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Episode Description
In this episode of On Record, hosts Mike Anzalone and Kyle Shelstad speak with Dr. Kelly Foltz-Ramos, Assistant Professor and Director of Simulation and Innovation at the University of Buffalo School of Nursing, a Fellow of the American Academy of Nursing and the leader behind UB's designation as New York State's first simulation center of excellence.
Kelly traces her path from health information administration to bedside nursing to clinical education, landing at UB after spending five years building a simulation program from scratch at a large hospital system — largely self-taught at a time when simulation in healthcare was still a new field. She credits a combination of institutional trust, a background in educational theory, and a drive to research every new initiative she introduces with keeping the program moving forward.
The conversation covers several of Kelly's current and recent projects: using virtual reality, funded through a 2023 grant, to give urban-campus nursing students exposure to rural and underserved care environments; a custom GPT she built from the ground up — trained on healthcare simulation standards, interprofessional education competencies, and best practice frameworks — that can generate a complete simulation scenario in about five minutes; and AI voices integrated into mannequin-based simulations to improve standardization and realism.
Kelly's most technically involved current project is the Shared Mental Model study, a collaboration with UB's School of Engineering that combines two-angle video capture, EEG brain activity data, and eye-tracking inside a virtual reality environment to predict in real time when communication or teamwork is breaking down. She also walks through how UB uses video across the full simulation arc — pre-briefing, live facilitation, observer learning, and debrief — and shares her advice for programs evaluating video systems: start with a needs assessment, prioritize tools built for simulation, and talk to peers who've recently gone through implementation.
"I call it quality healthcare simulations in five minutes."
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00:00:02:04 - 00:00:32:11
Unknown
Welcome to the On Record podcast. This is a podcast where we talk with professionals and subject matter experts from diverse markets that are using video and audio and innovative ways to support their organizations objectives. My name is Mike Anzalone and my co-host today is Kyle Shelstad and our guest is Doctor Kelly Foltz-Ramos. Kelly is an assistant professor and the director of simulation and innovation at the University of Buffalo.
00:00:32:13 - 00:01:01:06
Unknown
Welcome, Kelly. Thank you. Before we get started. You have a long list of accomplishments, and I'd like to highlight at least a couple to let our listeners really know. Your passion for nursing. And I think, first and foremost, you've been nationally recognized as a leader in simulation based education. You've been recently designated as a fellow in the American Academy of Nursing.
00:01:01:06 - 00:01:35:15
Unknown
Congratulations on that. Thank you. And then you've also been able to usher in the University of Buffalo as a statewide simulation center of excellence, which I think is one of the first times in New York State that that has been recognized. Yes, the first, the first. So once again, congratulations on that. So, Kelly, tell us a little bit about how you've been able to accomplish some of these accolades and a little bit more about your journey in the field of nursing.
00:01:35:17 - 00:02:12:01
Unknown
Sure. Well, I will talk about my journey first, because then I think that leads me to how I've been able to accomplish what I've been able to accomplish. So I have always been passionate about technology from as young as like ten years old. I would program video games. When I initially chose a profession. I went into Health Information Administration, some a second career nurse, and that's kind of like informatics.
00:02:12:01 - 00:02:41:14
Unknown
I was not satisfied with that profession. I wanted to actually touch the patient. So I went back to school and became a nurse and decided that education really was what made me happy when I was presenting new nurses. So I took a job as a corporate nurse educator for a large hospital system, and my first day on that job, my new boss told me.
00:02:41:15 - 00:03:12:09
Unknown
Last year we purchased two patient simulators for $80,000 apiece. We paid for all the training. Everyone's been trained, but no one has taken them out of the box. So your job is to take them out of the box. We can't pay to train you because we already did all the training last year. So you have to teach yourself how to use them and then integrate them into continuing education and new hire orientation for the whole hospital system.
00:03:12:10 - 00:03:49:12
Unknown
So I really taught myself, and I think in those old days, that was like 2008, a lot of people who work in simulation and healthcare ourselves were self-taught, because there weren't a lot of people who weren't doing it. So I then worked in that capacity for about five years, did successfully implement simulation, and then I decided to come to the University of Buffalo, where there were more opportunities for advancement.
00:03:49:13 - 00:04:16:10
Unknown
And I had done my family nurse practitioner degree here. So when I got to the University at Buffalo, I took over the clinical skills lab and really kind of revamped all the simulation that was being done here. At the same time, I, I went to school, I got my PhD in curriculum instruction in the science of learning, and I also got an advanced certificate in educational technology and new literacies.
00:04:16:12 - 00:04:55:05
Unknown
So I think having that background of educational theory is extremely important. And then kind of put everything together. The people I work with at UB have always supported me and my growth and my crazy ideas. They trust what I'm going to do. So it really has given me the freedom to try new things, to innovate. And I always say that what sets us apart, our simulation program, apart from other ones, is that we try new things.
00:04:55:05 - 00:05:21:03
Unknown
We definitely are the first ones to try new things and to innovate, but we also do research when we try those new things so that we can provide the evidence to other schools who may, may need a little bit more of a push to adopt new technology or new ways of teaching and learning. What are some of the new ideas and things that you that you've been working with?
