ORLANDO — After a 20-year career in the Army, Eric Bruns retired in 2008 and almost immediately found the private sector unsatisfying.
“The issue for me is that there wasn’t a larger mission,” Bruns explained. “It’s hard to come out of 20 years in the Army and go into an organization where the only mission is to make money.”
Invited to a VA job fair, he found his way into a presentation by VA’s Employee Education System (EES). As the son of an educator, the work EES did appealed to him. He was interviewed and hired that day and hasn’t had to worry about lacking a mission since.
Now as the Director of the VA’s Simulations Learning, Education and Research Network (SimLEARN), Bruns’ mission is to give VA providers an environment where they can practice life-saving techniques without the high-stakes environment where a life could possibly be lost.
Launched in 2016, the idea behind SimLEARN was inspired by similar efforts in the military, aviation, nuclear energy and other areas where, if something went wrong, it could be devastating, and so simulation practice becomes necessary.
“These are all areas where you focus on practice, practice, practice, train, train, train. And commit to doing no harm,” Bruns explained. “You practice in an environment where you don’t have a real patient. And I think that’s very beneficial. That makes us reliable. It improves processes and flow. That lets us see where the points of failure are. So when you’re in the real environment, you’re ready.”
SimLEARN is based at the National Simulation Center (NSC) in Orlando. A 53,000 square foot hospital, the NSC has the ability to replicate any situation you’d find in a VA medical center. Based on a schoolhouse model, trainees are brought from around the country to take courses at the NSC and practice their skills in an environment where they don’t have to be afraid to get something wrong.
“We have mannequins that actually cry, bleed, sweat, breathe. All of this is controlled—to use an Orlando term—by the Disney magic of technicians behind a two-way mirror,” Bruns said. “If something goes wrong, we can change vital signs. If they do something right, they’ll see the vital signs go to the normalcy they’re looking for.”
The NSC provides scenarios for everything from trauma nurse courses to clinicians focusing on specific body parts to airway management.
“That’s become very important in the times we’re living in—intubating patients,” Bruns noted. “We’ve actually had to modify that course over the last few months to include donning protective equipment and ensuring the clinicians could operate using that equipment.”
SimLEARN also employees actors—standardized patients who can provide nuanced feedback to providers. Actors are used to give clinicians the experience of interacting with an agitated family member or explaining a procedure that’s dangerous and may have a low probability of success.
“This way they can understand how to change their dialogue if need be,” Bruns said.
There are simulation labs of varying sizes at every large VA facility, and so SimLEARN also provides courses for simulationists.
“Some labs are more robust than others, but the staffing of those labs requires some sort of training, so we teach intro and advanced simulation skills,” Bruns explained. “They learn how to design and run scenarios and how to run the equipment.”
Over the last few months, SimLEARN has had to adapt to COVID-19, throttling back on its schoolhouse model and relying more on distance learning. The trauma nurse core course has been particularly successful, Bruns said, with close to 100 nurses being trained online over the last three months.
“Regardless of the pandemic, we can’t stop,” Bruns declared. “During a pandemic, this training becomes even more important.”
In the future, SimLEARN plans to create simulations using augmented and virtual reality—another way that could support training during times of social distancing.
“As we bring on newer clinicians, those who grew up with this technology, we think it would be very beneficial,” Bruns said.
The benefits of SimLEARN programs are realized in better patient outcomes across the board. That is most clearly seen in SimLEARN’s resuscitation education initiative, which provides a standardized way of training resuscitation and life-saving skills across VA. Rather than the usual every-other-year training that many systems require, SimLEARN employs a low-dose, high-frequency style of training that refreshes on certain skills every quarter.
“Veterans of a certain age—their numbers have shown they are 50% more likely to survive a resuscitation type event at a VA facility than anywhere else,” Bruns said. “Because of this training, physicians are better prepared and able to act faster.”