June 14, 2012By Lance Baily

Top 5 Questions I Am Asked About Managing a Medical Simulation Program

Below are the answers to the Top 5 questions Lance Baily, former Director of the Nevada System of Higher Education’s Clinical Simulation Center of Las Vegas is regularly asked about with regards to running a medical simulation program. Lance wrote this article to demonstrate the kinds of topics discussed at HealthySimAdmin – an innovative two-day event which specifically addressed the needs of healthcare simulation program administrators.

5) Where can I find medical simulation job descriptions?

First, look at HealthySimulation.com‘s medical simulation jobs listings to see some of the positions that have been posted by the community in the current market.  Grab any of the job descriptions there that pertain to your new position and start building your database.  Next, repeat that process on simplyhired.comhigheredjobs.com, and indeed.com – all of which also regularly post job position that are based in medical simulation.

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There are also job descriptions for technical-based positions hosted on the subscribers-only section of SimGhosts.Org, which is the home of the Gathering of Healthcare Simulation Technology Specialists.  You may also utilize the email list-serves of GHOSTS, as well as the International Nursing Association for Clinical Simulation and Learning and the Society for Simulation in Healthcare to ask the community for their most recent job descriptions.  SSH‘s International Meeting for Simulation in Healthcare also has a jobs board as well.

Lastly, look for resources such as the California Healthcare Workforce Initiative’s “Simulation Technology Specialist” and “Simulation Coordinator” job responsibilities lists to get a better feel for your position description.

4) How did you train faculty/educators in medical simulation?

Before the Clinical Simulation Center of Las Vegas opened its doors in May of 2009 the three collaborative partners (University of Nevada Las Vegas SON, Nevada State College SON and the University of Nevada SOM) that would eventually make up the new program were all operating simulations through the knowledge gained and maintained by each institutions in-house “simulation champion”.

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When the collaborative schools joined together under one roof for clinical training at the CSC in Las Vegas, the deans quickly realized that a standardized process would be required to foster interdisciplinary training and increase operational efficiency.  So by 2010 the CSCLV hired an outside consultant group (which at that time was called Medical Simulation Design and comprised of Jane Kleinman and Kristy Chambers) to provide eight faculty from each institution and the two simulation technology specialists with a semester- long training program which included:

  • 1 day of didactic and hands on training for scenario development, followed by…
  • A month of weekly 1 hour phone calls to create 5 collaborative simulation scenarios.
  • 1 day of didactic training in simulation facilitation immediately followed by…
  • 1 day of didactic training in simulation debriefing which was followed by …
  • A complete day of hands on guided simulation facilitation and debriefing practice with student learners for a mixed group of faculty each day over a period of 5 days.

Summarizing, the CSCLV’s twenty four collaborative faculty spent about five days together across the semester learning the basics of simulation-based methodology.  MedSimDesign continued to provide advanced debriefing training over the next two years as faculty began running simulation experiences with the new procedures they were learning.  While the CSCLV advisory committee (comprised of the three deans and myself as the Director) felt that the training program was a success, by 2012 we would have to change the center’s operational mode. Due to the high rate of faculty turnover we could not continue to provide the resources necessary to train all of the 75+ educators in simulation facilitation and debriefing.  Funds would instead be reallocated to provide for a “concierge model” at the center where only a handful of specific instructors were given release time to facilitate simulations for their programs.  At least two educators from each institution were selected to continue to receive simulation based training so that knowledge would not be lost with continued faculty turn-overs.

In other words, the CSCLV started with training a lot of educators a little bit about simulation and then moved to training a few educators a lot more about simulation.  If we had to do it over again I still think this method worked as it not only demonstrated to a larger audience the work and process involved with operating medical simulation, but also provided a bigger pool from which “simulation champions” could be selected for continued program development.

3) How did you get educators to start running collaborative simulations?

The best part about having a multidisciplinary simulation center is that educators from different clinical departments naturally meet one another in the halls!  Just by chance “water-cooler meetings”, several mock code simulation collaborative sessions were organized between the Internal Medicine Resident group from the UN School of Medicine and the 4th level Nursing faculty from UNLV.