00:05:21:05 - 00:05:58:16
Unknown
So we are using virtual reality. We are using artificial intelligence. Virtual reality has been around for a long time now, but we didn't implement it until 2024. I, I got a hearse, a grant in 2023 to fund our virtual reality program. I had been trying to find a reason to get virtual reality implemented in the curriculum for a few years, and I have the rift Oculus Rift at home.
00:05:58:16 - 00:06:30:08
Unknown
I had the quest, and so I finally found a good reason for it. And what we use it for is to teach our nursing students to care for patients from rural and underserved communities. So we are an urban campus. Our students go to clinical within driving distance of our campus, so there aren't a lot of opportunities for them to experience health care in those types of settings.
00:06:30:08 - 00:06:52:00
Unknown
And they might not decide to go on and work in a rural or underserved environment. But even if they're in a hospital in a city, they're going to have patients who are going back to those environments. And so knowing that their limited resources and how they might have to treat a patient differently is really important. That's virtual reality.
00:06:52:02 - 00:07:35:06
Unknown
Artificial intelligence, I think. I don't know that there's an email or any kind of advertisement for any training that I get now that does not talk about artificial intelligence. I think it's kind of creeping into every single part of our lives. But I have definitely embraced it myself. Again, as an innovator, I did a fellowship and advanced teaching with or advanced generative AI for teaching, and I learned a lot of tools, and I actually was able to create a custom GPT that will generate simulation scenarios.
00:07:35:06 - 00:08:14:09
Unknown
And I curated all of the important materials. So it has the healthcare simulation standards for best practice for nursing. It has the arcade essentials, which are are very important to us. I'm also really involved in interprofessional education. So it has the core competencies, which is what we follow in interprofessional education. And so you can just write in a prompt, give me a simulation about this for nursing pharmacy PT students.
00:08:14:09 - 00:08:51:19
Unknown
And it will give you an entire simulation that you then have to read through and and edit. But I call it quality quality healthcare simulations in five minutes. Wow. So that is my personal AI. But we have also integrated AI into our simulation by using AI voices for our mannequins. So instead of having them voiced by a person in the control room, an actor, a student, we actually use an AI speaker.
00:08:51:21 - 00:09:27:01
Unknown
And this helps make our simulations more standardized because everyone's getting the same programing. It also helps us, you know, if the patient is a 78 year old female, we can actually make her sound like a 78 year old female, not one of our graduate students in the control room. So yeah, that is one of our newest initiatives. From all the guests that we've had so far, it sounds like you are really on the cutting edge of technology and how you are implementing some of these new technologies.
00:09:27:01 - 00:09:54:19
Unknown
That sounds really cool. How do your how do your students respond to some of this new technology that you're incorporating into the simulation? Well, our students are great because remember I said every time that we introduce something new. We also do research. And sometimes that research will be kind of mandatory part of their coursework just because whatever we're implementing is part of that simulation.
00:09:55:00 - 00:10:20:01
Unknown
But there are also studies that we do that require volunteers. And I never have a problem getting volunteers to come and help. I think that they they are eager for anything that's new, they're eager for anything that's active. And they always say that they want more simulations. When I was doing my homework before our interview today, I was going through some of your published research.
00:10:20:01 - 00:11:03:03
Unknown
And there's a lot that involves technology. There's even some that involve escape rooms to develop communication skills, things like that. It's super interesting. Curious if there's anything currently that you're working on. Sure. I think I said interprofessional education is something that's really important to me. Teamwork and communication are really, really key to ensuring patient safety. So one of the newest studies that I'm working on with colleagues from the School of Engineering, Systems and Industrial Engineering here at UB, it's called the Shared Mental Model Project.
00:11:03:03 - 00:11:38:10
Unknown
So we are actually using a whole bunch of data streams. So we are looking at video from inside the room, so captured from two different angles. We are looking at brain activity using an EEG cap. And we're looking at I tracking using Toby glasses. We also capture headset video because we are doing the study in virtual reality. So we put two participants into the same virtual room.
00:11:38:10 - 00:12:13:00
Unknown
We have different scenarios that we put them through that have triggers that would make them work together. And what we're doing is training a model that will be able to predict when when these participants have a shared mental model, and also when they don't have a shared mental model. So the end goal is to have a real time feedback system that will alert students when a breakdown in communication or teamwork is predicted.
00:12:13:05 - 00:12:43:12
Unknown
Give them a little reminder, okay, stop and do a huddle. Something like that. It's a lot of data, but I think in the end it's going to be very rewarding. And we're starting with nursing students. But this definitely is something that would work with every health care team. Kelly, you mentioned a number of terms like shared mental model, the huddle, and those are terms I'm familiar with from team steps, level of communication.
00:12:43:13 - 00:13:09:09
Unknown
Could could you expand on what a shared mental model is? Seems kind of obvious, but I know there's more behind it. Yes. So the most simple way that I can explain it, it's being on the same page. So having a shared mental model is having the same idea of what roles are, what the situation is, what changes are going on.
00:13:09:10 - 00:13:33:14
Unknown
So it's really getting on the same page. And if I say a huddle is needed, a huddle is kind of like putting your heads together to get back on the same page. If you're not currently on the same page. And yes, team steps is something that we kind of weave throughout our curriculum and they're they're basically communication and conflict resolution tools.
00:13:33:15 - 00:14:05:00
Unknown
They were developed in response to the two errors human report from a while back. That said, a large percentage of medical errors are due to communication. So this this group of tools is a way for health care professionals to speak the same language. So if we all learn team steps, we know a huddle. We know that anyone can ask for a huddle.
