Collaborating for Excellence: Honoring Simulated Participants in Health Care Simulation

In this episode of Nursing EDge Unscripted, host Kellie Bryant from the National League for Nursing’s Center for Innovation in Education Excellence is joined by Dr. Lou Clark, current president of the Association of SP Educators (ASPE) and the Executive Director of M Simulation at the University of Minnesota. This episode discusses a recent call to action from ASPE on properly honoring simulated participants (SPs) and collaborating with SP educators in healthcare education. Dr. Clark emphasizes the importance of respecting SPs as human beings, rather than referring to them as tools, and highlights the hidden work of SP educators in training, coaching, and safeguarding SPs. The conversation explores best practices for integrating SP methodology, such as using inclusive language, providing fair compensation, and recognizing SP educators' contributions in research and curriculum development. Listeners are encouraged to access ASPE resources for guidance on SP recruitment, training, and evaluation. The episode concludes with insights on the future of SPs in simulation, emphasizing the need for collaboration with emerging technologies while maintaining the human element in patient care training.
 
Learn more about the Association of SP Educators by visiting their website: https://www.aspeducators.org

Read the Call to Action referenced in this episode: Clark, L., Doyle, A., Elcin, M., McNaughton, N., Nicholas, C., Owens, T., Smith, C., Szauter, K., Xing, K., & Nestel, D. (2024). Call to Action: Honoring Simulated Participants and Collaborating With Simulated Participant Educators. Simulation in healthcare : journal of the Society for Simulation in Healthcare, 10.1097/SIH.0000000000000840. Advance online publication. https://doi.org/10.1097/SIH.0000000000000840

Dedicated to excellence in nursing, the National League for Nursing is the leading organization for nurse faculty and leaders in nursing education. Find past episodes of the NLN Nursing EDge podcast online. Get instant updates by following the NLN on LinkedIn, Facebook, Instagram, and YouTube. For more information, visit NLN.org.

Transcript

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[Music][Music] Hello everyone and welcome back to another edition of Nursing EDge Unscripted podcast. I'm really  excited today to talk about today's topic which is we're going to talk about a call to action  article that was just released by ASPE called, "Honoring Simulated Participants and Collaborating  with Simulated Participant Educators." Lou, I told you I saw you at IMSH and I said, oh my goodness,  we have to have a podcast about this article because I learned so much things that I was not  doing correctly when it comes to the way that we again honor our SPs. So I'm glad to have  you here today so we can talk a little bit more about this call to action and what kind of brought  you to writing this article. So first, before we begin and really get into it, do you mind just  introducing yourself. Yeah, absolutely Kellie. Thanks for having me on. I'm really excited to share some  of this information with the National League for Nursing and your members. So for those I haven't  met, I'm Lou Clark and I'm the current president of the Association of SP Educators, ASPE,  and for those who don't know us you can find us at aspeducators.org. We're a global organization  we've been around for going on 25 years and our whole mission is to promote human interaction in  healthcare education and training working with our simulated participants using SP methodology  but not using people. So that's is really the heart of this call to action. And for those  unfamiliar, SPs are individuals trained to portray a role, to give constructive feedback to learners,  and they're really the heart of what we do as SP educators is we guide, we coach, we safeguard  our SPs through this process because unlike other sort of simulation modalities that are essentially  inanimate, which are tools for learning, SPs are not. They're human beings and that's at the heart of  this. So the reason that I came together with the nine other authors of this short call to action is  that over the years we've all sort of experienced different language use, different ways people  interact with SPs, with us as SP educators, and we felt it was time to sort of come out and say the  things that we know in our community that are sort of tacit in a way when we're around others who  are not immersed in the work. And we thought, let's just, you know, get it on the record for everybody.  This is how we want people to talk about it. And it's on us, right, to get together and say this is  please do this. So we wanted to issue a call that anybody can join us. We want everybody to  join us. We want to be inclusive about how we approach it and we don't want to shame anyone  who have been doing some of the things we write about in the call. That's what...that is not what  this is about. This is about saying join us, come on, get, come with us. We want you to get on board  and the inclusivity train of working with SPs and SP educators. Great, so you kind of answered  my first question, which was what inspired you to write the article. But what was the biggest message  that you wanted simulationists to kind of take away from reading that article? Yeah, so I think  it evolved as we wrote it. And the biggest sort of, what makes this piece different than some that  have come before is some of the messages have been written about for years quite honestly. So Debra  Nestel in Australia has been a real champion for the phrase simulated participant. I really have to  credit her because she's come out early years ago and said we really need a more inclusive  term for describing the work that SPs do. And while a bulk of the work of course is in healthcare  importantly, the other thing that makes SPs really in interesting and unique in our work is  that we go beyond healthcare. We work with police departments. We work with superintendent of schools  and leaders to train them in conflict management and other types of communication related skills.  