Welcome to Health queries, a podcast where your health questions are answered by faculty and experts and the Macquarie College of Health and Human Services at Missouri State University. I'm your host, Lauren Stockam. And this month, I sat down with Brandon Rochelle, a clinical Associate Professor of nursing and coordinator of the Missouri State University simulation center. We talked about how MSU is using the simulation lab to uniquely prepare MC HHS students for their future careers.
Hey, everyone, my name is Brandon, I am a assistant clinical professor here at Missouri State are primarily I belong to the nursing program. But and I say it that way because my other role is I'm also the simulation center coordinator. I'm the lab coordinator here from a query Health and Human Services. So I also get to collaborate and work side by side with many of our other disciplines within the query. So I also get to work and collaborate with Physician Assistant Program occupational therapy program is where nutrition dietetics Social Work psychology, my case econ program, and it's just to name a handful of them. And so so that's the role that I have here at Missouri State. And so this is year 11. As a nurse for me, I have my Master's in nursing.
I got my my bachelor's degree in nursing, I'm from Louisiana. So from LSU Go Tigers, I actually have tigers and bears in my office, from my alma mater, but I got my bachelor's from LSU back in 2009, is when I finished up nursing school. And then I since then I've I've worked in various different settings in a couple of different cities. So I've done critical care in pediatrics, home health, hospice, case management, medical surgical nursing. And then I've also worked in in a handful of academic settings on the university side, and then I've also done some executive leadership in education for for some other health systems in the state as well. So So it's been a fun ride and, and just being able to see nursing from so many different perspectives and not just nursing but healthcare from various different perspectives, I think has allowed me to, to bring a wide almost 360 view to what we do here and book query and really to be able to develop learning experiences and, and experiential learning opportunities for our students that allows them to immerse themselves in a in a sage healthcare setting where they can learn. Can you tell me a little bit about what you do in the day to day at the simulation center, and how different students across the college are using it.
So our simulation center here at Missouri State, it's what I often refer to when I'm given to us is a six bit virtual hospital, even though it's a it's a simulated setting, I call it that because we have a we have several rooms that simulate acute care settings, acute care rooms, and one of those is the clinic room. That one is primarily utilized by a nurse practitioner students are physician assistant program uses that space a lot. And we also use it with our undergraduate nursing students as well if we want to do like a clinic based room or an emergency room staff setting. But then we also have three acute care rooms. Two of those actually are fully fitted with a bathroom with a shower and, and we've done scenarios with patient transferring from one space to the other. We have a pediatric room. And then we also have a mother baby birthing suite. So all of our rooms are primarily occupied by what we will call a high fidelity simulator, which is basically a fancy term for a bit computer. And then as a matter of fact, with that mother baby suite, we actually have a high fidelity mannequin that can also birth rip tear, bleed and have every complication of pregnancy, but also have kind of prenatal care. So we can also simulate fetal rhythms and heart rhythms and those types of things along with contractions of Mama, we're juggling that labor. But as you can tell, it gives us a space where we can immerse students and a healthcare environment. We use academic EHR, so we actually use a charting based system four, so each one of our patients or clients also have a electronic healthcare record system. We use a medication dispensing system, a supply dispensing system, and everything is bar coded. So it feels very much like the hospital based setting. And so students get to walk into this space. And what I often tell the students is that when I'm explaining the simulation area to them is that so in the hospital, you go out and you get to do that. things that other people have already thought of already made the decisions about. And so it's somewhat safe, because somebody else has already kind of made the indecision for you. And you're really doing a delegated task. Versus in the simulation area, you are making a decision, you are somewhat of a free thinker, you're, you're expected to use your clinical judgment and interpret the cues that are around you and interpret the situation to then prioritize your concern and then hypothesize what may be going on with these clients in the healthcare setting, or their healthcare scenario in that moment, and then make decisions on your own without being shoulder to shoulder to a faculty or preceptor or mentor. So there is this empowerment of you have learned all of these things in the didactic setting or in your prep. And now you get to come and put all of those things together, and fill the fill the achievement and kind of that, that, that intrinsic fulfillment that I've made the decisions on my own, and hopefully, it's led to a viable outcome in my, in my client, whenever I get to make those decisions.