00:14:05:00 - 00:14:30:11
Unknown
If we think that there's a breakdown in communication, we know how to respond to conflict when it might be, you know, there might be hierarchical issues by using a course. As soon as you say I'm concerned. If you've been trained in team steps, the other person knows, okay. Something important is going on. I need to stop what I'm doing and figure out what the problem is.
00:14:30:13 - 00:15:05:10
Unknown
That's a different cuss than I use in communication breakdowns. So when you're when you're kind of researching some of those communication skills, teamwork skills, tell us a little bit about how you've been able to incorporate video and the types of things that you're looking for in video. Sure. I think video and simulation kind of go hand in hand for our any of our simulations.
00:15:05:10 - 00:15:32:00
Unknown
If they're uni professional or interprofessional, we use it for pre briefing for preparing our students for simulation. We use it during simulation so that our facilitators can watch what's happening, but we also have other students who are observing. And then we use it in debriefing as a way to help students see something they may not have noticed during the scenario.
00:15:32:02 - 00:16:01:01
Unknown
In our interprofessional simulations, it's usually about communication. That's usually what those scenarios are about. So sometimes it's it's seeing like, okay, you're from two different professions. You're standing at two different sides of the room and kind of like taking turns talking to the patient instead of integrating what you're doing and working together.
00:16:01:03 - 00:16:32:01
Unknown
And so the benefit of the video then, is to be able to watch the simulation live and then to use it for reflection afterwards. And then again, I keep harping on research, but for us, we probably are doing research on that simulation scenario. And that gives us the ability to have observer rating of performance, which makes the research much stronger than if we were just taking a survey from a participant.
00:16:32:03 - 00:16:56:20
Unknown
So when you mentioned observer rating, are you doing like inter rater reliability studies on the collected data? Yeah. So we definitely can do that. If we have the recording, we can have as many people watch and rate to make sure that we're we have in a rater reliability. I know there's been a fair amount of work on and research.
00:16:56:21 - 00:17:35:01
Unknown
Well, maybe not a lot of research, but where the observers can gain just as much learning experience as participants in the so-called hot seat right in the simulation. What's your what's been your experience from that perspective? Sure. So we actually have done research on that here at the University of Buffalo. And both of our studies have shown that our observers have equal knowledge gain and satisfaction and self-confidence and learning as the students who were active in the simulation.
00:17:35:03 - 00:18:03:20
Unknown
I think part of it is probably cognitive load. So there is some anxiety going into a simulation when you're kind of, you said in the hot seat, I think you kind of get at it right like that. There is some increase in cognitive load, which means that your brain cannot take in as much new information as the observer who's sitting there watching.
00:18:03:20 - 00:18:36:16
Unknown
They can take everything in. So we really think that that's part of the reasoning for that. And that's why we kind of do a balance. When we bring students in for simulation, we will bring in a group of eight, and we will do three different simulation scenarios and have them take turns being active or observing. Do you find from an observer perspective, is there more to be gained from watching a recorded video versus watching a live scenario?
00:18:36:17 - 00:19:10:02
Unknown
I would say that the difference would be in what happens afterwards. So if you're watching a recording, are you going to debrief right afterwards? Because that's where like the learning occurs. Usually if you're watching it live, the students are going to come right back out and you're all going to debrief together. And so you get that whole experience if you're watching it recorded, I'm wondering if that means it's more of like an asynchronous thing and you might not get that same experience.
00:19:10:03 - 00:19:39:16
Unknown
I you familiar? I've heard the term you observe what you focus on. And there was this famous video where there's 3 or 4 people that are tossing a ball around and there's a gorilla, a man in a gorilla suit that walks behind them. Well, the observer is is basically instructed to watch how they pass the ball around. And so they're focused on those individuals.
00:19:39:16 - 00:20:03:19
Unknown
And they never really they never see the gorilla behind them. And but when you are watching the video, you have the opportunity to you have the element of time because you can stop the video, you can review the video, you can see things that you may not see in the moment because of what you're focused in on. And I'm kind of curious what your thoughts are on something like that.
00:20:03:20 - 00:20:31:08
Unknown
Yeah, I think that there probably is some truth to that, but we also think we also use the terminology focused observer in a different way. That might make a difference. We will actually like thinking about our team step simulations with an interprofessional audience. We will have five students in the room and.
00:20:31:10 - 00:21:07:18
Unknown
Ten watching those ten students who are watching. We give an observer tool to with the team steps, tools, asking them if they see any of them used or if they see a situation where one could have been used but wasn't. So we kind of are focusing them in on what we want them to be looking at. What was your I'm kind of curious till your involvement, when the when you started using video at University of Buffalo, I'm sure you were very instrumental in the design of the system.
00:21:07:18 - 00:21:39:08
Unknown
What were some of the thoughts, thought processes that you had in terms of designing that system? Well, I will tell you, when I got to the University of Buffalo, they were using a casino security system for video and simulation and, and burning DVDs. So everything recorded 24 hours a day in our health assessment lab, in our simulation rooms.
00:21:39:08 - 00:22:10:05
Unknown
And then if you wanted to keep something, you would actually have to pull it off and burn it onto a DVD, which then later we were upgrading to a flash drive. But if we wanted to go back and look at something, it is like hitting the rewind. The it was really time intensive. It was not easy to use and when there was a power outage, sometimes it would it would break and things would have to be replaced.
