Surface - BASE Camp: Acclimating Interprofessional Teams to Overcome the Impossible - Part 1

This episode of the NLN Nursing EDge Unscripted Surface track is part 1 of 2 featuring guests Kevin Ching and Kathryn Muccino. 

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Transcript

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Welcome to this episode of the NLN podcast Nursing EDge Unscripted the Surface track and thank you  for joining us. This episode is entitled, "BASE Camp: Acclimating Interprofessional Teams to  Overcome the Impossible." And to help us today we have two very special guests.  Dr. Kevin Ching and Ms. Kathryn Muccino. Dr. Ching is an associate professor in emergency  medicine and pediatrics at Weill Cornell Medical College and an attending in the  division of pediatric emergency medicine at New York Presbyterian Hospital where he also serves  as the medical director for the Simulation Center. As director, Dr. Ching oversees the development and  implementation of multi-disciplinary teaching programs and simulation for residents faculty  and medical students. He's actively engaged in simulation research on the role of human  factors in pediatric emergencies, procedural skills, success and retention, and the effect  of simulation on patient outcomes. In addition, Dr. Ching is the co-founder and chair of BASE Camp, an  annual multi-institutional, multi-disciplinary conference using simulation models to introduce,  review, and practice teamwork crisis resource management and emergency resuscitation procedures.  Kathryn Muccino is a nurse practitioner at Shriners Children's Boston with the specialty  area in burn surgery. Kathryn has a dual master's degree in health care and business and diverse  professional experience in clinical provision and operational efficiency, educative processes and  curriculum development, policy, and accreditation procedures. She also seeks to utilize clinical  expertise within an innovative operational and strategic health care position. Kathryn has been  co-directing the BASE camp experience with her colleague Dr. Ching for 13 years. I also want to  add as we get started with this episode that I had the privilege to participate as a faculty  in the annual BASE Camp experience in November of this year. It was by far the most influential  simulation learning experience I have experienced that brought me right to the edge of my comfort  zone as a teacher, a nurse, and honestly as a parent. It was at this edge that I was able to experience  what Rachel and I always talk about, this desirable difficulty, this willingness to lean  into discomfort in the service of learning. This invigorating and slightly uncomfortable place is  where memorable and transformational learning occurs and I'm grateful to have experienced  it. So let's jump into our conversation to learn more about BASE Camp. Welcome Kevin and Kathryn. Kathryn, Kevin it is so great to have you here on this podcast episode. The first  time Michelle and I spoke after she came back with her experience with you all, she was like - Rachel, I have to tell you about this. This was the most transformative, amazing experience. She's like  trying to rope me into future experiences and I just couldn't wait to hear more about it so  I want to kick it out to you all to share with us what is BASE Camp? What it's about?  Help us understand this magic and such transformative experience.  Well thank you for having us and you are welcome to all future BASE Camps! I'm sure Kevin will agree.  Absolutely. I'm 100 on board with Kathryn's invitation.  Thank you. So tell us more about BASE Camp and how it got started.  BASE Camp started about 13 years ago in 2010. It was born out of a need to  find a way for nurses and pediatric emergency medicine fellows, new physicians to work together.  We saw how nurses and pediatric emergency medicine fellows were trained  and expected to really quickly assess critically ill and injured kids  and at the same time you have to provide like these emergency medicine resuscitation  measures. I was a new attending at the time and we  looked all around us and we said, you know, this is a really fast-paced environment  and we expect that you know these fellows who I was only just a few years removed from.  I had to really quickly step into their new roles and have like competencies in  critical behaviors and skills and somehow provide very safe and effective high quality care.  At the time I was working at NYU in Bellevue Hospital and we had a whole slew  of new team members, not only fellows but nurses and and so what it got us thinking.  The first I guess first inspiration came from when we thought about ourselves as,  I should say that we were all new attendings. We were like a crop of sort of young recruits  and we remembered that when we were residents that the truth was the  opportunities to experience and practice many of these sort of very high acuity, low frequency  events were limited and of course that's the reason we have a medical  simulation, right? Health care simulation is born out of that need but we also remembered that  truth be told, even combining together our real clinical experiences with those from our simulated  education training it was still it was still very sparse. The American College of  Graduate Medical Education for fellows requires only four months of acute and emergency care  training in all three years of residency. That's not a lot. I mean, it's entirely  likely that you graduate like I did from residency without ever caring for someone who's in  cardio pulmonary arrest or like put a chest tube in or and this is the thing that really struck  us. I never led a team when I was a resident and so suddenly I became a fellow and I had remembered  people expected me to somehow lead this team and I didn't have the training or the experiences  and so again as colleagues, we looked around us and there was a  whole team of new nurses fellows and we got to thinking what could we do to sort of like  bridge the gap between our the expectations of us and like what we were capable of doing.  And that's when we thought of creating BASE Camp. Now there was an inspiration for  