So how has the simulation experience changed since let's say when you were in nursing school, and how has it changed even since you've been teaching at Missouri State.
So my my final semester of nursing school, which was December of oh nine, when I graduated, a simulation, it really was just kind of kind of coming on that on the scene as far as being accessible. So I would say in the past decade, we've seen a tremendous amount of growth in the sim world. So we didn't actually get a chance to do any high fidelity sim in my program, while I was on the floor of of the cohort that I was in. So my last semester, the School of Nursing was actually just beginning to use simulation with our anesthesia students. So with the crna students, they were just beginning to dabble into high fidelity simulators at the time. And so we actually only had a skills area, which was basically a bay of have a pastoral base, very similar to what we have here in our skills lab in O'Reilly, but we actually had to check out VHS tapes, to watch the skill a couple of times and then go and practice it with our our faculty and show them that we were competent, or at least proficient in the skill and so so I think it has changed tremendously. I mean, kids whenever I'm giving family tours, I like to say and so at the end of the day, I run a big computer lab, our our IT team I work super close with with our guys who run that area. And so that the amount of technology that that is now driving the, the simulation world or that's even available, is has changed everything. You know, our our anesthesia department actually, actually also has a simulated or and they have high fidelity mannequins as well in in some of the ones they have actually have the ability to, to look around the room, and there's a pediatric mannequin that can cry that can turn multiple colors, and that can move their mouth when you are speaking through the mannequin. And so it has allowed us to as technology continues to progress to fully immerse students because at the end of the day, you know, especially today's students, a mannequin is a mannequin. They'll they'll they'll say it, you know, it's hard because it's a mannequin, and so that we have vendors and creators in technology who tried to overcome that particular barrier. But the thing that makes the simulator experience, I think kind of next level is our ability as as facilitators as educators to to build fidelity, even just outside of the mannequin itself. And so allowing the students to fully immerse themselves in a hospital based setting or clinic based setting and make decisions on their own, I think has completely changed the way that we prepare students to even go into the hospital based setting because they now are able to again, understand before they get to the hospital, how to navigate a patient chart how to look back at a trend over three days and interpret what that means. That time management it takes to go and pull all the supplies you need for a particular skill and then be ready to come back into the room and explain those things. You know, the the twists and turns and the nuances with pulling various medications and and how long that really Because it's one thing to say it and teach it, it's another thing to start to experience the things that snag you and the things that may not happen and, and will understocked some areas or, you know, we will put in various snags into that area because it's a controlled space, and we don't have humans, we use mannequins and and if we make errors or mistakes, it's, it's a safe setting. So there is no, there is no no terminal damage that comes to a patient and their family. If we don't have optimal outcomes, it gives us a learning experience. And it gives us an opportunity to debrief to reflect, and to do better moving forward.
What exactly have you done in the Missouri State simulation center, specifically that is unique? And what do students necessarily like really like about it? Or what are the things that you hear them talk about that they are really learning from and enjoying.
