

of them said to me why don't you

19:26

debrief this case ? And

19:28

it was quite a technical case

19:31

involving an anesthesia machine

19:33

problem . And I said , okay

19:35

, well , I'll give it a try . And

19:37

it actually went okay . And

19:40

I thought , huh , that's surprising

19:42

, because I have no business teaching

19:45

these people anything . And

19:48

then a couple of weeks later the person

19:50

who was supposed to teach the course didn't show

19:52

up . And so there

19:54

I was and I had to run all the cases

19:57

and debrief them . And

19:59

somehow I don't even remember

20:01

. It's just I know it happened

20:03

, but I don't remember the details

20:06

of the day . But I was able to

20:08

kind of work my way through

20:10

the cases and debrief them based

20:12

on what I heard my colleagues

20:15

do before and of course I could

20:17

ask a lot of very naive questions

20:19

and people

20:21

appreciated that . And

20:24

as time went on and I continued

20:26

doing this , I realized that

20:28

I had a huge advantage

20:30

over my

20:32

physician colleagues in debriefing

20:35

the cases because

20:38

I was not threatening

20:40

to the learners and

20:42

even though my colleagues

20:44

tried not to be , they

20:47

were competitors in a way

20:49

. It was sort of a funny dynamic

20:51

and as the courses

20:54

became actually more

20:56

high stakes , so

20:58

Jeff Cooper managed to convince

21:01

the chiefs of anesthesia

21:03

of four Harvard teaching hospitals

21:06

to come and take a course and

21:09

everybody thought this was a great

21:11

idea and everyone was excited about

21:14

it . And all of our clinician

21:16

instructors turned to me and said

21:18

you have to do all the debriefing

21:21

. And I

21:23

said why ? And they're

21:26

the boss , I

21:28

can't debrief my own boss . And

21:30

I was like , okay

21:32

, I don't get it , but

21:35

I'm happy to do it . And of course

21:37

the chiefs were so mature

21:40

and thoughtful and they

21:42

performed in a very

21:44

different way than their

21:47

faculty did . And I

21:49

started to realize that

21:52

if you're curious enough and

21:56

you see your role

21:58

as getting people to talk

22:00

about their thinking , that

22:03

things became self-debriefing

22:05

that no matter who the

22:07

participant was , no matter what

22:10

level they were , no matter

22:12

, they could have the Nobel

22:14

Prize in the topic of

22:16

the case you were doing , and if

22:18

you were curious as a debriefer

22:21

, you could get them to teach

22:23

everybody about it , no matter what

22:25

they did . Even if they screwed up , they

22:27

would freely admit it and talk

22:30

about it . And so , as a

22:32

debriefer , I realized that that

22:34

was the key to

22:36

be curious . Never

22:39

ask a question . You know the answer

22:41

. To always ask a question

22:43

that you wonder about . And

22:45

that kind of changed everything

22:47

and that became , with the

22:49

help of lots of others , CMS's

22:52

philosophy , and

22:54

we started to get asked to

22:57

give instructor courses

22:59

, and so we developed a curriculum

23:01

with Jenny Rudolph . She

23:05

was actually a PhD student

23:07

and I was an advisor

23:09

that did her dissertation

23:11

research with her , and so

23:13

she was an obvious person to bring

23:15

on board . And Robert Simon

23:18

joined us and we had

23:20

several people who were very thoughtful

23:23

about education and about how

23:25

people give feedback , and

23:28

also some spectacular

23:30

clinicians , and so CMS

23:33

was able to develop an

23:35

instructor course that seemed

23:37

to just resonate with people . It

23:39

became very popular . We gave it all

23:41

around the world . There are thousands

23:44

of people who have taken that

23:46

course , week-long course , and

23:48

I think they benefited

23:50

especially from that notion

23:53

of curiosity . So I became

23:56

mostly by teaching it to

23:58

other people I became very good at it , I

24:00

think , and so I could model

24:02

how to ask questions in

24:04

a curious way that

24:07

really elicited thoughtful

24:09

and revealing responses

24:12

from participants , and so

24:14

that was really how that evolved

24:16

, and I think what I became

24:19

known for among my colleagues

24:21

is being a good debriefer .