BASE Camp: 7:48

there's a pediatric critical care boot camp that is in CHOP Children's  Hospital of Philadelphia and at that time they had been around for a few years and that boot  camp was focused on pediatric critical care fellow training. It was a two-day  intensive course based on what fellows needed to to become proficient critical care intensivists.  We saw that as being inspirational, but we also wanted to challenge ourselves to sort  of think about how fellows as physicians really are dependent...codependent on how as  an interprofessional team we all work together. Like all resuscitations are it's like a team-based  sport, right? I don't need to preach to the choir, but that's that's where we got the  idea that we would create this interprofessional, high impact, learner-centered program that was  at the time really focused on interprofessional teamwork, advanced life support resuscitation,  advanced airway resuscitation, trauma resuscitation, and very importantly the cherry on top was that  we thought about mass casualty incident disasters. I remember that mass casualties and disasters  was an addition to BASE Camp, the cherry on top if you will because we had a quintessential  school bus that rolls into the ER. The quintessential, what do you do when a school bus  rolls into the ER with like whatever number of kids. And I do remember that day because  we were given a notification we were told that there was going to be this like bus full of  kids that I don't even remember what the issue was I think it was probably some accident and  we started getting prepared and it was painfully apparent that we were all on different  pages about what was necessary in order to sort of work together and so again that was  another different inspiration for the addition of mass casualty incident disaster training  to BASE Camp and it has a very special place in the instructional design of the program. That's great Kevin. I'm wondering if you can actually describe the instructional  design of the program, briefly talking, walking through the different  highlights, the different events that occur throughout the weekend  to give our listeners a little bit of an understanding of what it might be like. Sure.  So in many ways there are three phases to the instructional design of BASE Camp.  It starts with a pre-conference cognitive load so in this stepwise sequential model  of learning it begins with sort of this idea that even before you know any of the nurses or  fellows and now Child Life Specialists come to BASE Camp there's an expectation that they come  prepared. We want everyone to have a shared mental model before they arrive because it sort of  elevates the sort of practice of everyone around them. When we started, the idea was that we  were trying to foster more purposeful learning. We want a deeper engagement at BASE Camp and  so these pre-conference sort of educational modules, which to be honest, after  Covid it now seems like you know asynchronous learning is sort of way to go.  For us, it was trying to get people to develop declarative knowledge and  we customized all these modules which included something that was dear to me which is  I have a very short attention span and so they're all  high quality graphics with very little text. It's just basically very high  yield information many of them have multiple choice self-assessment questions and they're  tailored to stimulate self-directed learning and and self-appraisal. If you have an  advanced opportunity to sort of learn these things, appraise what you do know or what you need to know  more, then by the time you get to BASE Camp you can explore those topics in greater detail in  a way that sort of makes sense to each learner and then there's a side effect of that  and something that both Kathryn and I hold dear and that is it eliminates lectures. Neither of  us like podium-style lecture learning and so yeah what it does is it gives  more time for hands-on experiential like practice and learning, more time for simulation at BASE Camp.  So in that stepwise sequential model we're learning that begins sort of before  BASE Camp like when people arrive, when the nurses Child Life Specialists and  fellows arrive and they're suddenly thrust into working together on these interprofessional  teams they hit the ground running and we have multiple opportunities in what's  essentially an integrative and like experimental phase where people get to practice those  skills. We always talk about like deliberate practice and a very  smart friend of mine used to always criticize when deliberate practice is invoked and said  you know, well, people always think of it as just repetitive practice but deliberate practice really  needs to be something that has a goal in mind. And you have to know what your own goal is  and that's where that self-appraisal comes with those pre-conference modules  and then there has to be some targeted feedback towards that goal, which is why again we try  very hard not to have lectures at BASE Camp so that people have faculty who provide guided  mentorship and best practices rather than having to provide little mini lectures. In  this second phase in the sequential stepwise model the nurses, the Child  Life Specialists, the fellows get to practice different sort of like skills and behaviors  whether it's teamwork, airway resuscitation, trauma skills, et cetera, communication skills, and then they get  to integrate that into the many simulations that we have. These are sort of like  high fidelity, immersive, theater-based sort of simulations. Kathryn and I work  very hard to try to make them as authentic as possible so that people feel like they're really  in their own sort of environment. The hope is that people get to sort of put all  of those skills, those behaviors into practice and experiment with them and one of  the sort of worries that someone had shared with us years ago when we first started  BASE Camp was that you learn something in a high impact program and then you probably  just a week later you forget it. So as Kathryn and I have developed  the program iteratively over the years. It's been important for us to sort of provide opportunities  for reinforcement and that's why it's a very long two days. We're not shy about telling all  the participants before they come that you know, be ready. These are long, long two days.  