I've developed a training for chaplains in the Marines using SP methodology but not using SPs. And  so I really want to credit Debra and so what makes this a little bit different is that 10 of us  from around the world decided we're going to get together in a concentrated, short period of time  and we're going to almost like, I would say, we had a little idea think tank, right, last spring and we  said, you know what, we are just so uncomfortable seeing the phrase using, using, using SPs. We don't  want people to do that anymore. And then at the same time, members within ASPE, you know, we had  done a compensation study quite frankly in our last membership survey and we found that we really  need to better describe in detail the work that SP, educators perform. So what makes this different, I  had hoped you'd ask this question. I'm going to read the sentence that I think makes it really  different, which is the end of the first paragraph and it's says, "We call the global simulation  community to action now because, as leaders, we recognize our responsibility to examine key  tenets core to SP methodology in a novel way that explicitly amplifies the hidden work of  SP educators in relation to the contributions of SPs." To me, that's the heart of what is different  because the hidden work, the work that people don't see, we need to call it out. It's like any  profession. There's so much that goes on behind the scenes and in order to truly value it, to  compensate SP educators accurately, to understand why these people are needed, why were needed, and  to support and guide the SPs and provide that safety, we have to say it. And so that's to me what  makes this different than other, you know, really great pieces that have come before it that touch  on other aspects of this. Absolutely, even for me it was a aha moment. I've been in simulation for about  16 years and I felt the article was speaking to me because some of the things that you talked about  like oh, I have a SP case. I'm using a SP. That's been in my vocabulary and that article made me  pause and said, let me really rephrase and rethink the way that I'm, you know, it's almost like I'm  taking, you know, individual and turning into a piece of equipment or you know so I do appreciate  this article so much and I think you know we needed this. One of the other questions I  have for people because a lot of people are new to simulation or maybe they haven't had kind of  that training or education on how to incorporate SP methodology into their curriculum, so how can  simulation programs and simulation is whether it's directors or deans, ensure that simulated  participants feel valued, respected, and integral to the education process? I love that question  and I think there's so many ways that are sort of local ways, bigger ways. I think just from a really  local perspective if you are part of a sim program that has an SP program as part of your say a more  comprehensive program that also has technical simulation. My home institution is University  of Minnesota and we have, that I happen to be the executive director there, and so in my role I think  it's meaningful for the SPs and the SP educators when I pop into the SP training room and I say  thank you. Thank you for your work. I mean there are such basic things that folks can do to demonstrate,  who were in leadership roles, demonstrate I care about the work you're doing. Tell them! You know,  like send the occasional...simple and free right, like send a message like if they've  just done a major OSCE, send a message to them that says we really appreciate everything you do to  help our learners you know. That's another thing is simple written communication. Some other kinds of  ways that we talk about in our call to action have to do with the full-time or part-time SP  educators who create the events that, quite frankly, lots of tenured faculty members write about to get  their tenure, right. I've encountered this so many times. My work before I got a doctorate, which I did  later in my career and go on and get a faculty member, my work has supported others in getting  their tenure and there have been times where maybe I've been acknowledged, which is always  nice, but when you don't have that authorship, that equal, collaborative authorship on the work that  would not have been possible with your labor, it's holding back an entire profession quite frankly.  And I don't think it's intentional, which is the other piece we're really getting at, which is very  explicit and I think a novel thing in this piece is saying - there are people coming up as  SP educators and what was really great in my experience, I started off at the University of  New Mexico and was put on a small grant project my second week of work and it changed my life  because I had mentorship. And people recognized that they thought this is a person who may go  on in this career field. I was hired as an SP trainer. I love the University of New Mexico,  was still friends with them. I got my Master's of Fine Arts and playwriting there and they  hired me and realized I had an aptitude for writing curriculum that was SP based because  I understood writing a script that was brought to life. And so I'm really grateful to the people who  mentored me there. And I think it's about mentoring. It's about looking at the transferable skills that  your SP educators have and recognizing that the skills that go with things like developing  SP case, that go with training, these should be things highlighted and included even briefly in  peer-reviewed publications. And SP educators should be included as co-authors, you know. And that, that  changed my life. They stuck me in the middle of like of a bunch of authors and it didn't matter.  