1. Congratulations on the upcoming publication of the book Healthcare Simulation: A Guide for Operations Specialists which aims to be a focused guide for healthcare simulation operations in education and training. How did the writing process begin? Did you already know each other?

Laura: A mutual friend, John M. Rice, who we knew from the Society for Simulation in Healthcare, introduced Michael and me. Michael and I were working separately until that time. John knew that we were interested in some of the same ideas, so he introduced us. John also helped us identify other chapter authors from contacts he has across the country.

Michael: I was already familiar with Laura through some of her journal articles addressing the role of the simulation technician (an iteration of the operations specialist role), and when John offered to introduce me to Laura I was excited to see where this new professional relationship might go. The idea of a book was intimidating, but the process ultimately made Laura a good friend and also improved my confidence as an editor and author.

2. What were your main objectives during the writing process?

Laura: Frankly, our main objective was to keep the process going! Some of the chapter authors had great ideas but could not get those on paper; in some cases, chapter contributors were changed. Our other objective was to produce something cutting edge that would contribute to the simulation profession. Michael and I knew that there was not another book like the one we were working on. We wanted to provide chapters on a lot of different topics that were relevant to the whole. As we began to get material, we had to make sure that there was not too much overlapping content between chapters, whilst also ensuring that each chapter could stand-alone. Nevertheless, some duplication occurs between some contributors’ chapters, but in such a way that its content was complimentary.

Michael: Accuracy. Other books have been written that include some content related to the simulation “technician” but not as comprehensively as this book does. While we focused on the emerging role of the operations specialist, we recognize that there are simulation educators who also perform this function in their individual institutions. However, the book encourages simulation programs to entertain the value of hiring such specialists to provide support and relief to their educators. Additionally, few resources are available for those who desire to take the Certified Healthcare Simulation Operations Specialist (CHSOS) certification offered by SSH. While this book is not developed specifically for CHSOS exam preparation, the content will certainly improve a candidates understanding of the role.

3. The book provides a much needed resource for developing the roles and responsibilities of simulation operations specialists, and also illustrates the current state and evolution of the simulation professional workforce and discusses the topics necessary for the development of this pivotal role. Please could you explain more about the simulation professional workforce?

Michael: The idea of the “workforce” grew out of the clear gaps in simulation-based education. The underlying theme surrounds the need for a higher level of expertise in technology, but also the incorporation of other domains that include medical terminology, and educational concepts of which together provide a great foundation for innovation. The “workforce” as a whole has demonstrated gaps where technological skills and understanding has crippled the simulation educator’s ability to incorporate advanced features available in the simulation technology, as well as its connection to the technological infrastructure common to most simulation programs. The role of the operations specialist represents a balanced approach to addressing the gaps present in many simulation-based education programs. Overall the workforce includes educators and operations administrators and specialists.

4. The book also promotes the value of simulation in healthcare and its associated outcomes while clarifying the operational requirements of successful simulations. It includes numerous contributions from international experts, consultants, and specialists. Could you please give us a taste of an example of how you determine that simulation has an impact?

Laura: I have been a part of simulation-based continuing education for most of my nursing career. Even before simulation evolved to the use of electronic manikins and virtual reality, we used it to evaluate competency. For example, even basic life support and cardiopulmonary resuscitation (CPR) courses involve rudimentary use of simulation. I don’t believe that anyone could argue that CPR is not a beneficial skill for healthcare professionals to know. While we may not be able to completely measure the effect of simulation in training and maintaining competency, we know that that these are necessary components of having a well-prepared healthcare workforce. Just as we would not want an untrained pilot to fly a plane full of passengers around, we also do not want untrained healthcare professionals practicing on live patients.

Michael: A constant challenge faced by simulationists, regardless of their role, is that existing technologies don’t always meet every need. The ability to innovate is a skill that is validated each time a workaround is needed for a particular scenario where the simulator cannot emulate all physiological presentations, so third party solutions are introduced. Some of these solutions were not developed for this purpose, but do provide nice adaptations. For example, the use of a syringe pump can be used to create a bleeding wound where the simulator may not be able to do so. The syringe would have simulated blood and it can be activated at variable speeds depending on how bad the wound is. In other cases, the simulated patient monitors developed for simulators can be repurposed for use with standardized/simulated patients where vitals must be different than the real vitals of the actor in order to make the scenario more real.