But it's those opportunities for reinforcement that are intended to sort of stave off  that sort of like decay or decline in like how people sort of think about these skills.  We've studied some of them and so we know that we know that this model works.  The final stage in this step by sequential model learning is where we get to that  mass casualty. That's the sort of opportunity to consolidate everything that everyone's worked on all weekend, whether it's teamwork, trauma  resuscitation, mass casualty triage. Everybody brings something different to the table  and it's squarely in the autonomous space. This is a crazy event where  like all heck breaks loose as a mass shooting and people are expected to sort of  call upon all of those experiences and practice the rehearsals that they've had all weekend and  put it into use.  It's the end of the weekend and  the ideas to have people leave having demonstrated best practices so that they can return  to their home institutions wherever that may be and share what they have successfully learned  with a larger network of providers elsewhere. I have a lot of things running for me. I  think this is a phenomenal program. A couple of the things that are coming to mind as you're sharing  this with us one I think you've articulated beautifully how to set up a program that  identifies a gap in knowledge and skills among an interdisciplinary group and be able to scaffold  the learning process in a way that translates to long-term retention and application of the skills.  And the second thing that is running for me is you spoke to our educator heart when I hear you  say we want to move away from the lectures and we do these high impact, high-yield, short bursts of  of content or knowledge so that we can get folks on the same page. I think that's so  important for our listeners to hear because I think there's pockets and particularly nursing  education where they think if they're going to dive into interdisciplinary or interprofessional  education that they have to create these long lectures or content delivery so that everyone's  on the same page that has a shared mental model and that's just not necessary. I think you've  demonstrated that really well so I appreciate you sharing that. Then finally I really want  to touch on this mass casualty event if if you don't mind and go there for a second because you  know when Michelle was painting this picture for me when we first talked after she came back it  just hearing it was one impressive the amount of psychological fidelity that you all were able to  build into this experience and how activating it would be emotionally and replicate that  and I may have just been in the throes of you know the postpartum hormones of having you know  a newborn at home but I'm hearing this thinking man, if I was one of those debriefers, holy smokes  how would I have responded and how would I have balanced my own emotional activation with the task  of debriefing this interprofessional group?  So while our listeners may not always be doing  mass casualty simulations I think that they are a lot of times debriefing simulations that are  activating in some way to learners to debriefers or both and so I just wanted to ask both you and  Kathryn what experience if any have you had with helping support your debriefers in navigating  those waters of their own personal activation in a really high psychological fidelity experience  and not only managing themselves but managing that interprofessional group? Those are really great points Rachel. Thank you so much for sharing.  Something that and I'm going to touch on this something that I met Kevin in the ER at Cornell  at New York Presbyterian Cornell. I was a nurse practitioner there and that was the first nurse  practitioner job I ever took and I was the first and only nurse practitioner in the ER and  so it was a wild experience to go from bedside nursing to a new nurse practitioner and be the  only one without any kind of support and the attendings didn't necessarily know what my role  was and I didn't necessarily know what my role was and as I fell into that it was really great to  have such wonderful attendings and wonderful nurses be able to support on both sides. But I still felt  like this little peg in the middle and I saw the nursing side and I saw the attending site and so  being able to blend working as a provider but also working at the bedside was something that's really  nice to being a nurse practitioner and having worked in nursing and I think that that is  something that I get to see both sides of at BASE Camp. I love the collaborative feel and I love  the interdisciplinary feel because there's so much support and everybody brings something  unique and you can see the professional growth of all the different roles that come nursing,  child life, and the physicians, the fellows.  As this mass casualty has been developed over  the years, you're 100 right and I feel like even as the frequency of these advances has happened  and you know we're a day away from the anniversary of Sandy Hook yesterday, these  events are more frequent and they're scary and they're real and they're in more common settings  and so being able to support the staff for these events that really can occur anywhere  that you can imagine is it's hugely important.  