00:22:10:07 - 00:22:37:12
Unknown
So when we were looking for a new video system, obviously I wanted something that was updated. But my biggest need, the one thing that I was looking for is the ability to annotate. So when we're watching a simulation, we can put the marker in and then easily use that video during debriefing to show like, okay, what were you thinking in this spot of the simulation?
00:22:37:14 - 00:22:45:20
Unknown
Having that ability just really, really, really helps.
00:22:46:00 - 00:23:14:15
Unknown
Do you do you record all the simulations? No, we do not. What's the reasoning for that? What makes you decide whether to record or not? Record. So it really depends on the purpose of the simulation. We will almost always be streaming the video if we're not using it for research purposes, or if it's not something that's being graded summative.
00:23:14:17 - 00:23:47:16
Unknown
We don't necessarily always recorded. And a lot of our simulation is done with formative evaluation. So we aren't we aren't grading them. We're looking at at how they perform and how they really react during debriefing. When you mentioned formative evaluation, can you define that a little bit more for our listeners? Sure. So formative and summative would be the two different types of evaluation.
00:23:47:16 - 00:24:17:10
Unknown
And summative is where you are giving someone a grade. So it can be used as when you think of high stakes testing. So like it end of the course exam head to toe assessment that summative evaluation formative is more of looking at overall quality. And in our in our context we do it more as like a participation than participating.
00:24:17:12 - 00:24:57:11
Unknown
But that's really the difference between formative and summative. We're not giving them a grade informative. So the formative assessment is building skills towards that summative assessment. In some cases we actually don't use summative at the end of every course. So it might not be. But we definitely do scaffolding. So what that means is we kind of start smaller with more kind of beginning easier skills, and then kind of put them together and make our simulations more complex.
00:24:57:13 - 00:25:33:11
Unknown
As time goes on, as our students move through the program. So we don't always need a summative assessment as long as they're progressing through those different stages. As you've kind of modernized your video system from the old DVD kind of technology, what challenges have you experienced? I mean, there's definitely challenges with people getting to know the system, which you're going to have whenever you implement something new.
00:25:33:13 - 00:25:59:11
Unknown
I don't think anyone knew how to use the casino security system, but when we got when we got vault, people wanted to use it. So we had more people who we had to kind of get up to speed on how to use it. Other than that, I mean, we have kind of some of the same challenges. Not everyone wants to be recorded.
00:25:59:11 - 00:26:08:10
Unknown
It does, you know, cause some anxiety sometimes. But beyond that.
00:26:08:11 - 00:26:38:01
Unknown
Nothing that's really stands out. Just kind of pulling back to the observer versus participant where you were saying, you know, stress of being the participant could impact their learning. Is the observation there simply to supplement that? No. So the observation for us is a way to get more students through simulation. So I'm sure that you've heard that there's a nursing shortage.
00:26:38:02 - 00:27:13:06
Unknown
I feel like there's always been a nursing shortage, but there's really a nursing shortage right now. And we really need to increase enrollment and get some more nurses out there into the workforce. But the big thing that is keeping that enrollment down is the lack of clinical sites, the lack of faculty. And here in New York State in 2023, we passed legislation to allow for one third of clinical hours to be done through simulation in New York State.
00:27:13:06 - 00:27:45:11
Unknown
And that simulation counts if you're in the active or the observer role, as long as it's part of you have the whole process of pre briefing, the simulation scenario debriefing. So for us to be able to get eight students through one session of simulation versus the 2 to 3 who would go in at one time, that is really why we have the observer role.
00:27:45:11 - 00:28:26:00
Unknown
And then we make them focus to make sure that they're getting everything that they need out of it. And of course, we debrief everyone together. But for us, it has allowed us to increase our numbers of students in simulation. That actually is an interesting comment, because I was going to ask you a question in terms of a lot of the folks that we speak with have had challenges in terms of convincing stakeholders in universities to invest in some of these video systems, which it can represent a significant investment.
00:28:26:02 - 00:28:57:08
Unknown
But with the legislation I know in New York and in other states as well. What are some of your thoughts on helping clients that are having challenges? Convincing their stakeholders at video is a valuable and integral component of simulation. I think in the current environment, telling them that they can get more students in using video is probably the biggest selling point.
00:28:57:09 - 00:29:28:11
Unknown
I mean, we can talk about the numbers that we put through before having observers compared to the number that we have now, and that's like a really clear metric to show. I mean, we can definitely show the value from the research that we've done. We can show the value and our student evaluations, but being able to show them that ability to get more students through kind of is more important than anything else.
00:29:28:13 - 00:30:02:14
Unknown
Before we wrap up, one, one question I'd like to ask is if our listeners are in a position where they're involved with either designing a new video system or evaluating a new video system, what kind of guidance would you provide them? I think with any any new system that you're implementing, start with a needs assessment, looking at what your objectives are, what you're going to be using it for.
00:30:02:16 - 00:30:42:00
Unknown
And I, I think in the simulation world, having a system that has functions that are specific to simulation is really important because you can get AV systems for casino, that will work fine, but they're not going to have those extra features that really make your simulation special and much better. And then I also like to talk to other people who maybe have just implemented their systems to see what advice they have and how they like.