5. If there is one piece of information or advice that you would want your reader to take away and remember after reading your book, what would that be?

Laura: Simulation-based education is a team sport. Many different types of professionals stand to make huge contributions to moving the profession forward. The field of simulation is at a crossroads. Yes, the field is changing rapidly. Unfortunately, parts of it are not changing enough. Much of the content at many simulation conferences is recycled. This is because we haven’t welcomed diverse perspectives on the profession and cultivated new ideas and ways of looking at it.

Michael: Agreed. A “catch 22” exists among many simulation programs: financial resources are not established to provide dedicated full-time staff, nor continuing education specific to simulation education. The success of the simulation program needs a more diverse team, recognizing that the challenges faced by the team need skills from more than the healthcare community. Technological gaps are met with local IT in some cases, but in most, IT doesn’t have the expertise or interest in the use of these new technologies. My hope is that simulation leadership/educators will have the resources to hire those with technological expertise as well as offer salaries that encourage long-term investment of their employees. Often taking up to two years to learn the basics of simulation technology and simulation-based education, the position quickly changes from an entry-level adjunct role to a professional operations specialist. By “adjunct” I mean that some staff are hired to meet a particular need, but there is no expectation of long-term employment. Consequently, other simulation programs benefit from the training received at previous jobs, and the original employer has to start the process all over again with a new hire. Not very productive.

6. Who should read the book and why?

Laura: Simulation operations specialists should read it because it will validate a lot of their work, which may seem to be isolated, unrecognized and invisible. One of the interesting parts of writing the book was connecting people and ideas across the world. Another of our goals was to publish a book that would be read by those other than simulation operations specialists. Simulation lab coordinators and directors will also find the book useful in thinking through why they need operations specialists in their labs and helping to quantify the work done by them.

Michael: Other simulation professionals may also serve as the simulation technician or operations specialist, if not in name, then in the scope of responsibilities. Having multiple roles usually means that operations is a large part of their skillset. This book would benefit those roles as well.

7. Why is this book of particular interest now?

Laura: It will be of interest because it fulfils an unmet need. Another book of its kind does not exist to the best of our knowledge. As I described in chapter 1, I conceived of the book because I was not able to find resources of the nature it contains.

Michael: I came to the same conclusion. In fact, I often felt like an outsider within the simulation community in the beginning, as it was a world for administrators, educators and researchers in the medical profession. The role of IT and related skills was present, but the value of the conference courses etc. rarely dealt with the more practical aspects of operations. Obviously, some innovation was occurring in the community, but it was being introduced by educators and practitioners, whether or not the innovation was developed by them or their technicians back in their institutions. The community was very much exclusive of those who supported their programs. The introduction of SSH’s Sim Ops conferences, the CHSOS and other organizations (SimGHOSTS) over the last five years has resulted in a higher participation in national and international conferences. The simulation operations specialist is not a respected colleague (for the most part) among the simulation community.

Simulation operations specialists should read it because it will validate a lot of their work, which may seem to be isolated, unrecognized and invisible. One of the interesting parts of writing the book was connecting people and ideas across the world. Another of our goals was to publish a book that would be read by those other than simulation operations specialists. Simulation lab coordinators and directors will also find the book useful in thinking through why they need operations specialists in their labs and helping to quantify the work done by them.

8. Were there areas of the book that you found more challenging to write, and if so, why?

Laura: Michael and I are fortunate to know a great many creative people. But when it came time to describe that creativity, some people had great difficulty. Healthcare professionals sometimes think that every thought they have had has been thought before and must be written down somewhere. Because of this thinking, there is a reluctance to write an original piece for fear that others will judge it. Some of the chapters did not rise to the level of our vision for them, but we got as far as we could.

Michael: Communicating our vision for this book was difficult. Contributors struggled with how to translate our instructions to something that they could structure on the page. Others caught the vision and expounded on it – albeit it with close interaction with Laura and I. The content of the book, for the most part, was challenging as much of it was brand new in the context of the role of the operations specialist. The book has moved beyond theory without abandoning it, and presents practical solutions.

10. What is it about the area of healthcare simulation that fascinates you?

Laura: I am fascinated to work at describing processes that are intuitive in nature. For example, when one works in simulation-based education, there are things that you come to know that aren’t written down. For example, when I see my students in a simulation scenario, I know what they do and do not understand, though it may be hard for me to describe that. For simulation operations specialists, they know what works in translating simulation technology into near real experiences for learners.

