Harry Robinson, National Program Manager, Simulation Learning, Education and Research Network (SimLEARN), Veterans Health Administration (VHA).

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Harry Robinson was interviewed by Group Editor Marty Kauchak. The interview addressed a wide range of simulation and technology topics pertaining to the VHA SimLEARN program.

Harry Robinson, National Program Manager.

MEdSim: Congratulations on your recent decision to accept this challenging community leadership position and thanks for taking time to speak with MEdSim. To start, provide a current overview of the VHA's SimLEARN program.

Harry Robinson: We are continuing to execute the establishment of a national simulation training, education and research program within the Veterans Health Administration to improve the quality of our health care services. This is a two-fold process that involves training-the-trainers and getting the necessary training out to the field through our 21 geographically distributed Veterans Integrated Service Networks (VISNs) and the over 1,500 sites where health care is provided to our patient population of over 8.34 million enrolled veterans.

SimLEARN is making strong progress towards identifying and developing:

* clinical simulation-based curricula;

* policies and procedures for use of standardized patient, mannequin,

task trainer, and virtual environment learning; and

* simulated patient cases and scenarios to support clinical simulation with specific focus on veteran-specific scenarios.

We're leveraging internal expertise such as Dr. David Gaba, Staff Anesthesiologist and Director, Patient Simulation Center of Innovation, VA Palo Alto Health Care System. He also serves as Associate Dean for Immersive and Simulation-based Learning, and Professor of Anesthesia at Stanford University, using Modeling & Simulation (M&S) for Crisis Resource Management training. In addition, we're benefiting from the expertise of Dr. Haru Okuda, our SimLEARN

National Medical Director, who served as director and assistant vice president of the Institute for Medical Simulation and Advanced Learning for the New York City Health and Hospitals Corporation, the largest municipal health care system in the United States. We have a well-integrated staff of clinical experts, educational specialists/curriculum developers, information technologists, biomedical equipment support specialists, and project/program managers.

Additionally, we're aligning efforts of the VHA's REdI, or the Resuscitation Education Initiative (REdI) program established to standardize, document, track and monitor the provision of Advanced Cardiac Life Support, Basic Life Support and Advanced Trauma Life Support training throughout VHA.

A key component for SimLEARN future product delivery is the construction of a new 52,000 gross square foot stand-alone building that will serve as our national learning center. This will be erected immediately adjacent to the new Orlando VA Hospital being built as part of the new Medical City complex at Lake Nona, Orlando, Florida.

MEdSim: Briefly tell us about your responsibilities as National Program Manager for SimLEARN.

HR: SimLEARN is a cross-functional entity with numerous stakeholders that directly reports to the Employee Education System (EES) and closely collaborates with both the VHA's Office of Patient Care Services (PCS) and Office of Nursing Services (ONS). I coordinate closely with Dr. Okuda and Dr. Lygia Arcaro, our Nursing Program Director, to ensure our products serve clinical training needs.

I also look to coordinate with Dr. Tim Liezert, the Director of the Orlando VA Medical Center. Personally, I report to the Deputy Chief Learning Officer, Louise Van Diepen, a member of the senior executive service, who is a great advocate for our team. My charge is essentially to conduct "straight-stick" program management and support of our team members for bringing the various education, training, learning, and research component projects to fruition in an integrated fashion that gets the products delivered to our targeted workforce.

I'm very honored to have been selected to come on board the SimLEARN team. This is an exciting and challenging task to leverage the modeling and simulation domain for the conduct of training, education and research in achieving health care excellence. I'm fortunate to be working with consummate professionals like Louise, Tim, Haru, Lygia and our dedicated staff members.

MEdSim: Discuss the accreditation process for VA medical center simulation centers.

HR: As local VA medical center Simulation-Based Clinical Education (SBCE) programs evolve and local simulation centers are established, there will be increased interest in understanding VHA simulation center accreditation policy.

Currently, VHA has no policy stipulating a requirement for accreditation of local programs - the decision to seek accreditation is a local decision. The SimLEARN program will periodically evaluate VHA's simulation accreditation policy position as more data becomes available on the requirements for and the value of accreditation. It is anticipated that the National Center will seek accreditation from certain recognized bodies.

The American College of Surgeons (ACS) and the American Society for Anesthesiologists (ASA) and Society for Simulation in Healthcare (SSH) are the primary bodies currently accrediting simulation centers.

As the use of healthcare simulation training grows, it is anticipated that additional accrediting bodies may offer simulation center accreditation as well, or formal certifications for trainers and educators.

MEdSim: Describe SimLEARN's collaborative efforts in medical simulation with the

U.S. DoD and other public and private sector organizations.

