Connecting the Dots With Medical Simulation

Marty Kauchak describes how the medical simulation center technician community is on the cusp of embracing standards, enhanced formal education programs and other initiatives to bolster its professionalism.

MEdSim has had the privilege of visiting medical simulation centers on both sides of the Atlantic. While the mission of each center varies to address learning for individual and teams of health care providers, the one unifying element among the facilities is the technicians.

While the mission of medical simulation centers around the globe may vary to address learning throughout the continua of individual or team programs for different health care providers, there is one unifying element among the facilities- the technicians. Image Credit: Paul Phrampus, MD/WISER.

Paul Phrampus, MD, the Director of the Peter M. Winter Institute for Simulation, Education and Research (WISER), noted this occupational group is the one common, uniting, bonding element that “connects the dots” among the many community facilities. So, “they are at every point, the substrate layer of connectivity that is starting to emerge in a group that may often coalesce at an industry forum. These are the people who ‘keep the magic going’,” he emphasized.

Similarly, Paul Pribaz, the Executive Director at the Center for Education in Medicine, Feinberg School of Medicine, Northwestern University, pointed out the technician is the one common feature in simulation, across medical specialties, professions, learner levels, and geography. “They truly are the source of ‘cross-pollination’ in simulation-based medical education, sharing what works best and helping faculty take maximum advantage of the learning opportunities in simulation,” he said.

Varying Job Descriptions and Responsibilities

The responsibilities of medical simulation center technicians vary greatly throughout the community. In some instances, smaller centers with one or several training devices may have a part-time staff member to provide technical support. At the other end of the spectrum are the larger facilities with full time staff members immersed in simulation-like responsibilities throughout their workday.

H. Michael Young, a Simulation Technology Specialist at Tarleton State University’s Center for Instructional Innovation, told MEdSim that he supports the university’s nursing department in its simulation activities, and has other wide-ranging responsibilities including his consultations with partner and extension campuses in their simulation programs.

Similarly, James Cypert, the Technical Director for the School of Nursing at California Baptist University, modestly indicated his expansive job portfolio includes “anything that touches electronics and electrical, and data, the day-to-day IT [information technology] issues, exclusively for the School of Nursing – with a special concentration on simulation.”

The Riverside, California-based community member recalled his simulation-specific activities include in-depth collaboration with faculty and learning content educators to establish scenarios and finalize hands-on time with learners and mannequins. “I also work with the mannequins to make sure they are prepared to help create the appropriate learning environment, whether it be a staged presentation so they know what is happening or even a ‘surprise’,” he added.

Cypert also draws upon his previous 15 years of experience as a technical educator to go beyond being a “button pusher”, to develop innovative ways to integrate simulation into the curriculum. “I can definitely communicate with the nurse educators here at a different level,” he remarked.

Brian Florek, an Audio Visual (AV) Systems Engineer for Simulation Technology and Immersive Learning at Northwestern’s Feinberg School of Medicine shared insights from a larger community facility’s perspective. Florek noted his colleagues have several main areas of function. “The primary responsibility includes day-to-day operation of the center, which ranges from setting up and taking down events to running high fidelity simulations. Each tech is responsible for learning the features and operation of each simulator, as well as all AV equipment used within the center. The techs are also responsible for maintaining the center's infrastructure of IT, AV and simulator equipment,” he said. Repairs and upgrades are kept as much in house as possible to ensure minimal costs and maximum up time of equipment. The Feinberg School of Medicine’s technicians are also encouraged to play an active role in assisting faculty with the development of future simulations. Florek continued, “Techs have a unique perspective on ensuring the proper amount of fidelity goes into each simulation. Techs are asked to play ‘confederate roles’ such as nurse, attending, resident, medical student, and family members during simulations. They also help faculty pick simulators appropriate to their needs, which might include modifications to those simulators if needed.”

Certification and Standards

While these individuals often have impressive resumes, skill sets and experience, they collectively lack the rigor of certification, qualification and standards found in the technical workforces in other high risk industries.

Indeed, when this author visited the Delta Airline TechOps center in Atlanta to write an article for MEdSim’s sister publication CAT (http://halldale.com/cat), that organization’s leadership emphasized how its airline maintenance academic program, instructors and graduating students have agency and airline certifications, and other credentials. (“A Firm Maintenance Foundation in Atlanta,” CAT issue 6, 2012, pp. 8-10).