I am also fascinated with the promise of simulation. In some parts of the world, all healthcare professionals must successfully complete a simulation based competency exam in order to become licensed. Simulation-based education and competency have the potential to assure that healthcare professionals operate at a certain baseline level.

Michael: As an IT professional, I enjoyed “new” and “different” challenges. When I first encountered a simulator in the nursing department, very few technicians existed in this field, at least compared to the current workforce. When I was much, much younger, I dreamed of what I wanted to do when I grew up, as most young people do. The idea of being a physician seemed out of reach. For years I worked in IT (after years of doing other types of work), but when I got involved in simulation, mostly by default, I found new purpose in how to apply my knowledge of technology and supporting those less comfortable with technology. Through simulation, I am able to impact patient outcomes for hundreds, if not thousands of patient outcomes, as well as the preparation of the practitioners responsible for those outcomes.

11. What will be your next book-length undertaking?

Laura: Ask Michael 🙂 Seriously, one of my biggest fears in completing this book is the possibility of a second edition! As I have mentioned, the field of simulation is changing rapidly and what we have written may become outdated in very little time. It might also be the case that we will have to write another book altogether since the readers’ needs may change.

Michael: While we did discuss a second edition, much to the chagrin of Laura while writing the book, I have come around to her way of thinking. The level of work it takes to do this well, was overwhelming. At some point a second edition may be necessary as technology and methods change in operations, but it really isn’t something I would consider lightly.

I have begun talking to the co-contributor on Chapter 10 and discussing whether that chapter could be expanded to a new book on the same chapter. However, the jury is still out on that, although Valeriy stated that he was interested in doing so. If we did this, I would love to recruit Laura to help us with the editing of the book, if not contribute some content in it as well. However, I’m still mulling over how we would structure the book. If we actually get into the step by step “how to” (Scenario Programming for Dummies), we are at risk of seeing the software platform change by the time the book is done. So I’m more in favour of addressing the content by focusing on conceptual process for development of automated scenarios. If that is done, then perhaps Laerdal, Gaumard, and CAE would develop online tutorials (if they don’t already) that reference the new book’s rationale, concepts and terminology. In Chapter 10, Valeriy and I introduced some new terminology that we believe changes how some concepts should be understood, particularly as it applies to standardization through automation. The vendor tutorial sites would be the responsibility of each vendor, so that if it is out of date, that would be their problem, not the responsibility of the authors of this book.

12. Please could you tell us more about your individual backgrounds and what inspired you to pursue your careers in your chosen subject areas?

Laura: I have been a nurse for 36.5 years. However, in terms of this book, the chosen subject area “found” me. As I mentioned, I have taken almost every imaginable simulation-based educational offering. Most of my nursing career has been in practice, but I have always been interested in research, which is what drew me to the university. My practice background proved to be invaluable in getting simulation labs up and running, since one must know practice in order to recreate reality in simulation. Over the time that I have been interested in simulation, I have had two main passions with in it. One was educational research on learner assessment using simulation, while the other was simulation technology. At different points over the last ten years, I have focused on one or the other.

Michael: I had been working in IT since 1994 in one role or another. I started out part-time working out of my home. It was more of a hobby business to supplement my full time job, which did not pay very well. By 1998, I was working full time for a curriculum publisher as their IT director and production manager. After working there for about eight years, I was burned out from working long, underappreciated hours. I was ready to take any job I could just to get out. Then there was a job announcement on the Tarleton State University website for the Department of Nursing. They were looking for a computer lab technician that would also help them implement the use of two new simulators they had purchased. I got the job, and the rest, as they say, is history. By 2014 my only job was working with simulation technologies. In 2011, I joined the Society for Simulation in Healthcare, and by 2013 was serving on the Board of Directors. Each step of the journey only underscored that I had something to offer to the simulation community, but also that I found a lot of satisfaction from doing the work. This book underscores these accomplishments, but also has a huge impact on my career and the good that can come from collaboration with other thought leaders in this industry. My partnership with Laura has been very meaningful, as I consider her more than a colleague, but also a friend. That won’t keep her from cracking the whip when I drop the ball though. 😉