24:24

Yes , you've been known to have a gift

24:26

.

24:28

It's also interesting to me that both

24:31

things that you mentioned , you know , with anesthesiology

24:33

and this simulation

24:36

, with the overlap with Jeff Cooper

24:38

, and then now this CMS

24:40

course , like both of the things , kind of

24:42

happened by accident in a way . It

24:45

wouldn't be , intentional by any means

24:47

.

24:47

Serendipity is amazing . You

24:50

just you know , I'm so

24:53

fortunate , as everyone is

24:55

, who has a career you just happen

24:57

to be in the right place at the right time

24:59

and you have to be willing to

25:02

have an open mind to things

25:04

and take them on . And so

25:06

I mean I could have said no . There

25:08

was a time early on in simulation

25:11

where just didn't seem to be

25:13

catching on and I thought , oh well

25:15

, I'll just leave this and

25:17

do something else . And

25:19

somebody convinced me that

25:22

I should stay , and he was

25:24

a very wise man and he thought it was

25:26

valuable and anesthesia

25:28

chief , by the way and he talked

25:30

to me and he said you're really good at this

25:32

. I think you need to stay here because something's

25:34

happening that hasn't happened before

25:37

, and so , but you know , just being open

25:39

to hearing those kinds of things and

25:41

taking advantage of them , I

25:44

think is key , because those opportunities

25:46

come along in a career lifetime

25:48

and seems like serendipity

25:51

, it seems like by accident , but

25:53

it's not really . It's really

25:55

pretty natural . And

25:57

I think the key is to be able

25:59

to say to yourself ah

26:02

, this just seems risky and

26:04

it doesn't all make sense , but

26:06

I have a good feeling like this is

26:08

something I should try to do and

26:11

if you could put yourself in that place

26:13

. You take advantage of those opportunities

26:16

and what seems like an accident

26:18

is actually a little more intentional

26:21

than seems from the outside

26:23

.

26:24

Yeah , some pretty profound

26:26

information you've shared so far . Do

26:28

you happen to have a favorite or

26:30

most impactful simulation story with

26:33

your vast experience ?

