Welcome to Illuminating InSights, our blog interview series, where our team speaks with programs and professionals to learn about their experience in navigating various areas and topics related to healthcare training and education. In this post, our team spoke with Dr.Natalya Pasklinsky, DNP, executive director of Simulation Learning at New York University (NYU), Rory Meyers College of Nursing. She has been in her position for the past five years and has been teaching in simulation for the past thirteen. She is also an adult acute care nurse practitioner and a certified healthcare simulation educator who is in charge of the undergraduate and graduate simulation learning at the college.
Our interview began with Dr. Pasklinksy, DNP, describing how she started in the simulation space:
Dr. Pasklinksy: We (NYU) began the simulation curriculum in 2010, we opened a new building in 2015 in the health corridor (that we refer to), which is downtown New York, and we are right in the middle of the health corridor, which all the hospitals are just down the block from us. So it's easier for us to go and check on students and what they're doing in their clinical.
Dr. Pasklinksy went on to explain some of the important questions that her and her colleagues keep in mind when working with simulation geared towards nursing education:
I know that in terms of preparing a space for simulation use, you need to really do quite a bit of thinking and deciding: Well, what are the needs of the program? What gaps are we trying to fill? What do we want our outcomes to be? You need to have all the buy-in of administration to have a successful center with the top technology that's currently available.
It's important to know how many students this is for. How many times are they going to be participating? What type of experiences do we want to provide for our students? So, again, the options are limitless, but I think it's very important to kind of have a plan and not just buy equipment just to buy it and say: “OK, I have a mannequin.” Right, but you want to make sure that you have the right mannequin and you always need a mannequin.
Now, sometimes you need a trainer or sometimes you need a standardized patient that's more appropriate for the particular simulation. So you really need to know what the purpose is before you start moving forward. Everything is very expensive and time consuming. So you want to do this right, and you want to do this once and not have to redo it. So, you know, our center, I know they've done their research. They've gone to other simulation centers that were currently up and running to view the space, reading articles and literature on what are the best practices, what's recommended.
Since our company’s focus is on simulation technology and software, we welcomed Dr. Pasklinsky’s thoughts on the power and importance of simulation in pedagogy and education:
Last year, my center, the CSLC, was accredited by the Society of Simulation and Health Care for teaching and education, which is a huge deal because it's kind of like a hospital getting like a magnet designation because we're now officially a center of excellence and it's the stamp of approval that we are running our simulation curriculum up to all the standards and we have all of our I’s dotted and T’s crossed. You could see that because students are participating, they're doing well- gaining confidence, critical thinking, and practicing decision making skills. You could see their progress throughout the semester or from semester to semester. And we always ask for feedback in terms of “How did you relate this into clinical practice?” and look for how it improved students’ critical thinking in the situation. I've heard students say, “I wasn't quite sure what to do, but then I remembered that we did something similar like this in simulation, and then I remembered what I needed to do.”
Simulation is a very powerful tool in pedagogy and in education. And again, when you do it right, the results are just amazing.
“Simulation is a very powerful tool in pedagogy and education. When you do it right, the results are just amazing.”
Our conversation also touched upon product mobility and flexibility, which play a huge part in our product development at Lumis. Dr. Pasklinsky shared her thoughts on the need for adaptable products in the constantly evolving simulation field:
You want it to be a versatile space. You want things to be easily moved. You don't want to necessarily bolt too many things into walls or ground them to the floor because you never know when you may need to change that space. Also, when you're designing a simulation center, I think it's important to not only think about what you're currently doing, but think big and anticipate for the future because the program is potentially going to grow.
You'll have more students, and again, you don't want to limit yourself by the space that you have, especially if you have enough students to participate and faculty to teach. So I think designing it with some foresight is important as well.
“You want it to be a versatile space.”
Product adaptability became an immensely relevant topic this year due to the Covid-19 pandemic. Many programs shut the doors to their simulation centers and labs and had to figure out a way to continue educating in a safe and effective manner. Thus, online and VR training provided the go-to solution for healthcare programs and medical schools around the globe.
I introduced and incorporated V.R. into the College of Nursing about a year ago, and I was lucky to get funded. We started out small because we have large numbers and we want to give students the tools to independently practice in real time and the ability to receive feedback in real time utilizing virtual reality. We were using Oxford Medical Simulation (OMS) with the Oculus Rift headset while onsite, and students utilized their laptops or PCs to practice scenarios from home. So, they were really fully immersed.
Once Covid-19 hit and we had to go fully remote, we took a deeper dive into our math and we needed to use the platform just virtually on a computer screen. So, you still get the same outcomes in the same experience. I personally think that once you have that headset on and you're fully immersed in that space, it's an experience like no other. I think being on a computer screen, not fully immersed, yes, you're still getting the same content.