So I think what makes our center unique in terms of what we've been able to do so when I came into the the center, we had a lot of technology, and I don't think we're fully using to its full to its full capacity in order to fully integrate students into that setting. So we were still we had the ability to use the academic Electronic Health Record system. But primarily we're using it I think, not to its full, full ability. Our students are tech savvy, of course, they navigate technology without really hardly any, any rigorous effort, it comes somewhat natural to them. So one of the things that I think does make ours unique is the fact that we utilize the electronic health record the academic electronic health record to the degree that we do with even come up with our vendor that I'll ask questions about, about the chart and doing various things. And he's like, you're the only you guys are the only school that are utilizing it in this particular area. Because we, we have the features of even being able to populate lab orders in real time. So everything that we do, we are truly responding to the students behaviors. So the students are expected to come with a certain amount of awareness of the situation so that they can walk into making clinical judgment decisions. So the ability to take our chart and put in a physician admitting note, and a nursing note and Anna therapy note and given the students you know, 2530 different orders that they would see in the hospital, but only about eight or nine of those are actually applicable to now, or being able to, to place in the lab panels that shows a trend for, you know, a four day stay, but getting multiple vital signs and being able to see those trends that helps our students to, to anticipate and to understand that trajectory that they don't always see in a clinical based setting. I think that's one thing that makes us unique on top of so we just in the past, I think about year, maybe year and a half, we've gotten a few different grants that have allowed us to to increase our our mannequins, so we've gotten another additional female mannequin of color, which gives us some diversity in our lab as well. So we've done another high fidelity mannequin of color. And then we've also so I spoke about our, our electronic medication dispensing system and supply dispensing system. Those are things that make the setting like candidate next levels, realism for the students that there's nothing like the feeling of going into a room to get something and then going out to the supply area, grabbing all the supplies you need, and then coming back and not having everything you need and then having to explain to the patient or the or the family member that's in the room, why you don't have what you need in going back out. And and again, you begin to learn time management, you begin to learn that things cost money, that everything that we do impacts the overall cost of the healthcare system. Because we want to be fiscally responsible, we only want to get the things that we need. You know, there's the there's the safety checks with the medications that the students begin to understand of the importance of it takes the whole level of medication rights to another level when you actually have the system in front of you. And I'm not caught it comes up that you have to go get another peer to come and witness with you. Again, these are things that students don't get to experience and make the decision. In a clinical setting. You know how to waste medications just with peers without a faculty oversight. Because as a nurse, those are the things that you're doing you're responsible for. And then I think one of the other things that makes, the way that we do simulation somewhat unique for our nursing students is, so we call simulation a, a safe space, it's a place that's non punitive unless there's a track record of unsafe or not quite competent behavior for the appropriate cohort that you are in. But we also, we do Sentinel event reporting, and we do that we do safety event reporting. So if students, you know, make decisions that lead to unsafe, or I should say, to negligent behaviors, or or anything that can hurt or harm the patient, or even what we would call a near miss and hospital based setting, our students have to walk through what it means to report that kind of an error, they have to identify what were the risk factors that led to that error? Is this something that the unit as a whole should take a look at. And those things are built into our medication dispensing system. So we'll put two look alike sound alikes next to each other, we'll put a wrong dose in. In it, we'll put a wrong dose in the correct drawer. And so again, another distraction for the students or even in the room, we'll put, we'll put the found of live TV on the monitor, while the students are trying to manage something critical, because that's real life. Those are the things that happened in real life. So I think really, it's it's not even so much of, of what we do that's so different, its ability to think outside of the box and look at all of these things that we have. And how can we just raise the bar to make this more of an immersive experience for students because at the end of their computers, computer mannequin is a mannequin. So if it's high fidelity as they are with the heart sounds in the lung sounds, it's still a big mannequin in the bed. So as much as we can raise the fidelity and immersive Jessup, everything else within the experience, I think is what makes what we do a bit more unique than some of the other simulation settings.
Yeah, when Mark was telling me about it, he described it as almost like an escape room setting. Yeah, you're like, throwing tricks at them kind of not necessarily trying to trip them up, but like, make sure that they're paying really close attention to what they're doing.
So one of the things that that is a trend in nursing education, specifically is the idea of using escape rooms. And primarily the way that the way that the literature is suggested is to use like a Google form and make it into a a interactive responsive quiz. So you make this selection, and then you build the back rules to lead somewhere else. And so I took that concept, and said, Well, what if we take this idea and move it into an actual hospital based setting and turn the entire space into an escape room, so we've done it with, with pediatric clients, we've done it with geriatric client, we just set up one for for a geriatric client who came in with a an exacerbation of a pulmonary disease, and the students go into the space and we essentially Close the door. And they get depending on the scenario, we've done them with it up to two hours long. And we were a little worried, because all of the research kind of shied away from from scenarios that are that long, but we have evaluated the students and really critically looked at their feedback and they prefer they truly do prefer and we have not seen any, any fatigue or like decision making fatigue. What we found is that students actually eager to get to the next clue on the air. So for instance, we will have a heavy pump program with the wrong dose or we will have they will have to perform a certain assessment and get the correct values and then add all those numbers together to unlock the next part of the scenario. And so it's primarily driven by we actually build the survey in Qualtrics, which is our survey software here at the university. So we drive the scenario based on this survey that we built. But we also have chosen the academic EHR so they will have to scan a medication in order to unlock the next part of the specific scenario and we'll put things in the room you know, we'll put the patient's overnight bag in overnight bag, maybe it's a peel box, and you know, they have to put the pills in the correct order to get the letters to unlock the next clue. And again, it's thinking outside of the box because students love games they love gamification. One of the one of the questions we actually have been able to correlate On our posts, evaluation of the experiences, we can look at the students who, who say, Yes, I prefer gamification. And then we can see how do they what feedback they give on the various styles of clues and the things that we do. And we can see a correlation to students who aren't really in the game that much and how well they enjoy versus students who are. But the overall feedback from students is also is always that they have learned something new and, and identify errors that are very easy to miss in the in the clinical setting, especially when you're moving at the speed of managing multiple patients at one time. So it's, it's been really fun. And it's kind of a it's, it's fun when you're in the entire senate because like I said, we're a six bit unit. And so it's fun to be running a scenario in one room. And then you can hear like the laughter and the end, they cheer for each other, like when they unlock a clue they get excited. And so it's fun to kind of hear that in earshot while you're doing another one because you know, kind of what's happening over there, and that the students actually enjoying the learning experience that they're going through.