HR: Understanding the close ties between clinical services provided by DoD and VHA, there are numerous opportunities to achieve effective and efficient patient outcomes through delivery of excellence in patient- centered health care using an enterprise approach that leverages state-of-the-art Modeling & Simulation technologies. VHA EES was invited to participate as a key member of the Federal Medical Simulation and Training Consortium (FMSTC). Our colleagues include representatives from all the respective service medical providers, Uniformed Services University of the Health Sciences, Medical Education and Training Campus, and TRICARE Management Activity for Patient Safety. FMSTC's mission is to enhance the medical education and training practices of its member institutions by knowledge sharing, collaboration toward common goals, and participation in joint training initiatives. Our plan for achieving these goals

is based on 5 pillars: knowledge management, curriculum, validation, research and development, and strategic partnerships. We've already identified some exciting opportunities for partnering, and we are preparing to brief our respective leadership on recommended paths forward.

MEdSim: Highlight some of SimLEARN's milestones and goals for the remainder of 2012.

HR: Last year, prior to my arrival, SimLEARN commenced delivery of many clinical training initiatives. These included training over 50 clinical simulation instructors through collaboration with VA Palo Alto and Dr. Gaba; coordination with the VA National Center for Patient Safety and National Surgery Office for a curriculum composed of web-based, video, and simulation training of 76 trainers for ensuring correct execution of surgery / invasive procedures; and supporting the Women Veterans' Health Care Office for conduct of a Women's Primary Health Care mini-residency for over 200 students using simulator equipment and standardized patients. 2012 kicked off with training provided at the International Meeting on Simulation in Healthcare (IMSH). We're following up with delivery of REdI training, delivery of web-based Women's Health/Specialty Care cognitive training courses, instructional development for Out of Operating Room Airway Management, Tele-ICU, and Code team training, and supporting activation efforts for opening new VA hospitals.

MEdSim: Discuss some of the shortfalls in the state-of-the-art in medical simulation that SimLEARN needs the assistance of industry to solve. And as a follow-up, provide insights on returns on investment the VA is seeking to achieve from its funding of the SimLEARN program.

HR: These are great questions! The smartest response I can give you is to respectfully request a "rain check" in providing answers. A lot of outstanding work has been done by our SimLEARN team and the stellar program management leadership provided by Dr. Paula Molloy and Dr. Kristin Day. Having been on board less than four weeks, I need a little more time to provide you with worthy and meaningful answers. We are in the process of completing our comprehensive evaluation of the "as is" situation within the VHA. Our next step will be to define further details for the overall strategy and tactical steps needed to derive the improvements in health care delivery to our veterans. The metrics to drive its execution will encompass improvements in both effectiveness and efficiency of training to clinical providers and end state delivery of patient -centered health care to our veterans. I'd be honored to be given another opportunity to answer these questions for you and your readers in the near future. In the meantime, I'm grateful for your patience and understanding.

MEdSim: We accept your invitation for a follow-up discussion. On another topic, what is the level for SimLEARN funding in the president's FY 2013 budget proposal submitted this February?

HR: SimLEARN is a part of the Medical Care Appropriation and has been supported at appropriate levels in the Veterans Health Administration budget allocation process. Additionally, to the degree that non-Medical Care funding is required to accomplish parts of SimLEARN's mission (e.g., construction), the Department of Veterans Affairs has similarly supported SimLEARN's needs at appropriate levels.

In general, federal budget proposals for Medical Care and other VA funding requests submitted by the administration require Congressional approval (authorization and appropriation) prior to being forwarded to the president for signature into law. For FY 2013, the Medical Care appropriation request was for $52.7 billion. That request, along with all of VA's appropriation requests, are currently under Congressional review. After administration and Congressional

review, negotiation, and agreement (enactment), VHA SimLEARN's allocation request would be assessed in the context of all medical care priorities to determine the appropriate allocation level.

Group shot is most of the SimLEARN team in it's Orlando office. (Photo: VA)

MEdSim: Anything else to add?

HR: This is a thrilling and invigorating time to be associated with the efforts to improve the delivery of health care services through increasing clinical provider human performance. The military has a long and venerable history obtaining synergies through Modeling & Simulation to accomplish better training modalities. More effective and more efficient. I got to see a lot of those toolsets while I was on active duty with the Navy, and I was honored to be a provider of training solutions for the fleet at the Naval Air Warfare Center Training Systems Division (NAWCTSD), the Navy's center of excellence in cradle-to-grave acquisitions, including development, evaluation, fielding, sustainment, and disposal. There are plenty of opportunities to comprehensively train critical personnel to be prepared to successfully accomplish and respond to normal and atypical clinical events. Many of the thought processes and good ideas behind the training systems acquired for improving our warfighters' performance, combat readiness, and proficiency have applications in the medical field. Especially, we need to be cognizant of lessons learned so that we can reap the benefits without the need to "re-learn" or "re-invent". Keep in mind solutions need to be scalable to meet user specific demands. Health care institutions, academia, accreditation entities, and industry need to continue to keep an open dialogue to develop a common and shared understanding of challenges and potential solutions. I think we're on the precipice of a watershed era for improving delivered health care. It's an honor and a privilege to be a part of this.


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