Dr. Isabel Gross shares her views with Judith Riess, Editor in Chief, on INSPIRE and their research network.

Medical Training Magazine: Please tell us about your background.
Dr. Isabel Gross: I am the Scientific Review Committee Co-Chair for INSPIRE managing the research proposal and grant review process, assisting with research consultations, and overseeing the scientific content of our bi-annual INSPIRE meetings. I have been part of INSPIRE since 2016 and I have not missed a single INSPIRE meeting since then chairing the most recent one during IMSH in San Antonio, Texas. I am very enthusiastic about simulation-based research and it is a true honor for me to speak about INSPIRE with you.

MTM: Please share with us how INSPIRE began and the vision of those involved.
IG: INSPIRE began when two different simulation research networks learned about each other’s existence and rebranded into INSPIRE.

The POISE (patient outcome in simulation education) network was formed in 2008 and evolved from 10 centers focused on studying the clinical impact of infant lumbar puncture training to include more than 30 academic medical centers throughout the United States whose intent was to improve outcomes for patients.

EXPRESS (Examining Pediatric Resuscitation Education using Simulation), founded in 2007 had investigators from 21 centers participating in a study designed to improve debriefing quality in resuscitation education which was grant funded.

In 2011, the two networks merged into one under the name INSPIRE which strove to keep the structure manageable while providing enough infrastructure to support network activities. INSPIRE used an offshoot of the Reverse Merlin methodology, a reverse planning activity which engages the team in planning for the end goal. It has been used in the business world where team members generated reasons for the project’s failure while still in the planning phase of a project. In the case of INSPIRE, we wanted to know if in 10 years we failed to identify how simulation can be implemented to impact patient outcomes for children- what would be the main reason? This inspired the early vision to break down silos and work together to perform high quality research and solve pediatric problems using simulation.

MTM: How is INSPIRE improving care?
IG: It is our mission to improve lives for children through healthcare simulation science. INSPIRE uses simulation as a method to make a direct impact on pediatrics and promotes valuable studies that have an impact on patient outcomes. Two great examples are Betsy Hunt’s work on improving cardiac arrest outcomes using CPR coaches and Marc Auerbach’s ImPACTs study using simulations as an assessment tool to assess pediatric preparedness in Emergency Departments.


 INSPIRE strategic planning retreat for the executive board in Canmore, Canada. 
 From left to right: Adam Cheng, Travis Whitfill, Vinay Nadkarni, David Kessler, Jonathan Duff, Isabel Gross, Jennifer Arnold, Aaron Calhoun, Nancy Tofil, Todd Chang.
INSPIRE strategic planning retreat for the executive board in Canmore, Canada.
From left to right: Adam Cheng, Travis Whitfill, Vinay Nadkarni, David Kessler, Jonathan Duff, Isabel Gross, Jennifer Arnold, Aaron Calhoun, Nancy Tofil, Todd Chang. All Images: Dr. Isabel Gross.

MTM: There are many organizations that fund your research how do you get the word out so that people are aware of the funding opportunities?
IG: It seems like right now people find us! What we do is unique in the simulation community. We see the need and get the work done. We have a collaborative environment with open-sharing of ideas and accessibility between members and are now expanding our visibility through social media (Twitter, Facebook, LinkedIn) as examples.

MTM: Discuss some of the leading research undertaken by the group that has improved outcomes for children.
IG: Procedural skills: lumbar puncture just in time training by David Kessler (unfortunately, many babies need a lumbar puncture when they have a fever within the first month of life. This critical skill can be practiced on a mannequin right before the procedure is performed on a real patient. Here, simulation is used as a training instrument).

Betsy Hunt - CPR coach. High quality CPR is crucial for favorable pediatric outcomes. Simulation can be used as a method to improve pediatric cardiac arrest survival. Dr Hunt recently received a gift from INSPIRE to continue her work.

Marc Auerbach: ImPACTs - most pediatric patients are seen outside the big pediatric centers – 80% of patients are seen in the community by general emergency physicians. In this study, simulation is used as an assessment tool of pediatric preparedness. This is empowering community hospitals to know how prepared they are – now improvement initiatives are starting to improve patient outcomes.