Yeah, honestly, it sounds like a lot of fun, even if it is, you know, a test or whatever. Yeah, might be a little stressful, like, just to do something unique like that, I think is so interesting. Yeah. And helpful. I mean, it gives them real world experience for sure. How do you see the simulation center at Missouri State and just simulation in general, evolving even more over the next, you know, five to 10 years? And not necessarily what are your ideas? But what what do you think the potential of the simulation center could be in the future.
So when we look at the outlook of, of simulation moving forward, especially when I think about what we do here at Missouri State, looking at an AI if we place it here in, in our region, so Springfield, the greater Ozarks, where we touch, and our students go, we only have so many hospitals, our students can only get into so many clinical areas, and I think, to continue to grow, to continue to meet the demand of a shortage of healthcare providers. The answer and all of the research is simulation, the National Council for the State Board of Nursing has invested lots of resources into research behind the clinical outcomes of being in the clinical setting versus in a simulation based setting. And what they have found is the learning outcomes of being in both settings are actually somewhat equal. And in some areas, it's actually higher in the simulated base setting. So I think it is primed for growth, when I look around at our ability to collaborate within disciplines, to, to build scenarios to work more side by side to, to fill all six beds in and manage a hospital with various disciplines taking care of various patients at one time, that's a that's a big time collaboration. But at the same time, nothing is impossible. I think that that leaves us with so much potential actually, I think I see us outgrowing the simulation center, as we continue to, to innovate and think in ways that allow us to give the students because at the end of the day, it's also given our students and experiential learning modality that sets us apart from from other institutions, and also does not take away anything from being in the in the actual hospital based setting. I think the fact that we have this this area, and a university where we have where we have colleges of the arts in in and and other various soft sciences, you know, that allows us I think the potential for what you would call in a simulation where a standardized patient program where you have human actors who are trained in in just a little bit of healthcare acumen and knowledge and in terminology to be able to be human actors. So we have standard as patients that come in so we're not necessarily tied down to to a big computerized mannequin. You know, there's wearable simulators in this. There's simulated shirts with what sounds that we can use. So the possibilities really are endless. And I think as we continue to again, look forward into growth, how can we? How can we develop more more nurses for our region? How can we develop more healthcare providers for our region? What areas do we have to give them that hands on training that simulator based training, I think settings very similar to a simulation lab are are the answer for that moving forward?
Well, after hearing all that you've talked about with the simulation center, I have to believe that it's a very valuable resource for all the students in this college and I really enjoyed learning more about it.
Thank you so much. I have really enjoyed it. And I'm just excited that we get to, to share what I think is one of our hidden hidden secrets here at Macquarie about what we do as far as simulated based learning and, and using simulation as a way to engage students in something that's real, and really kind of bridge the gap between the classroom and the global setting.
Join us back here next month as we take another dive into your health questions and interests. For more information on the mcqueary College of Health and Human Services, visit Missouri state.edu slash NC HHS and follow us on Twitter, Instagram and Facebook at MSU MC HHS.