They introduced me to the process and that was a really big deal. That was 18 years ago. Wow. And  talk about finding a way to value SPs. I think for a lot of simulation programs when they think  of collaborating with SPs it's simply, you're in this scenario. I need you to play the role of  the patient and that's it. And so I love the fact that you really just then explained that it's so  SPs can contribute so much more to our simulation curriculum. Yeah, and I should, I should add to that  another way to value the SPs is you know asking their perspective and paying for their time for  that perspective. So if we're working on a new piece of curriculum at our institution there  are times we will ask SPs if they're comfortable to give us some insights into the case. And  that's really important you know depending on what sort of curriculum you're working on. And I'll just  say broadly, if you want to include voices from underrepresented patient populations, it's really  critical to involve them in developing those scenarios so they are authentic and they  are going to, really going to serve the learners best ultimately in achieving clinical learning  objectives when you are holistic about how you develop it. And SPs are wonderful partners in  that respect. Excellent and that kind of leads me to my next question too. Can you share insights  or examples how effective collaboration with simulated participant educators has positively  impacted learner outcomes? I mean, I look at our whole profession quite honestly because it's  interesting. This profession, SP education, goes back to 1964 when Dr. Howard Barrows got the  idea to innovate and work with SPs. And so for 60 years this began as assessment, really. That's what...  that's really...it started with him and and he was working with neurology residents and then quickly  went into medical schools taking this up to assess learners. And there is tons of literature  that for, you know, really if you look at the 1980s and 90s it was like a an explosion  of literature about how SPs are incredibly valid and reliable raters. So SP programs and you know  it started more in medical education, so a lot of physician educators and leaders had SPs doing  the rating and what they also learned was it was more cost effective for their institutions. That's  really where this burgeoned and kind of went to there and very I think very wonderfully...nursing  began, pharmacy began. You saw other programs in the 70s begin to experiment and quickly in  the 80s people think, oh, nursing recently came to this. No. The first nursing publication that  discusses working with SPs is from the 1970s. So what began as assessment is now more I think in  an exciting way, different health sciences programs are experimenting with formative sessions. And I  see, I teach with SPs. I say with SPs. I'm a co-course director. I am, and just for your listeners, I am not,  I don't have clinical background. My background is theater and a doctorate in health communication  and I work with four physician colleagues. I'm a course director of our clinical skills course for  first and second year med students and I partner with SPs to teach relationship building skills  with our new students across different campuses. What does that mean? It means I'll introduce a  concept about whether it's about non-verbal or different verbal ways to, you know, things  to say to develop that relationship, build that trust in the second week of school. And I have  SPs in the room with me and students working in small groups so I'll suggest some strategies  and then they immediately apply them and what I see is right there in real time. I see it in the  course evaluations. There's proof there. What's their favorite thing about the course? SP, SP, SP.  Yes. Yeah. So I've seen that firsthand. Yeah, so to kind of bring it around to your question, I think there's  just absolutely tons of evidence in the literature for decades that SPs make valid and reliable  raters when ... you're working on assessments and that's across all kinds of health  professions. And then just there is also literature out there about the value and the contributions of  SPs guided by going back to your question, guided by SP educators for these formative sessions and  what we all have to pay more attention to is in our method sections in peer review articles not  leaving out even a few sentences explaining how the SPs are trained because that's been, that's  historically been left out of a lot of method sections. So another way people can kind of join  the call and speak to this in your own institution, go to your SP educator and say, how did you train  the SPs? Can you write this section? Can you write me a couple of sentences here? It's going to make  it better and what I hope I stop seeing is the SPs were trained because it doesn't tell us who,  it doesn't tell us were they trained in accordance with the ASPE Standards of Best Practices, a freely  downloadable article we're in the process of revising that was published in 2017? So really just  giving a couple more details is meaningful because if we don't describe how the SPs are trained,   in my opinion, the outcome data is less valuable because it's human interaction, right? So  it's not, it's variable so if you describe better the training protocol you can understand  the depth that SP educators go to to ensure consistency across learners. I think that's an  important part of that and so I want to also ask you as we have some listeners who are again new  to simulation, new to using SP methodology. Where can they go if they want to you know find out  what are the best practices when it comes to SP methodology or even how to how to hire SPs to how  to have SPs, you know, when it comes to evaluation process, where are those resources, where can people  go to find more information about best practices? Yeah, so glad you asked that and the good news  is listeners, you can do it after you finish this podcast. Just click on aspeducators.org. We have  so many resources from our members. And one is a freely downloadable bibliography by Dr. Karen Szauter,  a longtime member physician out of Galveston. Her hobby is research. She has an database with 7500  articles from 1964 to now. And you can download that, an Excel spreadsheet that's searchable. So  we give that to you just by visiting our website. If you become an ASPE member, you'll have access  to online modules developed by many of us by so many different experts in the field. And there is  a Center for SP Methodology and you can go through on your own time an online course with many, many  lessons and modules about the things you're asking about Kellie: how to recruit, how to train,  how to coach SPs in providing verbal feedback to learners, all sorts of different modules. And I'm a  longtime member of the ASPE grants and research committee. Our committee is currently working on  several different modules around best practices of research, doing research with SPs and SP educators.  