MTM: INSPIRE has rapidly grown around the world and now includes many disciplines beyond pediatrics. Will you give us examples of how those groups are working together to improve outcomes.
IG: INSPIRE is working to be interprofessional and we now have and influence beyond the pediatric patient population. While the movement started with physicians we now have expanded beyond to educators, nurses, paramedics, respiratory therapists, and many other disciplines. We believe that the quality of our work greatly benefits from working together as a team with members that have very different backgrounds both educationally but also culturally and in their way of approaching education and patient care.

While we don’t have too many studies addressing adult patient care that directly arose from INSPIRE, we do collaborate with our colleagues that take care of adult patients and that specialize in simulations to improve adult patient outcomes.

What we have to offer is the concept of how we work, and this method could be translated to the adult research networks.

We collaborate with large societies (including IMSH) that involve many different specialties’

We believe that breaking down silos, collaborating, and promoting novice learning to promote future generation of simulation researchers is a concept that could very well work for the adult simulation research community.

MTM: What role does simulation play in the organization and in the research?
IG: Simulation is the heart of what we do.

Simulation can be used as the subject of study (for example when you perform studies assessing simulation-techniques); or It can be used as a method of study (for example when you use simulation as a method to study a clinical problem).

We are very enthusiastic to explore the role of simulation as a research method which can help us improve patient outcomes. Everything we do is concentrated on simulation-based research.

MTM: How are research opportunities decided and how does INSPIRE encourage multiple institutions, groups, hospitals to participate?
IG: Research projects evolve naturally through the process as we provide a collaborative environment for research. We support simulation-based research for any feasible concept in pediatric to improve care for children.

During our two annual meetings, we call for so called “ALERT” presentations (5-minute presentations of a research idea), presentations are followed by round-table discussions where novice and senior researchers will discuss the projects at eye-level, and anybody interested can join the round table discussion. A mentor will then help the researcher follow through with the project and help facilitate the discussion as well as the study progress over time. The great thing about the round table discussions is that like-minded people with different levels of experience will shape the projects and multi-center approaches can be developed especially because we all work at different institutions across the world. This way, the power of studies can be increased, and the research vigor enhanced through collaboration and mentorship.

Round-table discussion at the INSPIRE meeting during the International Meeting on Simulation in Healthcare (IMSH) 2017.
Round-table discussion at the INSPIRE meeting during the International Meeting on Simulation in Healthcare (IMSH) 2017.

MTM: How has INSPIRE improved pediatric simulation research and will you give some concrete examples.
IG: INSPIRE improves pediatric simulation research by leading as an example and by conducting high quality research studies. The above-mentioned ALERT process helps improve study designs before the studies have entered a point of no return. Mentorship across the continuum of the study helps ensure continuous quality. INSPIRE developed the simulation-based research reporting guidelines that help researchers both plan and report their research appropriately. Those guidelines are based on the CONSORT (for randomized controlled trials) and STROBE (for observational studies) guidelines. This is especially helpful for the novice investigator – and this could be somebody with research experience but a novice to simulation-based research.

MTM: Other thoughts? Ideas you would like to share?
IG: Our focus is truly supportive and collaborative. We are an interprofessional team of self-declared members, there is no membership fee and no membership requirement other than an interest in simulation-based research. INSPIRE fosters a friendly, inclusive and collaborative environment. It is quite unique that experienced researchers work alongside with novice investigators. I personally experienced that when I joined INSPIRE as a pediatric resident. I was working at an institution where my mentors had limited experience with simulation-based research. After presenting my first ALERT, my mentor helped me design and conduct my first simulation-based research study and now three years later, I serve as the Scientific Review Committee Chair and I am giving an interview on behalf of INSPIRE. We are stronger when we work together as a team!

About Dr. Isabel Gross:

Dr. Isabel Theresia Gross was born and raised in Germany. She earned her MD and PhD at the Albert-Ludwigs University Freiburg, Germany. Thereafter, she started her pediatric residency in Germany and then moved to the United States to complete a pediatric residency and chief residency at the University of South Florida. During residency, she completed an MPH with a concentration on Disaster Management and Humanitarian Relief at the University of South Florida, Tampa.

Dr. Gross is currently in the final year of her pediatric emergency medicine fellowship at Yale University School of Medicine. She is the Chair of the Scientific Review Committee of the INSPIRE pediatric research network and she served as the meeting chair for the most recent INSPIRE meeting during IMSH. She also serves on the Board of Directors for the International Pediatric Simulation Society (IPSS) and she led the development of the joined IPSS-INSPIRE Pediatric Simulation Fellowship. 

Originally published in Issue 2, 2019 of MT Magazine.