Of initial interest for the medical simulation technician community is the lack of commonality among institutions on their requirements for prospective workforce members. An undated University of Miami School of Nursing and Health Studies “Positions Available” announcement distributed at this January’s 2013 International Meeting on Simulation in Healthcare (IMSH) conference listed requirements, in part, for a Simulation Technician: “high school diploma or equivalent and a minimum of 1 year work experience, Associate Degree and/or working toward a BS in computer science, engineering, or other related field preferred; experience in a medically related field or certificate program preferred. EMT [Emergency Medical Technician] training preferred.”

Conversely several other positions available announcements randomly viewed online for community technicians specified IT and medically related experiences as required for consideration by the human resources offices.

This and other gaps may soon be closing. What emerges from discussions with healthcare community members is a compelling need to elevate the position of center technicians through the types of certification, standards and formal education found in other sectors.

In one instance, the Society for Simulation in Healthcare (SSH) is helping to establish a certification process for medical simulation center technicians.

WISER’s Phrampus, who is also the society’s president and holds faculty assignments at the University of Pittsburgh School of Medicine, said his organization’s Technology Specialists Special Interest Group, to which center technicians may join, has been growing by “leaps and bounds” through the recent past. Indeed, when he spoke with MEdSim this January that group’s increase in membership, activities and other criteria warranted consideration of its elevation to a Section within the society.

Another natural progression of the medical simulation center technician community’s growth is the interest in establishing certification and standards for the group. Phrampus pointed out that his society’s “certification committee this year is embarking on the development of the technician certification and associated standards and we are eagerly anticipating a launch of the program at our 2014 IMSH meeting.”

The concept of workforce standards resonates clearly with one front line professional, Northwestern’s Florek. “If a governing body did exist, it would certainly make things easier for institutions seeking to hire qualified techs for their labs. The time it takes for on-the-job training to proficiency in our lab is 6 to 9 months. If we were able to hire in certified techs, that time should be significantly reduced,” he explained.

Similarly, Northwestern’s Pribaz is a front office advocate for these professional enhancements, noting, in part, his institution has been very involved in the SSH efforts to help define technician competencies and develop a credentialing process. “The simulation technician is truly the one common feature between sim centers. As the research and validation around the use of simulation for high stakes exams progresses (e.g. MOCA), it is clear to me that clinicians must have the same learning experience wherever they choose to go to take a certifying exam,” he said and added, “The competency of the tech is absolutely critical if simulation is going to achieve acceptance for this purpose. My personal opinion is that a governing body should define standard/s and any institution can implement training programs that could be accredited to teach and assess that a standard has been achieved. At our institution, we would love to be a center for providing these kinds of training programs.”

A Boost for Education

Tarleton State University’s Young also holds positions of responsibility at SSH, including membership on its board of directors. With no actual formal education in simulation he mirrors many of his contemporaries who often come from a variety of different professional backgrounds.

In another dramatic development for this community, Young and others have a new-found professional interest to advance the state of formal education for this community – through the awarding of an associate degree, undergraduate degree or a certificate/s.

The proponents of formal education for this community conceptually want to provide the technicians with a common academic background to better understand the basics of human physiology and anatomy, support increasingly complex simulation center technologies through their life cycles, contribute to instructional course design, and obtain other skill sets.

A common academic framework would also level the playing field among different accessions into the community. So conceptually, nurses or EMTs and others with a medical background who become center technicians would increase their knowledge in IT and related technologies. Likewise those proficient in technology would learn about instructional design, basic medical topics and other “new” professional subjects.

California Baptist University’s Cypert noted that while a well-rounded certification plan and education strategy would help the community, he cautioned that technical skills should be only one part of a learning curriculum. “The component that is missed a lot is intercommunication, along the line of interdisciplinary education. We need to be able to deliver that in a manner so the faculty members who are content experts have to communicate with individuals who are very technically capable – there frequently is no ‘bridging experience’. The techs are not educators. It would be good to supplement those IT skills to allow them to communicate with healthcare educators who ‘don’t speak technology’ and similarly, help the tech who doesn’t understand many healthcare topics. This is the key,” he emphasized.

Young also provided several compelling reasons to develop professional education programs for the community. “We need to stop trying to niche the sim tech (simulator technician) role. The reality is there is not one sim tech role. The word ‘technician’ means different things to different communities. A technician in the medical community means an entry level, low level clinician tasked with very specific skills, an X-ray technician for example.” He further pointed out that at the same time the very complex learning technology domains are “always butting heads and crossing boundaries.” For instance, “a sophisticated technology crosses boundaries among audiovisual, pneumatics, microcomputers, networking, servers and in other ways these systems are all constructed.”

One embryonic academic program is the Associate of Applied Science (AAS) degree program in simulation technology under development between The University of Akron and the Austen BioInnovation Institute in Akron (ABIA).