00:30:42:00 - 00:31:05:21
Unknown
Whatever they chose will kill you. Really brought to the podcast today not only a wealth of technical expertise and nursing expertise, but the ability to kind of tie both of those together, which is, I think, a very unique position. If any of our listeners were interested in getting in touch with you, any follow up questions? Kind of based on what we talked about.
00:31:06:00 - 00:31:23:16
Unknown
Is there a good way for them to do that? Yes, probably. My email is the the best way. And that's Foltz@Buffalo.edu. Well, thank you very much Kelly. This has been an awesome conversation.
00:31:23:18 - 00:31:38:07
Unknown
On Record is a podcast presented by Intelligent Video Solutions, hosted by Mike Anzalone and Carmen Haak and produced by Kyle Shelstad. Find us online at IPIVS.com/onrecord and on social media at Intelligent Video Solutions.
Unknown
Welcome to the On Record podcast. This is a podcast where we talk with professionals and subject matter experts from diverse markets that are using video and audio and innovative ways to support their organizations objectives. My name is Mike Anzalone and my co-host today is Kyle Shelstad and our guest is Doctor Kelly Foltz-Ramos. Kelly is an assistant professor and the director of simulation and innovation at the University of Buffalo.
00:00:32:13 - 00:01:01:06
Unknown
Welcome, Kelly. Thank you. Before we get started. You have a long list of accomplishments, and I'd like to highlight at least a couple to let our listeners really know. Your passion for nursing. And I think, first and foremost, you've been nationally recognized as a leader in simulation based education. You've been recently designated as a fellow in the American Academy of Nursing.
00:01:01:06 - 00:01:35:15
Unknown
Congratulations on that. Thank you. And then you've also been able to usher in the University of Buffalo as a statewide simulation center of excellence, which I think is one of the first times in New York State that that has been recognized. Yes, the first, the first. So once again, congratulations on that. So, Kelly, tell us a little bit about how you've been able to accomplish some of these accolades and a little bit more about your journey in the field of nursing.
00:01:35:17 - 00:02:12:01
Unknown
Sure. Well, I will talk about my journey first, because then I think that leads me to how I've been able to accomplish what I've been able to accomplish. So I have always been passionate about technology from as young as like ten years old. I would program video games. When I initially chose a profession. I went into Health Information Administration, some a second career nurse, and that's kind of like informatics.
00:02:12:01 - 00:02:41:14
Unknown
I was not satisfied with that profession. I wanted to actually touch the patient. So I went back to school and became a nurse and decided that education really was what made me happy when I was presenting new nurses. So I took a job as a corporate nurse educator for a large hospital system, and my first day on that job, my new boss told me.
00:02:41:15 - 00:03:12:09
Unknown
Last year we purchased two patient simulators for $80,000 apiece. We paid for all the training. Everyone's been trained, but no one has taken them out of the box. So your job is to take them out of the box. We can't pay to train you because we already did all the training last year. So you have to teach yourself how to use them and then integrate them into continuing education and new hire orientation for the whole hospital system.
00:03:12:10 - 00:03:49:12
Unknown
So I really taught myself, and I think in those old days, that was like 2008, a lot of people who work in simulation and healthcare ourselves were self-taught, because there weren't a lot of people who weren't doing it. So I then worked in that capacity for about five years, did successfully implement simulation, and then I decided to come to the University of Buffalo, where there were more opportunities for advancement.
00:03:49:13 - 00:04:16:10
Unknown
And I had done my family nurse practitioner degree here. So when I got to the University at Buffalo, I took over the clinical skills lab and really kind of revamped all the simulation that was being done here. At the same time, I, I went to school, I got my PhD in curriculum instruction in the science of learning, and I also got an advanced certificate in educational technology and new literacies.
00:04:16:12 - 00:04:55:05
Unknown
So I think having that background of educational theory is extremely important. And then kind of put everything together. The people I work with at UB have always supported me and my growth and my crazy ideas. They trust what I'm going to do. So it really has given me the freedom to try new things, to innovate. And I always say that what sets us apart, our simulation program, apart from other ones, is that we try new things.
00:04:55:05 - 00:05:21:03
Unknown
We definitely are the first ones to try new things and to innovate, but we also do research when we try those new things so that we can provide the evidence to other schools who may, may need a little bit more of a push to adopt new technology or new ways of teaching and learning. What are some of the new ideas and things that you that you've been working with?
00:05:21:05 - 00:05:58:16
Unknown
So we are using virtual reality. We are using artificial intelligence. Virtual reality has been around for a long time now, but we didn't implement it until 2024. I, I got a hearse, a grant in 2023 to fund our virtual reality program. I had been trying to find a reason to get virtual reality implemented in the curriculum for a few years, and I have the rift Oculus Rift at home.
00:05:58:16 - 00:06:30:08
Unknown
I had the quest, and so I finally found a good reason for it. And what we use it for is to teach our nursing students to care for patients from rural and underserved communities. So we are an urban campus. Our students go to clinical within driving distance of our campus, so there aren't a lot of opportunities for them to experience health care in those types of settings.
00:06:30:08 - 00:06:52:00
Unknown
And they might not decide to go on and work in a rural or underserved environment. But even if they're in a hospital in a city, they're going to have patients who are going back to those environments. And so knowing that their limited resources and how they might have to treat a patient differently is really important. That's virtual reality.
