Meg Sutton, product manager for National Healthcareer Association, and Ron Goldman, co-founder of Kognito and chief simulation strategist, discuss the value of virtual simulation in a healthcare setting. During this episode, they dive into why communication is so critical in a healthcare setting and how this skill set can be improved through virtual simulation learning and practice with virtual humans.
Learn more about virtual simulation in this article from the 2020 edition of access™.
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Introduction: Welcome to access on air from NHA. This podcast is dedicated to providing educators and employers of frontline healthcare workers with expert perspective on trends impacting and elevating the industry. These discussions can help you achieve your goals as you continue to pave pathways toward professional success for those working in allied health. Thanks for listening.
Meg Sutton: Hello, this is Meg Sutton, I product manager with NHA and with me today, I have Ron Goldman, who is the cofounder and chief simulation strategists at Cognito. Ron, thank you for joining.
Ron Goldman: Sure. Happy to be here.
Meg Sutton: So I'm looking forward to our conversation today. And as I was preparing for this, I was just curious, you know, how did you get started or really interested in simulations and specifically virtual human simulation?
Ron Goldman: Yeah, we as a company started about 10 years ago to really look into a number of places within healthcare, where we felt that simulations and meaning the ability for people to learn through practice and the use of virtual humans can really make an impact. And one of the places that was very obvious very quickly is around communication skills. And it's you look at the statistics, you can see that poor communication between healthcare providers and patients is one of the key causes for adverse medical outcomes in hospitals. Many patients don't follow recommendations from, from their doctors and there's a lot of communication that is occurring all the time and that doesn't really lead to the outcomes that people want. And as the healthcare field have recognized more and more that the human factor, the how you talk to people and not just what you tell them impacts the likelihood that they will actually follow that treatment.
Ron Goldman: And that will be engaged. The need for communication skills have really become very evident, whether you're in health care, whether you are in medical school or nursing school. And those are skills that are really difficult to learn, obviously by just listening to a lecture or to somebody talking about different cases. Like we, we like to say that no one none of us learn how to ride the bike, the bicycle by just watching a movie of somebody else doing it, right. We all had to get on it and try and fail and get up and try again and really learn through experience and many skills, but especially communication skills are best taught through practice and feedback. So as we looked at that market and we look at the capabilities of simulations and virtual humans, which has many benefits that happy to talk more about, it was very clear that there is a tremendous need and that we could potentially as a company feel. And that's where we really started working together. Not just myself, but many other people at the company who are psychologists and software engineers and instructional designers to really build the capability to start helping anyone in healthcare, right? The allied health professionals, physicians, et cetera, to learn these communication skills so they can do a better job working with patients to improve outcomes.
Meg Sutton: That is, that is so true. And I was, you know, I recently was able to work with your team on, on a product and putting together a simulation. I thought it was fascinating that you do have the holistic approach where you have the psychologist, you have the writers, you have actors, you know, portraying these virtual characters to really build such a great quality simulation. And, and we hear it too, right. We hear it from our customers all the time that they are you're truly in need of, of having practice and having the ability for that safe practice within the classroom, because they are so overwhelmed with so many other things going on in the classroom. So simulation plays such a nice role there. So, you know, when you were opinion, when you look at the rise in the, the appeal of virtual training and virtual simulation why do you think that it is, it is so on the rise in the clinical setting?
Ron Goldman: I mean, it's an interesting question. I don't think it's just one thing. And, but I think what has really made an impact is the efficacy that efficacy data that hasn't been published in many peer reviewed journals that shows the ability of simulations, whether it's Kognito or, or other to really build skills and change behaviors of providers. Right? So, and, and that obviously is key for us as a company. You know, we, we go out there and we say, Hey, we're in the business of changing behavior. And therefore we want to make sure that we can actually back it up and communicate the clear value in what we were able to change. What we're not just interested in. People telling us that they you know, this was really fun or really interactive. I mean, we obviously care about it and we, we like to hear it and it's fun, but we want to know that it really changed the way that they practice and, and communicate with their patients.
