Patient Safety Advocate Brian Gillett

Brian Gillett, MD, is an Emergency Medicine physician with over two decades of leadership and innovation in simulation training and emergency preparedness. Brian built and served as the director of medical simulation for the Kings County Hospital Center, SUNY Downstate College of Medicine and Maimonides Medical Center. He also serves the Director of Strategic Technologies for New York Institute for All Hazard Preparedness. Brian is still a practicing physician in Denver, Colorado and the Co-Founder & President & Chief Medical Officer at Health Scholars.

Dr. Gillett’s nominator said: “Dr. Gillettis passionate about patient safety and has dedicated his professional career toimproving patient safety through the advancement of clinical trainingtechnologies, and truly believes that blended learning and emerging tech canfoster more effective, scalable training. Currently Dr. Gillett overseesclinical education strategies and healthcare direction for the organization tosupport Health Scholars' mission of improving patient safety through the use ofvirtual reality simulation. Prior to co-founding Health Scholars, Dr. Gillettwas founder and Chief Executive at SimCore Technologies, provider of widelyimplemented simulation management and quality improvement software tools, nowintegrated into Health Scholars’ blended learning platform. Dr. Gillett is arecognized national leader in immersive training and pedagogical research,having published and lectured extensively in these domains.

Unboxingthe Future

The Health Scholars’ platform deliversadvanced simulation management solutions, but also includes VR content anddelivery, marrying the benefit of in situ training with virtualization’s scale.

On the first day of my first job as anEmergency Medicine attending physician, my department chair rested a seasonedarm on my shoulder and said, “You need a thing.” I had no idea what he was hewas talking about, nor did I know how to respond. The “thing” that he wasreferring to was a boxed high-fidelity patient simulator, procured by arecently graduated resident and stowed in the department’s broom closet.

I can honestly say that this was the mosttransformative unboxing experience I’ve had in my lifetime. I was instantlytaken by the potential for this smart technology to provide clinicians andteams with reference experiences that could authentically provide sufficientrelevance to help them adjust their practices without having harmed or nearlyharmed a real human being. This would be the tool to learn from our errorsbefore they really happen.

We are all familiar with the English poet,Alexander Pope’s, proverbial phrase: “To err is human; to forgive, is divine.”I thought of this phrase as I unboxed the simulator, slightly adjusted tosomething like, ‘To err is human; to practice deliberately without harm, toreflect honestly and accurately is divine.’ I was hooked.

We’re humans, and we learn by doing. Thishas long been our modus operandi, and by and large, has served our kind well…until that mantra was applied to medical training. As healthcare workers, we’reprivileged with the public trust bestowed upon us to care for the well-being ofhumanity. We, in healthcare, hold this trust dearly and closely to our hearts.However, as a junior resident, I found myself violating this trust over andover again every time I performed a new patient care task or a procedure forthe first time. And every time I engaged in team-based care (which is all thetime in healthcare) without deliberately practicing. Those violations weresimply the result of a sounder alternative not yet being available.

It is available now with clinicalsimulation. The technology, pedagogy and infrastructure requisite forsuccessful simulation-based education has significantly matured over the pastdecade. Simulation champions now enjoy state-of-the-art simulation centers,accredited fellowships to master the craft and validated research methodology.

However, today’s healthcare ecosystem posesnew challenges to healthcare workers eager to participate in the type ofresonant training afforded by mannequin-based simulation. Healthcareprofessionals execute on a daunting quantity of critical tasks withincreasingly insurmountable time and resource constraints. As such, it’s notsurprising that the primary barriers to improving healthcare performancethrough immersive training are time and cost constraints. The result fortoday’s healthcare workforce is a similar paucity of opportunity to understandand practice the mitigation of performance gaps that we faced during thepre-simulation era.

Compounding the problem, simulation centersprimarily reside in academic institutions, which account for only 5% of UShospitals, (Dashoff, 2017) and are largely absent from the vast network ofcommunity-based outpatient clinics and long-term care facilities. Non-academichealthcare facilities allocate less budget for clinical education than theiracademic counterparts, and employment contracts for community-based staff havefewer accommodations for non-clinical time. Simulation directors (myselfincluded when I wore that hat) constantly struggle to find a sustainableprocess for staff to attain coverage so that they may participate in aconsequential simulation exercise. This task is doomed at the start line whencar travel is involved. Private healthcare facilities across the US are swiftlyintegrating with large healthcare organizations in order to remain sustainable.Because simulation centers are expensive to build and maintain, they tend to beconcentrated at the “mothership” hospital making travel unavoidable for many inour current brick-and-mortar sim center paradigm.

With that initial unboxing of the broom-closetpatient simulator, I became committed to streamlining and maximizing access toimmersive education. In 2013 I founded SimCore, a company with the mission ofproviding future ready simulation management solutions, with support for insitu exercises as a company priority. The goal was to streamline access toimmersive education in our rapidly consolidating healthcare landscape and ascarcity of simulation centers outside of academia. Our simulation managementsolutions worked, but we uncovered additional complexities and limitationsrelated to extending simulation education at scale. Someone still needs tophysically transport and operate these patient simulators in order to bring thetraining to the thousands of healthcare workers across an organization.

Additionally, acute and long-term carestaff, work both day and night shifts. The numbers of clinical educators inhealthcare organizations are limited, and these dedicated souls must somehowfind a way to deliver immersive training to thousands of individuals duringboth day and overnight hours. As custodians of health, we pride ourselves onalways delivering, no matter the challenge. However, we simulation championsare meeting our match with this one – delivering a suitable quantity oftraditional simulation at scale is just proving unrealistic.