00:06:52:02 - 00:07:35:06
Unknown
Artificial intelligence, I think. I don't know that there's an email or any kind of advertisement for any training that I get now that does not talk about artificial intelligence. I think it's kind of creeping into every single part of our lives. But I have definitely embraced it myself. Again, as an innovator, I did a fellowship and advanced teaching with or advanced generative AI for teaching, and I learned a lot of tools, and I actually was able to create a custom GPT that will generate simulation scenarios.
00:07:35:06 - 00:08:14:09
Unknown
And I curated all of the important materials. So it has the healthcare simulation standards for best practice for nursing. It has the arcade essentials, which are are very important to us. I'm also really involved in interprofessional education. So it has the core competencies, which is what we follow in interprofessional education. And so you can just write in a prompt, give me a simulation about this for nursing pharmacy PT students.
00:08:14:09 - 00:08:51:19
Unknown
And it will give you an entire simulation that you then have to read through and and edit. But I call it quality quality healthcare simulations in five minutes. Wow. So that is my personal AI. But we have also integrated AI into our simulation by using AI voices for our mannequins. So instead of having them voiced by a person in the control room, an actor, a student, we actually use an AI speaker.
00:08:51:21 - 00:09:27:01
Unknown
And this helps make our simulations more standardized because everyone's getting the same programing. It also helps us, you know, if the patient is a 78 year old female, we can actually make her sound like a 78 year old female, not one of our graduate students in the control room. So yeah, that is one of our newest initiatives. From all the guests that we've had so far, it sounds like you are really on the cutting edge of technology and how you are implementing some of these new technologies.
00:09:27:01 - 00:09:54:19
Unknown
That sounds really cool. How do your how do your students respond to some of this new technology that you're incorporating into the simulation? Well, our students are great because remember I said every time that we introduce something new. We also do research. And sometimes that research will be kind of mandatory part of their coursework just because whatever we're implementing is part of that simulation.
00:09:55:00 - 00:10:20:01
Unknown
But there are also studies that we do that require volunteers. And I never have a problem getting volunteers to come and help. I think that they they are eager for anything that's new, they're eager for anything that's active. And they always say that they want more simulations. When I was doing my homework before our interview today, I was going through some of your published research.
00:10:20:01 - 00:11:03:03
Unknown
And there's a lot that involves technology. There's even some that involve escape rooms to develop communication skills, things like that. It's super interesting. Curious if there's anything currently that you're working on. Sure. I think I said interprofessional education is something that's really important to me. Teamwork and communication are really, really key to ensuring patient safety. So one of the newest studies that I'm working on with colleagues from the School of Engineering, Systems and Industrial Engineering here at UB, it's called the Shared Mental Model Project.
00:11:03:03 - 00:11:38:10
Unknown
So we are actually using a whole bunch of data streams. So we are looking at video from inside the room, so captured from two different angles. We are looking at brain activity using an EEG cap. And we're looking at I tracking using Toby glasses. We also capture headset video because we are doing the study in virtual reality. So we put two participants into the same virtual room.
00:11:38:10 - 00:12:13:00
Unknown
We have different scenarios that we put them through that have triggers that would make them work together. And what we're doing is training a model that will be able to predict when when these participants have a shared mental model, and also when they don't have a shared mental model. So the end goal is to have a real time feedback system that will alert students when a breakdown in communication or teamwork is predicted.
00:12:13:05 - 00:12:43:12
Unknown
Give them a little reminder, okay, stop and do a huddle. Something like that. It's a lot of data, but I think in the end it's going to be very rewarding. And we're starting with nursing students. But this definitely is something that would work with every health care team. Kelly, you mentioned a number of terms like shared mental model, the huddle, and those are terms I'm familiar with from team steps, level of communication.
00:12:43:13 - 00:13:09:09
Unknown
Could could you expand on what a shared mental model is? Seems kind of obvious, but I know there's more behind it. Yes. So the most simple way that I can explain it, it's being on the same page. So having a shared mental model is having the same idea of what roles are, what the situation is, what changes are going on.
00:13:09:10 - 00:13:33:14
Unknown
So it's really getting on the same page. And if I say a huddle is needed, a huddle is kind of like putting your heads together to get back on the same page. If you're not currently on the same page. And yes, team steps is something that we kind of weave throughout our curriculum and they're they're basically communication and conflict resolution tools.
00:13:33:15 - 00:14:05:00
Unknown
They were developed in response to the two errors human report from a while back. That said, a large percentage of medical errors are due to communication. So this this group of tools is a way for health care professionals to speak the same language. So if we all learn team steps, we know a huddle. We know that anyone can ask for a huddle.
00:14:05:00 - 00:14:30:11
Unknown
If we think that there's a breakdown in communication, we know how to respond to conflict when it might be, you know, there might be hierarchical issues by using a course. As soon as you say I'm concerned. If you've been trained in team steps, the other person knows, okay. Something important is going on. I need to stop what I'm doing and figure out what the problem is.
00:14:30:13 - 00:15:05:10
Unknown
That's a different cuss than I use in communication breakdowns. So when you're when you're kind of researching some of those communication skills, teamwork skills, tell us a little bit about how you've been able to incorporate video and the types of things that you're looking for in video. Sure. I think video and simulation kind of go hand in hand for our any of our simulations.