26:36

Yeah , so I

26:38

have lots of them . I could go on for days

26:40

here , but one of my favorites

26:42

was we . You know , as

26:45

I explained , we started in anesthesiology , and

26:47

so all of the courses and cases

26:50

that we did were Anesthesia

26:52

oriented . Robert Simon

26:54

later joined us at CMS

26:56

, was a government contractor

26:58

who worked for the Defense

27:01

Department in aviation

27:03

training for the most part , and

27:05

he had gotten a contract to

27:08

train emergency

27:10

departments in safety

27:13

, and as part of that

27:15

he wanted to measure safety

27:18

and have this very elaborate research

27:20

project , and so he wound

27:22

up coming to CMS bringing

27:25

some of his emergency medicine

27:27

study participants

27:30

to see if Simulation

27:33

would be helpful in training

27:35

them about safety , and he got

27:38

this , because in aviation

27:40

they always had simulation

27:42

. He developed safety programs in

27:44

a military helicopter crews

27:46

and so he had

27:48

the benefit of having a helicopter

27:51

simulator and he thought the

27:53

one thing lacking in medicine is they

27:55

don't have a medicine simulator . And

27:57

he Stumbled upon CMS and

27:59

he brought this emergency medicine team and

28:02

so we set up the very first emergency

28:04

medicine simulation course , and

28:06

it was fairly elaborate

28:09

. I had the help of two emergency

28:11

physicians that got recruited

28:13

by the chiefs of emergency medicine , and

28:17

one of them was and was a resident

28:19

and we ran

28:21

our first course and

28:23

the very first case we

28:26

did with the CAE Eagle

28:28

mannequin at the time . Midway

28:30

through the case , all the vital

28:33

signs went flat and

28:35

Smoke started coming out of

28:37

the mannequin and

28:40

the team , to my amazement

28:43

, said a sisterly

28:45

and they started pumping on the chest and

28:47

treating but you know , the completely

28:49

electrically dead mannequin

28:51

. And you know , at some point

28:53

we called the case and and I

28:56

didn't debrief it one of the emergency physicians

28:58

debriefed it as a , you know

29:00

, a cardiac arrest leading to a

29:02

sisterly . I was like , oh

29:04

my god , what are we gonna do ? We've done

29:07

half of one case and

29:09

we have all these people and they paid

29:11

all this money . What are we gonna do

29:13

? I just like and the mannequin

29:15

is now bride , I

29:18

mean , the circuit boards had cooked

29:20

and so this

29:22

resident said well

29:25

, I don't think this is a problem , dan

29:27

, and I said what do you mean

29:29

? Are you kidding ? This is a crisis

29:31

? He said yeah , but you know , I'll

29:34

tell you what we'll do . He said have

29:36

you got a whiteboard ? And

29:38

I said yeah , there's one on the door

29:40

and we tore it off the door and

29:43

he said let's just do the cases

29:45

we were gonna do . I'll stand

29:47

next to the mannequin and I'll write

29:49

the vital signs on the whiteboard

29:51

, I Assume I said okay

29:54

, but it just didn't make any sense

29:56

to me . And so we did

29:58

the next case , with no

30:01

working mannequin but a whiteboard

30:03

, and it was a case very

30:05

similar to one that we had done in anesthesia

30:08

groups , and the

30:10

participant response was exactly

30:13

the same as it was

30:15

with the live mannequin and

30:18

I thought , oh my god

30:20

, we did the whole course that way and

30:24

it didn't change the

30:26

outcome at all . They loved it

30:28

, they thought it was terrific . I

30:31

was devastated . I thought , you know

30:33

, I thought I failed them because the

30:35

technology didn't work . But it

30:37

had nothing to do with the technology

30:40

. So fortunately

30:43

, emergency physicians don't

30:45

sit there and watch the vital signs

30:47

. They come into the bedside

30:49

, they ask the nurse what the vital signs are

30:51

, they get the information and then they make a

30:53

decision . And so I didn't

30:56

quite realize that they

30:58

weren't used to the seeing the monitor

31:00

continuously anyways . So

31:03

holding the whiteboard up was perfectly

31:05

fine for them and it was all

31:07

about the problem that they were presented

31:10

. If you presented them

31:12

with an interesting problem that

31:14

was at the edge of their practice

31:17

, not something that

31:19

you know , they could do with their eyes closed

31:21

, that they had to think about it . It

31:23

was compelling , and so long as

31:26

a debriefing brought that out

31:28

and got it discussed , the

31:30

whole simulation really

31:32

didn't matter all that much . It

31:35

led me to be much more confident

31:38

about every scenario that

31:40

we ever did . After that I

31:43

knew that , no matter what happened , the

31:46

story that

31:48

was embedded in what we were trying to

31:50

do was the important thing . And

31:53

so long as the story got told

31:55

, everything would be fine

31:57

. After that day I can't

32:00

tell you how many simulator

32:02

failures , simulation

32:04

failures I experienced

32:07

all kinds of crazy things didn't

32:09

work or didn't happen and

32:12

really it didn't matter all that much

32:14

. So that was one of my

32:16

favorite .

32:17

I love that lesson , but it actually leads me to another

32:19

question and we need to wrap up shortly

32:21

. But that question is where do you see the future

32:23

of simulation going ? Because I'm hearing

32:25

the story sometimes a simulator

32:27

doesn't matter , it's the resourcefulness

32:30

of everything . But how do you see simulation

32:32

evolving , especially with IMSH-24

32:35

? We see how much technology and

32:37

all these different aspects are there . I'd

32:39

love to hear your thoughts on that .

