Joey Wahler (Host): They're an advanced approach to obstetrics training, so we're discussing OB Hospitalist virtual simulations. Our guest is Dr. Lisbeth McKinnon, an OB hospitalist and Site Director at OB Hospitalist Group. This is the Obstetrics podcast from OB Hospitalist Group. Thanks so much for joining us. I'm Joey Wahler.

Hi there, Dr. McKinnon. Welcome.

Lisbeth McKinnon, MD: Thank you for having me.

Host: Great to have you aboard. So first, simply put, what exactly do you do as an OB hospitalist?

Lisbeth McKinnon, MD: Sure, I'm an OB GYN, physician, trained, certified OB GYN physician, and I specialize in the inpatient care of obstetrical and gynecologic emergencies for both unassigned patients and assigned patients, meaning patients that have a established provider and those that do not. And regardless of their circumstances, I provide their emergency care. I also serve as an extender, so to speak, and support clinician from our private OB GYN providers for the care of their patients in labor and delivery and in the OB emergency room. And my priority really is to provide a safety net for the hospital, caring for their OB GYN patients, and being available immediately for any emergencies occurring in the hospital, both in labor and delivery, as well as the main emergency room and the rest of the hospital. I also serve as a consultant for other multidisciplinary specialties who care for patients in the hospital with either obstetrical or gynecologic related illnesses. And then finally, I also participate in the hospital quality committees and quality improvement initiatives. And I also lead emergency drills.

Host: Gotcha. So what would you say, first, sparked your interest in virtual simulation training?

Lisbeth McKinnon, MD: Yeah, well, I've always been interested in education and the power it has of the knowledge and skills and particularly as it pertains to taking care of our patients. And so in 2013, I started participating in the Society of OB Hospitalists Medicine live annual clinical meeting, which includes a full comprehensive course in simulations.

And I eventually helped lead those courses as well. Then, in 2020 when the COVID pandemic hit, things changed dramatically and understanding the critical importance of keeping our simulation course alive, despite not being able to learn interactively in person, as an organization, the Society of OB Hospitalists, we were forced to consider alternative learning platforms. Thus we developed the virtual simulation platform. And the virtual simulation courses were really a great success. And we realized that this was a really highly effective platform for learning, both for emergency skill building and also in teamwork and development and training.

And so I wanted to share this effective learning platform that I learned with my own hospital at Overlake and at Overlake, we were in need of participation in drills and in our unit and the Joint Commission was actually coming for their assessment. And so the COVID pandemic created a really significant obstacle to completing our usual in-person drills, together with one of my amazing nurse educators; she and I developed a comprehensive multidisciplinary virtual simulation course involving severe hypertension, a maternal cardiac arrest and hemorrhage. It was such a success that Overlake hospital was actually acknowledged by the Joint Commission for innovative approach to simulation training. So that's where my interest began.

Host: Speaking of which, what does a typical virtual simulation scenario look like, and who generally participates in these?

Lisbeth McKinnon, MD: Yeah. The components of a virtual simulation typically include a filmed video vignette that simulates a patient emergency scenario. For example, postpartum hemorrhage or severe hypertension or cardiac arrest. And often the course includes a didactic, or we call inverted classroom pre-simulation learning unit, that the learners complete prior to the actual simulation course, and then the learners come together in a virtual environment, for example, utilizing a teams platform. They view the film scenario and then the film is, the course is facilitated by facilitators and the film is serially interrupted, during which the facilitators, engage the learners in questions related to that particular important learning moment in the scenario.

And then the learners are asked questions about management, diagnosis, teamwork, or next steps, for example. And we really emphasize psychological safety, where it is okay to not have the perfect answer, and where the learner can request assistance from their other team members, and while they're participating in the simulation, and the advantage of the virtual drills are really, they are easily accessible to a large diversity of multidisciplinary learners, and they can participate in the comfort of their own environment, for example, at home or their office, while still joining in with their colleagues in the learning course.

And participants can include a range of healthcare team members from the OB GYN clinician, midwives, family practitioners, medical students, residents, nurses, even ER physicians and nurses, postpartum care nurses. We even invite our OR technicians, anesthesiologists, NICU providers, and even our healthcare unit coordinators who are all really important in the healthcare team.