But the advisory committee of the CSCLV did not just leave collaborative simulation partnerships to chance and created several more opportunities for encouraging relationships.  First, the CSCLV administration provided collaborative faculty simulation training sessions (mentioned above) to help “stir the pot” of our combined faculties. Next, interested collaborative faculty groups were provided small research stipends to encourage continued partnerships. As well, open house events for alumni and local media also provided an opportunity to request collaborative thinking by the three institution’s educators to help demonstrate the concepts behind medical simulation training. Finally, administration provided mixers for educators outside the center to further help blend the “silos of training”.

At the end of the day it really came down to providing additional resources to those “simulation champions” who really wanted to go above and beyond their required training to consider expanded collaborative based educational learning opportunities.  You would be surprised how much offering to host a “working lunch” can get people in the room talking and planning for more!

2) Shouldn’t our technical problems have stopped happening by now?

Dozens of simulation administrators or IT directors have called me to ask “When do we get to stop borrowing the IT department’s support team?”. The short and honest answer is never!

Medical simulation is a methodology that exists through the use of modern technology. Yes the manikin, microphone, cameras, ultrasound device, monitor, network, phones, speakers, and screen should always work perfectly every time – but they don’t.  Whatever the sales person or integrator tells you, almost none of the hundreds or even thousands of pieces of equipment necessary to operate a sim lab consistently work perfectly (alone or with each other for that matter). Having that initial support from the IT department should get 80% of the bugs of a new program, technology or space launched but at no point should anyone running a medical simulation lab believe that those remaining 20% of technical items can ever be solved permanently.

That remaining 20% is what ongoing maintenance through updating, debugging, reinstalling, backing up, de-fragging, cleaning, and generally operating is all about.  Having a line item in your budget for at minimum a part-time IT support person should be built into your sim lab budget not now, but yesterday. Put it this way to whoever has to final approval over your medical simulation program budget: Do you really want to pay a master’s prepared clinical educator to spend their entire day trying to fix something a Healthcare Simulation Technology Specialist (at 2/3rds or even half the rate) could handle in just under thirty seconds?

Running a medical simulation program means dealing with technology, which is rapidly changing and usually unstable. Hiring a Sim Tech is worth every penny – and then some.

1) How much should we charge to outside users?

Unfortunately there is not just one answer to this question. Each contract the CSCLV secured while I was Director was as unique as the client’s needs.  But really the answer changes depending on your location mostly – because it should be whatever it would cost to take your entire team to Disneyland for the weekend. Read on to learn why I am only half-joking!

Whenever I am asked this #1 question I immediately ask one of my own: “What is your goal with trying to develop outside business contracts for your sim labs?”. Because at the end of the day you by taking on additional contracts you are asking to dramatically increase the workload on your simulation lab’s space, equipment and most importantly, staff. Why add extra work if it is not going to make your simulation center a better place in the long-run through better equipment, more staff and enhanced space?

What I am getting at is that the “pay out” better really be worth it, to not only cover expenses but make a real profit as well. Enough so that after the additional work is completed, your team can consider the amount of money that was earned for that work and all conclude that the services were not only a win for your clients… but for your center’s bank account as well.

This is why the price you charge outside users should feel like you get to stand up and shout “WE ARE GOING TO DISNEYLAND!”

Next your group must really determine its short and long-term business plans.  You absolutely have to start launching smaller external revenue based contracts first before tackling larger contracts.  This was a winning strategy for the Clinical Simulation Center of Las Vegas that ensured we could grow into the kind of success we saw!  Thus, your pricing structure will need to change over time and will be unique to the needs of each of the new training contracts you bring in to your program.  This is extremely important.

Next, consider these costs when trying to come up with a cost to charge outside users:

  • Who will be providing the educator for the training?
  • Prop supply costs
  • Medical supply costs
  • AV equipment wear + tear
  • Manikin equipment wear & tear + warranty costs
  • Medical equipment wear & tear + warranty costs
  • Staff hourly rates (including benefits if applicable)
  • Administrative fees (scheduling, legal contract development, parking, lunch)
  • Facilities maintenance costs (or square footage costs)
  • Facilities operational costs (water, power, etc.)
  • Marketing costs to advertise your program

Learning how to identify these points will be covered in more depth at HealthySimAdmin. But the important point you need to know right now is that all of this should be totaled and increased by AT LEAST 30% so that your program continues to make a profit and provide for it’s own long-term success.

Do you have answers for the above questions or questions of your own? Email Lance or leave a comment below….

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