32:41

Yeah , so clearly the technology

32:43

will change . Being a technology person

32:46

, I'm always excited about that . I think

32:48

the distance simulation stuff , the

32:50

3D glasses simulations

32:52

all those new approaches

32:55

are exciting . They work

32:57

really well in lots of circumstances

32:59

, but I don't think

33:02

that they are the

33:04

fundamental change

33:06

. I think the fundamental change

33:08

is how many

33:10

different ways stories

33:13

will be transmitted

33:16

to people and

33:18

how sophisticated will

33:20

be in helping people

33:22

analyze them , and so

33:24

that may involve AI

33:26

. It may involve other kinds

33:28

of instructor training . The

33:31

delivery platforms , obviously

33:33

, are changing . That's the most obvious

33:35

one on the surface , but

33:38

I think we'll become more sophisticated

33:40

in learning how

33:43

to improve people's

33:45

performance . We started off

33:47

before the podcast talking

33:49

about my tennis playing and

33:51

my retirement . Every

33:54

athletic sport has

33:56

improved in the

33:58

sophistication of how

34:01

to get the most out of the human

34:03

physiology , and

34:05

so tennis players studying

34:09

every muscle movement

34:11

and analyzing how they swing

34:13

the racket and the technology

34:16

of the racket and

34:18

the teams they have training

34:20

them with nutritionists and

34:22

strength coaches and sports

34:24

psychiatrists and psychologists

34:27

and the like , have

34:29

improved every sport immensely

34:31

, and so I think

34:33

practicing health care

34:35

needs to undergo that same

34:38

kind of improvement . How

34:40

do we improve people's performance

34:42

? And simulations are part of that , and

34:44

, as simulation moves inevitably

34:47

in its technology , the figure

34:50

out ways to more efficiently

34:52

improve people's performance , I think is

34:54

the future .

34:55

Thank you , Thank you now in

34:58

your retirement . Why don't you share a little bit about

35:00

what you're doing in your retirement ?

35:02

Yeah , well , I play lots of tennis

35:04

. I ride a bicycle 100

35:07

miles a week out into the farm

35:09

country . Here . I am enjoying

35:12

it immensely , but I miss my

35:14

work . So I do

35:17

review a lot of papers , I

35:19

attend meetings and I'm on some committees

35:21

and , most importantly , I

35:23

have a lab in my garage . I

35:26

have a 3D printer and

35:28

I've been making various simulation

35:30

devices , so I've made

35:32

the fiber . Later I 3D printed

35:34

a defibrillator and put electronics

35:37

in it so that it works and it beeps

35:39

and it makes all the sounds that a real

35:41

defibrillator does , charges

35:44

up and fires , but

35:46

it doesn't deliver any energy , because

35:48

I wanted to make a safe

35:50

training defibrillator . So

35:53

I'm pretty far along with that and I'm not sure

35:55

what I'll do with it , but it's

35:57

a fun hobby .

35:58

That's a long way from medical plastics laboratory

36:00

back in the 90s with the companies

36:05

visiting Ohio . You

36:08

just 3D print in someone's garage now .

36:10

Yeah , yeah , exactly , it takes

36:12

about 14 hours , but

36:14

it's simple

36:16

in principle .

36:18

Well , we really want to thank you so much

36:20

for your time and all your contributions to

36:23

medical simulation . Thank

36:25

you .

36:26

Well , thanks very much for having me . It's

36:28

fun talking to you guys .

36:30

We enjoyed hearing your story , that's for sure

36:32

. Well , Jerrod and

36:33

Dr . Raemer, thank you, Dr . Raemer , thank you and

36:35

happy simulating .

36:38

We thank Interact Solution for sponsoring

36:40

this week's episode of The SimCafe . Thanks

36:52

for joining us here at The SimCafe

36:54

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36:57

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