Scott Atkinson, a simulation specialist at ABIA’s Center for Simulation and Integrated Healthcare Education (CSIHE), told MEdSim that he is collaborating with Martha Conrad, ABIA’s Director of Interprofessional Education, and faculty from The University of Akron to develop the program.

Atkinson said the program has two proposed options, an AAS degree or a certificate award.

The certificate options will support the study of healthcare simulation technology. Conceptually, a nurse or paramedic without an IT background would learn basic skill sets in simulation technology. An IT or computer specialist with a strong technical background would learn about the basic concepts of simulation in healthcare. “We’re trying to help people with healthcare or technology backgrounds explore new ways to use their current skills and experience in simulation technology,” Atkinson said.

The second track, leading to the award of an AAS degree in simulation technology will offer courses in computer technology, healthcare simulation and leadership skills.

An important feature of both the certificate and the AAS degree options is Akron’s unique geographical location of multiple simulation centers. The program will support students’ engagement in simulation centers for nursing education, medical student education, acute care adult, children and inter-professional education. The ABIA CSIHE supports all levels of simulation education from novice to expert.

The outcomes of the AAS degree program will allow the aspiring technician to operate a simulator, work with inter-professional teams to embed simulation into curriculum, and manage daily operations of a simulation center.

The new AAS degree and Certificate Program at The University of Akron will launch in the fall semester 2013.

While the initial classes will be completed in residence, Atkinson envisions some of the courses migrating to an online format.

Northwestern’s Florek provided a compelling reason to continue the dialogue and progress in bolstering formal education programs for this workforce. “I believe at a minimum certificates should be issued. There truly is a science to being a simulation technician. It would be nearly impossible for anyone with an education in any one of the areas we cover to step in and be a proficient technician,” he pointed out and added, “Sim techs need formal education in such a wide variety of topics that it is necessary to develop a formal curriculum and degree path. Creating this educational pathway will also lead the way to full career paths for the tech, something that does not currently exist. I believe having this career path: from tech, to master to educator, will encourage more qualified applicants to enter into the field, and reduce turnover for institutions.”

Vendor-Supplied Training

As formal education programs evolve and expand for this community, the original equipment manufacturers of the centers’ products and systems also provide specialized instruction to support their materiel’s life cycle.

KbPort delivers high fidelity multimedia solutions to medical simulation centers – supporting after action reviews and other components of the training cycle for individuals and teams.

Only when center technicians are integrated into the life cycles of state-of-the-art multimedia and other systems’ are they able to effectively and efficiently operate the technologies on demand. KbPort has set one standard for the vendor community with its logistics model, which provides for hands-on training, supplemented by online and telephone help desk resources for all new customers.

Scott Giroir, a company sales manager, said that upon installation of a system, his technicians will typically spend one or two days with their simulation center counterparts to conduct familiarization training. “We sit down in front of the system and learn, for example, how to operate a mannequin from a laptop. We tailor our training depending on the type of equipment they get.”

A month later, the customer’s technicians will often complete online training. “At that point they are ‘getting their feet wet’ – moving into the system, understanding it better and retaining more. So they need to address some questions at that point,” Giroir emphasized. KbPort additionally provides a telephone help desk as another layer of customer support.

Wendy Jo Wilkinson, CAE Healthcare’s Director of Clinical Support Solutions, similarly said her company invites “simulation center technicians to participate in our Simulation in Practice and our Core Education courses alongside educators and clinicians where they can interact and share their expertise."

CAE Healthcare further integrates community technicians in its products’ life cycle support strategy by offering advanced training and certification for simulation technicians or operators who would like to learn how to troubleshoot, perform preventative maintenance and repair the company’s patient simulators. Wilkinson continued, “Our four-day Simulation Technologies course leads to certification in operating and maintaining our simulators. Since each customer site is unique, our educators, and our customer service and technical staff can provide a customized training course specific to the customer needs as well as ongoing support."

Other Resources

There are other resources, in addition to MEdSim and its supporting website http://halldale.com/medsim, to educate and inform this community and help it evolve.

One website which caught our attention was the simtech http://thesimtech.com/ The online resource notes that based “on continuing contributions from the simulation community, the simtech's goal is to become an 'online hub' for sharing ideas and information.”

And this August 6 through 9, the Gathering of Healthcare Simulation Technology Specialists (SimGhosts) http://www.simghosts.org/ will hold its annual meeting in San Antonio, Texas. This organization was created to provide technology specialists within the healthcare simulation field with a community dedicated to developing and sharing resources, knowledge, training and standards for fostering excellence in the operation of healthcare simulation.