00:15:05:10 - 00:15:32:00
Unknown
If they're uni professional or interprofessional, we use it for pre briefing for preparing our students for simulation. We use it during simulation so that our facilitators can watch what's happening, but we also have other students who are observing. And then we use it in debriefing as a way to help students see something they may not have noticed during the scenario.
00:15:32:02 - 00:16:01:01
Unknown
In our interprofessional simulations, it's usually about communication. That's usually what those scenarios are about. So sometimes it's it's seeing like, okay, you're from two different professions. You're standing at two different sides of the room and kind of like taking turns talking to the patient instead of integrating what you're doing and working together.
00:16:01:03 - 00:16:32:01
Unknown
And so the benefit of the video then, is to be able to watch the simulation live and then to use it for reflection afterwards. And then again, I keep harping on research, but for us, we probably are doing research on that simulation scenario. And that gives us the ability to have observer rating of performance, which makes the research much stronger than if we were just taking a survey from a participant.
00:16:32:03 - 00:16:56:20
Unknown
So when you mentioned observer rating, are you doing like inter rater reliability studies on the collected data? Yeah. So we definitely can do that. If we have the recording, we can have as many people watch and rate to make sure that we're we have in a rater reliability. I know there's been a fair amount of work on and research.
00:16:56:21 - 00:17:35:01
Unknown
Well, maybe not a lot of research, but where the observers can gain just as much learning experience as participants in the so-called hot seat right in the simulation. What's your what's been your experience from that perspective? Sure. So we actually have done research on that here at the University of Buffalo. And both of our studies have shown that our observers have equal knowledge gain and satisfaction and self-confidence and learning as the students who were active in the simulation.
00:17:35:03 - 00:18:03:20
Unknown
I think part of it is probably cognitive load. So there is some anxiety going into a simulation when you're kind of, you said in the hot seat, I think you kind of get at it right like that. There is some increase in cognitive load, which means that your brain cannot take in as much new information as the observer who's sitting there watching.
00:18:03:20 - 00:18:36:16
Unknown
They can take everything in. So we really think that that's part of the reasoning for that. And that's why we kind of do a balance. When we bring students in for simulation, we will bring in a group of eight, and we will do three different simulation scenarios and have them take turns being active or observing. Do you find from an observer perspective, is there more to be gained from watching a recorded video versus watching a live scenario?
00:18:36:17 - 00:19:10:02
Unknown
I would say that the difference would be in what happens afterwards. So if you're watching a recording, are you going to debrief right afterwards? Because that's where like the learning occurs. Usually if you're watching it live, the students are going to come right back out and you're all going to debrief together. And so you get that whole experience if you're watching it recorded, I'm wondering if that means it's more of like an asynchronous thing and you might not get that same experience.
00:19:10:03 - 00:19:39:16
Unknown
I you familiar? I've heard the term you observe what you focus on. And there was this famous video where there's 3 or 4 people that are tossing a ball around and there's a gorilla, a man in a gorilla suit that walks behind them. Well, the observer is is basically instructed to watch how they pass the ball around. And so they're focused on those individuals.
00:19:39:16 - 00:20:03:19
Unknown
And they never really they never see the gorilla behind them. And but when you are watching the video, you have the opportunity to you have the element of time because you can stop the video, you can review the video, you can see things that you may not see in the moment because of what you're focused in on. And I'm kind of curious what your thoughts are on something like that.
00:20:03:20 - 00:20:31:08
Unknown
Yeah, I think that there probably is some truth to that, but we also think we also use the terminology focused observer in a different way. That might make a difference. We will actually like thinking about our team step simulations with an interprofessional audience. We will have five students in the room and.
00:20:31:10 - 00:21:07:18
Unknown
Ten watching those ten students who are watching. We give an observer tool to with the team steps, tools, asking them if they see any of them used or if they see a situation where one could have been used but wasn't. So we kind of are focusing them in on what we want them to be looking at. What was your I'm kind of curious till your involvement, when the when you started using video at University of Buffalo, I'm sure you were very instrumental in the design of the system.
00:21:07:18 - 00:21:39:08
Unknown
What were some of the thoughts, thought processes that you had in terms of designing that system? Well, I will tell you, when I got to the University of Buffalo, they were using a casino security system for video and simulation and, and burning DVDs. So everything recorded 24 hours a day in our health assessment lab, in our simulation rooms.
00:21:39:08 - 00:22:10:05
Unknown
And then if you wanted to keep something, you would actually have to pull it off and burn it onto a DVD, which then later we were upgrading to a flash drive. But if we wanted to go back and look at something, it is like hitting the rewind. The it was really time intensive. It was not easy to use and when there was a power outage, sometimes it would it would break and things would have to be replaced.
00:22:10:07 - 00:22:37:12
Unknown
So when we were looking for a new video system, obviously I wanted something that was updated. But my biggest need, the one thing that I was looking for is the ability to annotate. So when we're watching a simulation, we can put the marker in and then easily use that video during debriefing to show like, okay, what were you thinking in this spot of the simulation?
00:22:37:14 - 00:22:45:20
Unknown
Having that ability just really, really, really helps.
00:22:46:00 - 00:23:14:15
Unknown
Do you do you record all the simulations? No, we do not. What's the reasoning for that? What makes you decide whether to record or not? Record. So it really depends on the purpose of the simulation. We will almost always be streaming the video if we're not using it for research purposes, or if it's not something that's being graded summative.
