Brian Gillett, MD, is an Emergency Medicine physician with over two decades of leadership and innovation in simulation training and emergency preparedness. Brian built and served as the director of medical simulation for the Kings County Hospital Center, SUNY Downstate College of Medicine and Maimonides Medical Center. He also serves the Director of Strategic Technologies for New York Institute for All Hazard Preparedness. Brian is still a practicing physician in Denver, Colorado and the Co-Founder & President & Chief Medical Officer at Health Scholars.

Brian Gillett

Dr. Gillett’s nominator said: “Dr. Gillett is passionate about patient safety and has dedicated his professional career to improving patient safety through the advancement of clinical training technologies, and truly believes that blended learning and emerging tech can foster more effective, scalable training. Currently Dr. Gillett oversees clinical education strategies and healthcare direction for the organization to support Health Scholars' mission of improving patient safety through the use of virtual reality simulation. Prior to co-founding Health Scholars, Dr. Gillett was founder and Chief Executive at SimCore Technologies, provider of widely implemented simulation management and quality improvement software tools, now integrated into Health Scholars’ blended learning platform. Dr. Gillett is a recognized national leader in immersive training and pedagogical research, having published and lectured extensively in these domains.

Unboxing the Future

The Health Scholars’ platform delivers advanced simulation management solutions, but also includes VR content and delivery, marrying the benefit of in situ training with virtualization’s scale.

On the first day of my first job as an Emergency Medicine attending physician, my department chair rested a seasoned arm on my shoulder and said, “You need a thing.” I had no idea what he was he was talking about, nor did I know how to respond. The “thing” that he was referring to was a boxed high-fidelity patient simulator, procured by a recently graduated resident and stowed in the department’s broom closet.

I can honestly say that this was the most transformative unboxing experience I’ve had in my lifetime. I was instantly taken by the potential for this smart technology to provide clinicians and teams with reference experiences that could authentically provide sufficient relevance to help them adjust their practices without having harmed or nearly harmed a real human being. This would be the tool to learn from our errors before they really happen.

We are all familiar with the English poet, Alexander Pope’s, proverbial phrase: “To err is human; to forgive, is divine.” I thought of this phrase as I unboxed the simulator, slightly adjusted to something like, ‘To err is human; to practice deliberately without harm, to reflect honestly and accurately is divine.’ I was hooked.

We’re humans, and we learn by doing. This has long been our modus operandi, and by and large, has served our kind well… until that mantra was applied to medical training. As healthcare workers, we’re privileged with the public trust bestowed upon us to care for the well-being of humanity. We, in healthcare, hold this trust dearly and closely to our hearts. However, as a junior resident, I found myself violating this trust over and over again every time I performed a new patient care task or a procedure for the first time. And every time I engaged in team-based care (which is all the time in healthcare) without deliberately practicing. Those violations were simply the result of a sounder alternative not yet being available.

It is available now with clinical simulation. The technology, pedagogy and infrastructure requisite for successful simulation-based education has significantly matured over the past decade. Simulation champions now enjoy state-of-the-art simulation centers, accredited fellowships to master the craft and validated research methodology.

However, today’s healthcare ecosystem poses new challenges to healthcare workers eager to participate in the type of resonant training afforded by mannequin-based simulation. Healthcare professionals execute on a daunting quantity of critical tasks with increasingly insurmountable time and resource constraints. As such, it’s not surprising that the primary barriers to improving healthcare performance through immersive training are time and cost constraints. The result for today’s healthcare workforce is a similar paucity of opportunity to understand and practice the mitigation of performance gaps that we faced during the pre-simulation era.

Compounding the problem, simulation centers primarily reside in academic institutions, which account for only 5% of US hospitals, (Dashoff, 2017) and are largely absent from the vast network of community-based outpatient clinics and long-term care facilities. Non-academic healthcare facilities allocate less budget for clinical education than their academic counterparts, and employment contracts for community-based staff have fewer accommodations for non-clinical time. Simulation directors (myself included when I wore that hat) constantly struggle to find a sustainable process for staff to attain coverage so that they may participate in a consequential simulation exercise. This task is doomed at the start line when car travel is involved. Private healthcare facilities across the US are swiftly integrating with large healthcare organizations in order to remain sustainable. Because simulation centers are expensive to build and maintain, they tend to be concentrated at the “mothership” hospital making travel unavoidable for many in our current brick-and-mortar sim center paradigm.

With that initial unboxing of the broom-closet patient simulator, I became committed to streamlining and maximizing access to immersive education. In 2013 I founded SimCore, a company with the mission of providing future ready simulation management solutions, with support for in situ exercises as a company priority. The goal was to streamline access to immersive education in our rapidly consolidating healthcare landscape and a scarcity of simulation centers outside of academia. Our simulation management solutions worked, but we uncovered additional complexities and limitations related to extending simulation education at scale. Someone still needs to physically transport and operate these patient simulators in order to bring the training to the thousands of healthcare workers across an organization.

Additionally, acute and long-term care staff, work both day and night shifts. The numbers of clinical educators in healthcare organizations are limited, and these dedicated souls must somehow find a way to deliver immersive training to thousands of individuals during both day and overnight hours. As custodians of health, we pride ourselves on always delivering, no matter the challenge. However, we simulation champions are meeting our match with this one – delivering a suitable quantity of traditional simulation at scale is just proving unrealistic.