Host: What would you say in comparing the two is the biggest difference between these virtual simulations and in-person hands-on training.

Lisbeth McKinnon, MD: In-person simulation involves learners who gather together in a single space, for example, in an operating room or labor and delivery room, and interact to manage a given clinical scenario. And then the virtual space involves learners interacting in a similar scenario, but virtually, utilizing an online platform.

We also can do hybrid drills that combine both techniques where learners practice skills, both in the virtual world platform and on hands-on scenarios. For example, shoulder dystocia would be a good example where teamwork skills can be drilled virtually, but together, both together, but also with in-person hands-on skills.

Host: So tell us a little bit more, if you would please, about what types of emergencies or situations you typically simulate virtually.

Lisbeth McKinnon, MD: There's so many opportunities, so you can simulate virtually almost any situation. So virtual simulations integrate film scenarios, which can depict a wide variety of situations. Not only clinical skills can be simulated virtually, but such as hemorrhage, eclamptic seizure, for example.

But we can also simulate what we might call soft skills, for instance, involving skills that are important in patient care. Trauma-informed care, managing the difficult patient, for example. And then really importantly, virtual simulations are very effective in practicing communication concepts and teamwork skills.

For example, the team steps program, those components can be incorporated really easily in the virtual simulation.

Host: You mentioned the importance of teamwork there, and in addition to that, how would you say these virtual simulations help to build clinical confidence or sharpen decision making in these high stakes OB situations?

Lisbeth McKinnon, MD: Yeah, the drills in general, build confidence for the clinician by allowing the learner to practice skills in a simulated environment where it's safe to make mistakes and also learn from one another. And virtual simulations are in a different, because of its quick and reachable platform, they can be run repetitively without extensive resources, time or physical space.

So you can do them over and over again and learners can really practice pretty repetitively.

Host: You mentioned confidence. Other than that, how have you seen a, a tangible difference in patient outcomes or team performance after these regular virtual simulation training sessions?

Lisbeth McKinnon, MD: We know emergency drill participation has been really widely recognized as an effective tool to improve and maintain patient safety and high quality patient care. The virtual simulation platform for emergency drills is relatively a new space, and we don't have all the data yet. However, this is really an exciting time as we can start to develop and begin research on patient outcomes and risk mitigation opportunities from participation in these simulation drills.

So that's something in the future that I look forward to.

Host: How about a time doctor when something learned in a simulation really directly helped in a real life clinical situation?

Lisbeth McKinnon, MD: Yeah, definitely. I think of at my institution, where I helped develop a virtual simulation course, and our course was on severe hypertension leading to maternal cardiac arrest. We involved providers from several departments including the emergency room, and I was one of the co-facilitators for this course.

And what I was impressed with was this mutual exchange of critical information amongst the participating disciplines in caring for the patient in our scenario. For example, the emergency room providers who participated, they learn to recognize a hypertensive emergency in the scenario, what constitutes a level at which to treat, for example, what medications to use and then, including the importance of starting a hypertension medication and magnesium for seizure prophylaxis.

And additionally they learned the importance of working with the OB team in mobilizing a patient immediately to the obstetrical unit. And then our OB providers in turn learned more details on how to manage an actual code and run the initial parts of a code, importance of identifying a team lead for the code, for example, and who in the code team actually shows up when a code is called.

Host: You did a great job there of asking, of answering the next question I was going to ask, which is, how does this simulation support that interdisciplinary teamwork? It must be great for just the comradery and the overall team feeling that goes on when this is being done right.

Lisbeth McKinnon, MD: Yeah, exactly. And what's nice about the virtual space is that it provides a direct accessibility and exposure for each participant to engage in the drill. There's no need to like squeeze several learners in a physical space. And there's no place really to hide, for example, so to speak. And so in virtual simulations, the learners are really visible by camera, and we ensure that each participant is engaging and called upon regularly during the scenario.

Host: Of course all of this is due in large part to new technology and platforms, so what are the ones that are most effective for this OB virtual simulation work?