I think that having all of the disciplines present,  nursing, child life and the positions is hugely impactful to that. In fact this year   there were a host of emotions that happened during some of the debriefing periods. There  was crying, there was a lot of conversation and I think that the professionals that we bring in  have been with BASE Camp forever they love this experience. As Kevin said,  it's two intensive days and there's a ton of time to collaborate, to talk, to get together and I feel  like everything kind of stays in BASE Camp and you are immersed, Michelle, as you can probably  imagine, in this experience and so it just feels like this overwhelmingly supportive weekend where  you get to talk about what you do for a living and how passionate you are about it and you feel  safe in that space and we make it very clear that what happens to BASE Camp stay is a BASE Camp. We want to support each other and whatever you need we're there. We have all we want to provide  the resources that you need if you need somebody to talk to but it just there is that inherent  trust and passion and desire to support that happens so organically while you're there that  you just you feel supported. You feel that you can express those emotions and being a mom that  was postpartum a month before BASE Camp and I get that and you just you feel all those those  emotions and I want I think that we have such a wonderful group of faculty volunteer faculty that  do this that come back year after year because they love it. Not all those faculty are fellows  that have graduated from the program are nurses that have graduated that come back every year  because it's so wonderful and because you see the impact that it has on others that I just  think that that organic support happens without even really having to talk about it but I do  think that throughout the weekend and the pediatric emergency medicine world is small. I  feel like those conversations continue and so the trust in those relationships once it's  it's cultivated that weekend it maintains itself and so the environment that we create kind of  gets carried around in little pockets where everybody goes in the world and it  comes back and you really see, not just through the education that's being put out there the  impact that you can have, but also like exactly you touched on, the professional  network that you have where everybody feels safe and supported  and collaborative. I don't know if that touched on exactly what you were looking for but that part  of that emotion that continues to come back year after year I feel like is what continues to draw  people back because it is such a dynamic unique experience. It's not just a normal conference  with lectures and simulations. It's truly this personal experience and you get that touch and  what I'm so proud of is as the size grows that personal touch never leaves. I feel like it only  gets bigger and that's rare in many things in life as things grow and multiply you lose  that sense, but I feel like that only gets bigger for our BASE Camp family. I love that  we can continue to share that with participants that come year after year and faculty.  You know Kathryn, since this was my first time attending I arrived as a nurse and as a teacher that's experiencing debriefing. However, I was really challenged in that I don't have any, very little, almost none, zero content knowledge around pediatric emergency  medicine so I was novice to that and then I was also very nervous to debriefing a mass casualty  simulation like that I had done it maybe one other time but it was a much smaller scale.  So I very intentionally took sort of more of an observational role being it was my  first time in debriefing that mass casualty simulation and let an experience physician  and debriefer take the lead and I will be eternally grateful for what I had learned from her.  Samreen is her name and she was a breath of fresh air and a beautiful debriefer. She opened  the debriefing by starting with a meditation, like a visualization type of meditation and it  wasn't like weird and fufu. It was the most important, most needed intervention at that  time that words really could not have, would not have done the service that just a moment  of getting into your body and you're finding your breath and kind of letting those emotions sort  of surfaced a little bit and be present and be felt and be supported with the group collectively.  She just did this beautiful job of just visualizing a peaceful place and so my point is I could just help - there's so many different ways to debrief in so many different styles and methods  of teaching effectively, but to be able to learn from somebody in that way interprofessionally  to learn just a really, really different way of acknowledging the need of the group in that moment  was just such a gift to me. I was so grateful to be a part of that  and to see that and now I can take that skill with me into my practice  and be able to implement that in a different way. I think that was one example that  I saw where the emotional needs of the group were met in the moment and using very different  ways of teaching and engaging. The weekend is very busy and packed with  many different simulations and activities and I work very closely with our child life  director Hillary Woodward and I have to say that I have learned a tremendous amount  from collaborating with her as I have with Kevin obviously. He's like my mentor for life.  But just some of the unique modalities that she shared exactly what you're speaking to  for debriefing and emotional support and just the way she asks questions. The way that the weekend is structured and purposefully is it really resonates and it  sticks with you as Kevin has touched upon. Just like you're saying, that's a piece that you're  going to take away and I think that's what that's what happens is everybody takes those  little pieces away and everybody leaves bigger and stronger and more dynamic because of  it and so it just ,again, it's just everybody so organically brings those pieces back that they  continue to share and grow upon them exactly what you're speaking to. We want to be conscious of  our time boundaries. This conversation could go on and it will. We will pick up with our conversation  with Kevin and Kathryn discussing the immersive and interprofessional simulation experiences of  BASE Camp. We hope you join us next time with the Nursing EDge Unscripted Surface podcast. Thank you for joining us on this episode of NLN Nursing EDge Unscripted Surface.  We hope you join us next time. Until then, remember, whether your water is calm or choppy,  stay connected, get vulnerable, and dare to go beneath the surface.[Music]