Simulation arose at the nexus of emerging technology and contemporary educational theory. We leveraged high-fidelity mannequins, packed with sensors and circuit boards, to emulate anatomic and physiologic realism and organic response to medical intervention. This enabled deliberate practice of procedural and communication tasks, and a vast body of research that unequivocally validated the benefits of immersive education. Simulation professionals must now continue to champion technological innovation in order to meet the complexities of today’s healthcare ecosystem.

This scale issue was what originally led me to look closer at virtual reality (VR). VR enables immersive education at scale and is the expected evolution of mannequin-based simulation. Clinicians and allied healthcare professionals can transport themselves to a highly realistic, fully immersive experience anywhere, anytime, simply by donning a pair of VR goggles. In 2017 SimCore evolved, integrated VR capabilities and launched a new blended learning platform called Health Scholars. The Health Scholars’ platform still delivers advanced simulation management solutions, but also includes VR content and delivery, marrying the benefit of in situ training with virtualization’s scale. VR simulation has become Health Scholars sweet spot and I believe VR will truly become a catalyst for making experience-based training more affordable and accessible.

Brian Gillett
Dr. Gillett practicing surgical fire management with Health Scholars' Fire in the OR virtual reality application.
Image credit: Health Scholars.

For example, the cost of VR training is exponentially less expensive than traditional mannequin-based simulation. An Oculus Quest, a stand-alone headset that does not require a PC, costs $399 (USD), approximately 1% of the cost for a high-fidelity patient simulator. VR exercises may be deployed to an unlimited target audience through cloud-based systems with minimal personnel overhead, solving travel needs associated with traditional brick-and-mortar simulation centers. Learners complete VR exercises in approximately 20 minutes, readily enabling participation during downtime without having to leaving their clinical units. Furthermore, learners may step out of a VR exercise for clinical duties and resume where they left off when or can even be completed at home. A recent study also revealed that 67% of participants preferred VR training over traditional methods(2). Thus, VR enables immersive healthcare education at scale, with trivial personnel and equipment cost. I am particularly enchanted by the capability of this emerging technology to detach the operational barriers that currently impede large-scale access to immersive healthcare training.

Today’s VR does not replace all mannequin-based simulation as scenarios often must be designed and executed quickly in response to mishaps. Currently, VR training modules take several months to design and build, so the technology does not solve for reactive training priorities that require a quick turnaround. Additionally, team-based training engages subtle human factors, such as eye contact, tone, closed loop communication, and situational awareness of team members involving subtleties and facial expressions. That said, VR technology is evolving rapidly to include artificial intelligence, and Health Scholars is actively working on applications that utilize glove technology and voice recognition to replace hand controllers. Just as high-fidelity mannequin and task trainer tech quickly overcame early limitations, VR will do the same.

Today, VR is best leveraged for non-reactive training topics that need to be rolled out to a large target audience. Additionally, VR is particularly suited to replace resource-intensive simulations. For example, many traditional simulation exercises require a technician, a subject matter expert, one or more embedded actors and unique environment requirements (i.e. wall gas, anesthesia machine, OR lights, etc.). VR recreates all of this in a virtual world, accomplishing learning gains at a fraction of the personnel and financial costs. Of particular interest to me, is VR’s aptness for patient-safety oriented training, where learning objectives are well established, are best transferred through immersion and must be disseminated in a meaningful way at scale.

Brian Gillett
Dr. Gillett demonstrating a lumbar puncture on task trainer.
Image credit: Health Scholars.

Medical error and improved patient safety are still very much a public concern and priority for today’s healthcare organizations. Which is why VR represents an important arrow in the modern simulation champion’s quiver by enabling self-directed immersive training where appropriate, and freeing up resources and clinician time for exercises that indisputably require real-world interactions. As such, modern simulation directors will increasingly shift away from tactical duties, which substantially involve pragmatics of operating the simulation center, toward a more strategic role as champions of distributed immersive education. The future ready simulation director will work closely with their quality leaders and liability insurers to identify and pair training priorities to the best-suited learning modalities. And they will begin to leverage innovations, like VR to ensure that their target audience has access to meaningful training that can directly promote error reduction and improve patient outcomes.

At the culmination of my medical school education, we recited the Hippocratic Oath. Among other things, I had committed “to help the sick according to my ability and judgment.” Reciting this statement has had profound resonance on my professional development as a physician, an educator and now as a business leader who leverages innovation and emerging technology to move the needle toward healthier and safer patient care. 

Originally published in Issue 1, 2019 of MTM Magazine.

References
1. Dashoff, J. (2017, October 19). Teaching Hospitals, Communities are Working to Get to the Root of Substance Use Disorders. AAMC News. Retrieved from https://news.aamc.org/patient-care/article/root-teaching-hospitals-substance-use/
2. Dorozhkin, D; Olasky, J; Jones, DB, et al. (2017, September 31). OR Fire Virtual Training Simulator: Design and Face Validity.” Surgical Endoscopy, p. 3262

Addendums
Brian Gillett LinkedIn: www.linkedin.com/in/brian-gillett-b4b51092/
Health Scholars Website: http://healthscholars.com
Health Scholars LinkedIn: www.linkedin.com/company/healthscholars/
Health Scholars twitter: www.twitter.com/HealthScholars1