We did have positive feedback from students, because they did say that these OMS scenarios helped them with their critical thinking, decision making process, and prioritization. These things are actually what I’ve seen trending from, let's say, first semester students to the fourth semester students.
Dr. Pasklinsky elaborated on the idea that VR is at its most effective point when educators consider the needs and the goals of their students:
When you ask somebody coming into nursing to tell you what their goals are for the simulation, they'll tell you everything technical. “I want to learn how to do an injection,” or “I want to know how to do an assessment.” So, the technical things that students are actually doing, hanging up an I.V. or drawing blood, they realize that all these things will be learned with practice and time. You are not going to be perfect at doing them when you graduate nursing school because practice makes perfect and you need to do a procedure hundreds of times to get it flawless. But what is going to be much needed and what is going to make the difference is to be able to make those critical decisions, to make the right decision for the right patient at the right time, or to know when to escalate the situation.
So, virtual reality is extremely beneficial because of multiple reasons: It could be done asynchronously, you can have an instructor lead versus student led, and there are many different options. I think it depends on the level of comfort of both maybe the students, the faculty, how much experience they've had with this and what their level is in the program. I think that also, speaking of VR, I wouldn't necessarily throw in my first semester students into virtual reality because they simply would not know what to do in these situations.
So the point that I'm getting at here is that it's crucial to choose the right modality for the appropriate level of the learner, because if you're giving them something that they've done, they're going to be bored, and uninterested. Maybe they won't read the product as helpful or maybe it didn't challenge them enough and vice versa. If you're putting the student in a situation where they've never experienced this before and it's sink or swim, that's not the point of simulation either. We're not there to set people up for failure. We're there to set people up for success. And we do believe that everybody participating in simulation is intelligent, capable and trying to do and want to do their best.
“We do believe that everybody participating in simulation is intelligent, capable and trying to do and want to do their best.”
Shifting from in-person to online instruction brought on many challenges and changes; However, feedback has remained valuable and necessary to students. Feedback is a critical step in the learning process, as it allows students to correct their mistakes and make improvements in their performance moving forward. Even in a virtual setting, Dr. Pasklinsky described the post-simulation feedback debrief as “crucial.”
Everybody should feel comfortable making mistakes and we want students to make the mistakes in simulation because that's how they learn in the debriefing. Debriefing: that's the most important part of the entire simulation, because if the debriefing didn't occur, it's as if no learning occurred at all. It's so crucial to follow up the simulation experience, whether it's virtual or in person with an in-depth debrief, and the sooner the better. After the experience, the second simulation is over, start speaking to each other. “How do you think it went?” “Oh, I messed up on this.” It is really important to get students in a group and discuss and debrief, and the “Aha!” moment light will be lighting up, and that's very, satisfying and rewarding as a simulation facilitator.
Just as feedback is useful and necessary to students, educators must also collect feedback from students during post-simulation evaluation processes in order to capture the overall effectiveness and success of simulation exercises.
In terms of evaluation, we constructed a survey and asked, “Have you ever had experience with this virtual reality technology?” or whatever technology we were using, and “What was your comfort level?” “Was it easy to use?” “If you needed support if something wasn't working, how fast and how easily was it resolved for you?” We're really looking for user-friendliness on our end.
Of course, we're also looking at content to make sure that it is the content that we need. OMS is in the U.K., so they do things slightly different, and the scenarios are geared towards the U.K. population. When we're doing them, there are minor things that we may have to tell the student, for example, “When you're going to be doing this scenario, just know that according to US guidelines…”, and we'll put the guideline in there so that they're aware that there may be differences.
I don't see it as problematic, because I think that students need to learn that it doesn't even have to be a different country, it could just be a different state or a different institution within the same state that may have different rules and regulations, so it is important to always be on the lookout for those and pay attention to detail, because that's what matters.
So, I really did enjoy using the OMS because the students feel that it improved their critical thinking, their clinical judgment, their assessment skills.
"We're really looking for user-friendliness on our end."
Likewise, Dr. Pasklinsky explained that it is necessary for companies to receive feedback in order for programs and companies to work together to find products that will fit perfectly together:
We're working with our OMS right now and the feedback that they're providing to students, and we wanted it a little bit more customized for us. We're working with one of their people on their team, and we have a faculty and an informatics student on this project. So, we're going to customize the feedback to the student from the scenario so the student gets a little bit more in-depth feedback.
Companies appreciate feedback. They want to improve, and we're very honest. If a product is not working, we'll let the company know that your product is not working for us and why. Perhaps if a company has something in the future that will work with us, they will feel free to come back. But if not, then this is just maybe not the right time. Or maybe we don't have the funding for it. Or, you know, maybe something else is priority.