Lisbeth McKinnon, MD: So, just as both high and low fidelity in situ drills can be effective learning tools, so can both high and a low fidelity virtual simulation drills. For instance, you can film a scenario from a simple smartphone and utilize a simple film editing application and develop a facilitating learning guide and utilize a platform like Teams or Zooms, for your learning space. But high fidelity, immersive technology is also available, although it's a little bit more expensive.

Host: Of course, so much of what you're discussing here involves accessibility, right? And speaking of which, is this kind of training widely accessible to clinicians in all types of hospitals, urban, rural, resource limited, et cetera? Is everyone included?

Lisbeth McKinnon, MD: Yeah, and I think the beauty of virtual learning, is that it can open up access to a really broad, multidisciplinary healthcare team. For instance, this could be really applicable in a rural and lower resource setting, where, for example, the space access to one site simulation training equipment may not be readily available.

Or the healthcare team members in lower resource area areas may be living and commuting, making in-person participation, um, in simulation training, really challenging. So this is a really great platform for that exact situation.

Host: Yeah, definitely sounds like it. So a few other things before we let you go. First, what do you think the future holds for virtual simulations in OB care?

Lisbeth McKinnon, MD: It's really an exciting area, the virtual world in general. And our life is here to stay. As AI and virtual immersion technology continues to improve and become more innovative and advanced, I really expect to see this to continue to translate into the medical simulation industry, which is really booming right now. Several platforms for virtual healthcare simulation training already exist. Some providing really realistic, highly immersive experiences. And similar to other professional industries that involve high stake emergency situations such as the airline industry, the military, the obstetric and gynecologic space will continue to see the virtual immersion, virtual and immersive world rapidly expand. The virtual platform is already recognized as an effective and acceptable learning tool. For example, the American Board of OBGYN, and its maintenance of certification program for our clinicians in the category of practice improvement activities, we commonly know it as part four.

One of the several national emergency simulation course is an option for completing this requirement, and this now includes virtual simulations. So, it's here to stay and I look forward to it developing and innovating.

Host: Along those lines, any particularly exciting innovations or tools that you're looking forward to incorporating into training down the road?

Lisbeth McKinnon, MD: Yeah, there's so many new creative, innovative technologies and opportunities in the future. I see more space for virtually immersive learning, both individual and team-based, as well as AI driven feedback and performance assessment, for example. I also see like more hybrid simulation models emerging, involving both hands-on skills together with virtual learning and assessment.

And I envision the expansion of what's already starting to happen is professional mobile simulation teams reaching to lower resource hospitals in rural areas as well as freestanding emergency rooms. The virtual platform allows for expansion of learning skills, not only locally but internationally to less economically developed countries providing emergency skill training for clinicians and healthcare teams even abroad.

Host: Yeah, I'm sure the worldwide reach is literally unlimited. Right?

Lisbeth McKinnon, MD: Exactly.

Host: And so in summary here, Doctor, what's your advice for OB clinicians or hospital leaders that may be thinking about starting their own virtual simulation program?

Lisbeth McKinnon, MD: Yeah, you know, the virtual training, simulation training is an accessible resource with a high level of impact. I think, it's an opportunity to take advantage of now this cemented world we live in a virtual interaction enhancing, or in some situations replacing hands-on personal training.

 The advice I would get is I would get to know your institution's resources and their needs. What are the gaps or opportunities in their clinical skills or teamwork communication that you may have identified? You will definitely need buy-in and ability to demonstrate that this virtual platform is a valuable tool, which we've already proven.

And then participate in simulation courses. There are some virtual simulation courses, as an example and I think as virtual simulation education develops, I anticipate the opportunity to access like pre-developed libraries of virtual simulation educational courses on a variety of topics in OB GYN and emergency care, which they could access easily anytime.

Host: It certainly all sounds very exciting indeed. Folks, we trust you are now more familiar with OB Hospitalist Virtual Simulations. Dr. McKinnon, keep up all your great work and thanks so much again.

Lisbeth McKinnon, MD: Thank you so much for having me. It was a pleasure.

Host: Same here. And to learn more, you can explore resources or connect with the team by visiting obhg.com to help you take the next step towards safer, stronger OB care. Now, if you found this podcast helpful, please do share it on your social media. Thanks again for being part of the Obstetrics Podcast from OB Hospitalist Group.