00:23:14:17 - 00:23:47:16
Unknown
We don't necessarily always recorded. And a lot of our simulation is done with formative evaluation. So we aren't we aren't grading them. We're looking at at how they perform and how they really react during debriefing. When you mentioned formative evaluation, can you define that a little bit more for our listeners? Sure. So formative and summative would be the two different types of evaluation.
00:23:47:16 - 00:24:17:10
Unknown
And summative is where you are giving someone a grade. So it can be used as when you think of high stakes testing. So like it end of the course exam head to toe assessment that summative evaluation formative is more of looking at overall quality. And in our in our context we do it more as like a participation than participating.
00:24:17:12 - 00:24:57:11
Unknown
But that's really the difference between formative and summative. We're not giving them a grade informative. So the formative assessment is building skills towards that summative assessment. In some cases we actually don't use summative at the end of every course. So it might not be. But we definitely do scaffolding. So what that means is we kind of start smaller with more kind of beginning easier skills, and then kind of put them together and make our simulations more complex.
00:24:57:13 - 00:25:33:11
Unknown
As time goes on, as our students move through the program. So we don't always need a summative assessment as long as they're progressing through those different stages. As you've kind of modernized your video system from the old DVD kind of technology, what challenges have you experienced? I mean, there's definitely challenges with people getting to know the system, which you're going to have whenever you implement something new.
00:25:33:13 - 00:25:59:11
Unknown
I don't think anyone knew how to use the casino security system, but when we got when we got vault, people wanted to use it. So we had more people who we had to kind of get up to speed on how to use it. Other than that, I mean, we have kind of some of the same challenges. Not everyone wants to be recorded.
00:25:59:11 - 00:26:08:10
Unknown
It does, you know, cause some anxiety sometimes. But beyond that.
00:26:08:11 - 00:26:38:01
Unknown
Nothing that's really stands out. Just kind of pulling back to the observer versus participant where you were saying, you know, stress of being the participant could impact their learning. Is the observation there simply to supplement that? No. So the observation for us is a way to get more students through simulation. So I'm sure that you've heard that there's a nursing shortage.
00:26:38:02 - 00:27:13:06
Unknown
I feel like there's always been a nursing shortage, but there's really a nursing shortage right now. And we really need to increase enrollment and get some more nurses out there into the workforce. But the big thing that is keeping that enrollment down is the lack of clinical sites, the lack of faculty. And here in New York State in 2023, we passed legislation to allow for one third of clinical hours to be done through simulation in New York State.
00:27:13:06 - 00:27:45:11
Unknown
And that simulation counts if you're in the active or the observer role, as long as it's part of you have the whole process of pre briefing, the simulation scenario debriefing. So for us to be able to get eight students through one session of simulation versus the 2 to 3 who would go in at one time, that is really why we have the observer role.
00:27:45:11 - 00:28:26:00
Unknown
And then we make them focus to make sure that they're getting everything that they need out of it. And of course, we debrief everyone together. But for us, it has allowed us to increase our numbers of students in simulation. That actually is an interesting comment, because I was going to ask you a question in terms of a lot of the folks that we speak with have had challenges in terms of convincing stakeholders in universities to invest in some of these video systems, which it can represent a significant investment.
00:28:26:02 - 00:28:57:08
Unknown
But with the legislation I know in New York and in other states as well. What are some of your thoughts on helping clients that are having challenges? Convincing their stakeholders at video is a valuable and integral component of simulation. I think in the current environment, telling them that they can get more students in using video is probably the biggest selling point.
00:28:57:09 - 00:29:28:11
Unknown
I mean, we can talk about the numbers that we put through before having observers compared to the number that we have now, and that's like a really clear metric to show. I mean, we can definitely show the value from the research that we've done. We can show the value and our student evaluations, but being able to show them that ability to get more students through kind of is more important than anything else.
00:29:28:13 - 00:30:02:14
Unknown
Before we wrap up, one, one question I'd like to ask is if our listeners are in a position where they're involved with either designing a new video system or evaluating a new video system, what kind of guidance would you provide them? I think with any any new system that you're implementing, start with a needs assessment, looking at what your objectives are, what you're going to be using it for.
00:30:02:16 - 00:30:42:00
Unknown
And I, I think in the simulation world, having a system that has functions that are specific to simulation is really important because you can get AV systems for casino, that will work fine, but they're not going to have those extra features that really make your simulation special and much better. And then I also like to talk to other people who maybe have just implemented their systems to see what advice they have and how they like.
00:30:42:00 - 00:31:05:21
Unknown
Whatever they chose will kill you. Really brought to the podcast today not only a wealth of technical expertise and nursing expertise, but the ability to kind of tie both of those together, which is, I think, a very unique position. If any of our listeners were interested in getting in touch with you, any follow up questions? Kind of based on what we talked about.
00:31:06:00 - 00:31:23:16
Unknown
Is there a good way for them to do that? Yes, probably. My email is the the best way. And that's Foltz@Buffalo.edu. Well, thank you very much Kelly. This has been an awesome conversation.
00:31:23:18 - 00:31:38:07
Unknown
On Record is a podcast presented by Intelligent Video Solutions, hosted by Mike Anzalone and Carmen Haak and produced by Kyle Shelstad. Find us online at IPIVS.com/onrecord and on social media at Intelligent Video Solutions.