So we offer that. We have our big conference coming up and that's once a year. That's going to  be in Montreal from June 1st to the 4th and we're going to have our very first ever Human Simulation  Research Forum as part of this conference. So we're really excited about it and we want to come out of  that with an ASPE-driven research agenda taking us forward into the next 25 years of ASPE. So I think  there are all kinds of resources. We do monthly webinars as well because we want to reach out to  people across the world who are our members. So we have, we are all things as in addition  to the publications, the best practices in this publication. There's so much there and my favorite  part about the ASPE community is that I think it's a very caring community. We care about our learners  and we really care about our SPs because it is our job to ensure that excellent learning with  SPs happens and that it does not come at the expense of the physical or psychosocial safety  anyone involved including and especially the SPs. So that's our, that's sort of I think  our guiding kind of touchstone is that SPs are wonderful partners and we want to value them and  all of that and we want to work with them.  But learning for health sciences students  should not come at the expense of the SP. And I just sort of think it's sort of antithetical  to the whole thing because the SPs are people. They're actually patients, right, in their own  right so we should in no way compromise patient safety because they're human. Absolutely. Because  they're in a learning role, right, teaching and learning role, right with the students. Well thank  you, thank you for providing all those resources. Sound like ASPE is a one-stop shop and you can go  there and get as much information as possible for those of us that want to improve the way that we  work with SPs. So I appreciate that and we'll make sure that we include website for ASPE for people  who may be interested. So one last question for you. Where do you see the future? What are  some of the trends and innovations that you see in the field of simulation regarding the role of  SPs? I appreciate that. I think it's critical and I'm going to speak to SP and SP educator  because I think it's really important to make that distinction and the call to action does that. Again,  kind of bringing it back that the SPs are often front-facing with the learners. and I would say 80%  of the work SP educators do including that work of developing scenarios collaboratively,  coaching the SPs on how to provide accurate and helpful verbal and written feedback to learners,  that is done in the shadows. And so I think I just want to call that out. So for the future, I think,  and this may be surprising to listeners coming from the president of ASPE, I think we need to  embrace technology. I think we need to be in step with the latest technologies. And I'll tell  you, in my almost 20 year career, I've had friends sort of that are more familiar with technical sim  kind of like, you know, kid me a little bit and say, Lou you know, eh, you know there won't be SPs X many  years from now. And my response to them is, I'm still here. The SPs are still here. We got over  a thousand, you know, we got close to a thousand members in ASPE. And I think it's a collaboration.  So I think we it's critical that we're working collaboratively with technical simulation  educators and colleagues and people who really are into using the technical simulation modalities,  people on the forefront of AI. I think it's critical that we inform that work because at  the end of the day, patients are human and so in that respect, I think SPs are the highest fidelity,  you know, simulation modality can get. And I think SP educators are uniquely qualified individuals  who understand what it takes to coach other people to get the maximum benefit for learners. That's the  gift that SP educators give. They understand how to literally bring curriculum to life and we do it  over and over and over again and that's exciting to me. You know, I think that that's the gift that  SP educators give, the hidden work that supports all of this. And you have to be so vigilant  and so committed because it takes the commitment of daily practice. You can't, you can't take your  eye off the ball to ensure safety when you're working with humans, when you're working with  people. And in that way, it's akin to patient care, right. As a clinician, I know you are so dedicated.  There's so many dedicated listeners out there. We give that same commitment every day to make sure  that SPs can be on stage, front and center doing the work they need to do with with, you know,  the learners who are also front and center. Well, thank you Lou. I really appreciate you taking  the time out to have this conversation and to talk about this very important article, which  again, for those of you who are interested, please read this article it is, "Honoring Simulated  Participants and Collaborating with Simulated Participant Educators." It's a must read for  anyone in a simulation field. So thank you again for taking a time out. we're so glad to have you  as president to give us some insight on how we can as simulationists do a better job of honoring  our SPs. So thank you so much. Thanks for having me and I just want to say thanks to your members  for listening. And please reach out to us if people have questions. We want to help. We want to  welcome you to the community and you know it's all about working together. so thanks for having me.[Music]