Simulation arose at the nexus of emergingtechnology and contemporary educational theory. We leveraged high-fidelitymannequins, packed with sensors and circuit boards, to emulate anatomic andphysiologic realism and organic response to medical intervention. This enableddeliberate practice of procedural and communication tasks, and a vast body ofresearch that unequivocally validated the benefits of immersive education.Simulation professionals must now continue to champion technological innovationin order to meet the complexities of today’s healthcare ecosystem.

This scale issue was what originally led meto look closer at virtual reality (VR). VR enables immersive education at scaleand is the expected evolution of mannequin-based simulation. Clinicians andallied healthcare professionals can transport themselves to a highly realistic,fully immersive experience anywhere, anytime, simply by donning a pair of VRgoggles. In 2017 SimCore evolved, integrated VR capabilities and launched a newblended learning platform called Health Scholars. The Health Scholars’ platformstill delivers advanced simulation management solutions, but also includes VRcontent and delivery, marrying the benefit of in situ training withvirtualization’s scale. VR simulation has become Health Scholars sweet spot andI believe VR will truly become a catalyst for making experience-based trainingmore affordable and accessible.

Dr. Gillett practicing surgical fire management with Health Scholars' Fire in the OR virtual reality application.
Image credit: Health Scholars.

For example, the cost of VR training isexponentially less expensive than traditional mannequin-based simulation. AnOculus Quest, a stand-alone headset that does not require a PC, costs $399(USD), approximately 1% of the cost for a high-fidelity patient simulator. VRexercises may be deployed to an unlimited target audience through cloud-basedsystems with minimal personnel overhead, solving travel needs associated withtraditional brick-and-mortar simulation centers. Learners complete VR exercisesin approximately 20 minutes, readily enabling participation during downtimewithout having to leaving their clinical units. Furthermore, learners may stepout of a VR exercise for clinical duties and resume where they left off when orcan even be completed at home. A recent study also revealed that 67% ofparticipants preferred VR training over traditional methods(2).Thus, VR enables immersive healthcare education at scale, with trivialpersonnel and equipment cost. I am particularly enchanted by the capability ofthis emerging technology to detach the operational barriers that currentlyimpede large-scale access to immersive healthcare training.

Today’s VR does not replace allmannequin-based simulation as scenarios often must be designed and executedquickly in response to mishaps. Currently, VR training modules take severalmonths to design and build, so the technology does not solve for reactivetraining priorities that require a quick turnaround. Additionally, team-basedtraining engages subtle human factors, such as eye contact, tone, closed loopcommunication, and situational awareness of team members involving subtletiesand facial expressions. That said, VR technology is evolving rapidly to includeartificial intelligence, and Health Scholars is actively working onapplications that utilize glove technology and voice recognition to replacehand controllers. Just as high-fidelity mannequin and task trainer tech quicklyovercame early limitations, VR will do the same.

Today, VR is best leveraged fornon-reactive training topics that need to be rolled out to a large targetaudience. Additionally, VR is particularly suited to replace resource-intensivesimulations. For example, many traditional simulation exercises require atechnician, a subject matter expert, one or more embedded actors and uniqueenvironment requirements (i.e. wall gas, anesthesia machine, OR lights, etc.).VR recreates all of this in a virtual world, accomplishing learning gains at afraction of the personnel and financial costs. Of particular interest to me, isVR’s aptness for patient-safety oriented training, where learning objectivesare well established, are best transferred through immersion and must bedisseminated in a meaningful way at scale.

Dr. Gillett demonstrating a lumbar puncture on task trainer.
Image credit: Health Scholars.

Medical error and improved patient safetyare still very much a public concern and priority for today’s healthcareorganizations. Which is why VR represents an important arrow in the modernsimulation champion’s quiver by enabling self-directed immersive training whereappropriate, and freeing up resources and clinician time for exercises thatindisputably require real-world interactions. As such, modern simulationdirectors will increasingly shift away from tactical duties, whichsubstantially involve pragmatics of operating the simulation center, toward amore strategic role as champions of distributed immersive education. The futureready simulation director will work closely with their quality leaders andliability insurers to identify and pair training priorities to the best-suitedlearning modalities. And they will begin to leverage innovations, like VR toensure that their target audience has access to meaningful training that candirectly promote error reduction and improve patient outcomes.

At the culmination of my medical school education, we recited the Hippocratic Oath. Among other things, I had committed “to help the sick according to my ability and judgment.” Reciting this statement has had profound resonance on my professional development as a physician, an educator and now as a business leader who leverages innovation and emerging technology to move the needle toward healthier and safer patient care.

Originally published in Issue 1, 2019 of MTM Magazine. 

References
1. Dashoff, J. (2017, October 19). Teaching Hospitals, Communities are Working to Get to the Root of Substance Use Disorders. AAMC News. Retrieved from https://news.aamc.org/patient-care/article/root-teaching-hospitals-substance-use/
2. Dorozhkin, D; Olasky, J; Jones, DB, et al. (2017, September 31). OR Fire Virtual Training Simulator: Design and Face Validity.” Surgical Endoscopy, p. 3262

Addendums
Brian Gillett LinkedIn: www.linkedin.com/in/brian-gillett-b4b51092/
Health Scholars Website: http://healthscholars.com
Health Scholars LinkedIn: www.linkedin.com/company/healthscholars/
Health Scholars twitter: www.twitter.com/HealthScholars1