Ron Goldman: So I think that the fact that the efficacy data has been published, and then this is their numerous publication. I think that have made a lot of the clients, if it's a healthcare system or government or, or schools to say, you know, there's something here beyond innovation or interactivity, we can really create a business case as an organization to using simulation. So I think that that is, that has been key and which is why it's so important that all of us continue to collect data and publish on the efficacy, because if we cannot prove the value you know, there's really no significant future here beyond early adopters, right. You're never going to get to everybody adopting it if there's no efficacy. So I think that's one, obviously the fact that this can be done on your computer or your phone just the convenience versus doing this in an in person format, which is the traditional way, right?
Ron Goldman: Let's bring everybody around the table, let's ask people to role play with each other or let's do what medical schools do. Let's get the standardized patient as an actor come in and role play, which are great ways, right. But it's difficult to standardize, difficult to schedule. It's difficult to bring people in. So just the fact that you can do this at your convenience at your time on whatever device you want. Obviously has been a huge benefit. I think the third one that I would mention is that by its nature, the fact that, you know, you're not watching a movie and you're not clicking next, next, next. Right. Which some people refer to that as interactivity, obviously that's, that's not what the word supposed to mean. Right. the fact that in the simulation, you are in control, you're in the driver's seat, you are making decisions if you don't make decision, nothing happens.
Ron Goldman: So the fact that you're interacting and driving the experience allows the, the engine that behind the scene, the engine that runs the stimulation to do two things. One is obviously personalize the experience to you based on the decision you were making, which is important, personalized learning is way more effective than trying to give everybody exactly the same. But the second part is that I can record and analyze everything that you're doing. So it gives the engine. And therefore, in this case, really the client, a deep understanding of where that individual stands in terms of what they've been able to develop as a skill and what they still need help with. So it can drive additional experiences to make them the great nurse or physician or pharmacy, the condition that the organization wanted to be. Which is very difficult to do. I mean, just imagine when you're doing a workshop,uyou have 30 people sitting in front of you sure.
Ron Goldman: You can give everybody an exam at the end but you know, how much do you really understand about how they're thinking, how they're making decisions, especially around communication. I mean, the only way for you to know that someone is good and having a conversation is to literally simulate it by bringing up a real person, asking them to play a role of, I don't know, a patient with diabetes and tell you, Hey, you're going to play role a, and you're going to try to talk to them about why, and I'm going to videotape this whole thing. And then I'm going to have the linguistic and the learning experts analyze everything you did, and then sit with you and give you feedback. I mean, that's really, really difficult to do and very expensive. So I think all of those three things from just the efficacy, the fact that it's so convenient for people to work within their schedule and the fact that it's an interaction, therefore there's data getting collected to really help make sure that we're using their time to the best and that we give them the right experience. Those are three, and there's probably not a 20, but I think those three are the ones that are really made things happen very quickly and rapidly as a growth industry for us.
Meg Sutton: It's so true. And, you know, you said the behavior change and how, how you're hearing that on your end too. That's the number one thing that when we went out with a soft skills product and we did a bunch of research and we talked to our customers and those within the industry, the number one thing that they were looking to solve for was does this soft skills product lead to true behavior change. And I think that that's such a, that's such an important point. And one that cannot be forgotten is that when you are, when you are looking for methods to use within a classroom or within the training environment, finding a product that, or, you know, finding a simulation that really shows you at the end, that, that the learner has made a change in attitude or behavior is so big. Cause you're making such a big investment into the time to do that. That's harder with you, something like a role play or a case study that doesn't give you, give you that.
Ron Goldman: Yeah. And I would add that, you know, one of the things that have benefited I think learning experiences in general, but definitely simulation is the fact that there's so much data getting collected now outside of the learning experience, that it's actually easier for organizations to track the impact. I'll give you an example. You know, if I have no other data from, from the hospital, for example, and I'm giving nurses as simulation so they can learn how to screen patients for substance use and then how to do brief intervention, where the concept of, if you screen positive to motivate, to actually change your behavior or connect you with behavioral health services in the past all week would have done is really go back to these nurses and say, okay, before you took this simulation, you told us that you have talked to this many patients on average every week that you referred this many.
Ron Goldman: Now it's been a couple of months since you took our simulation. Talk to me about what the average now, and try to kind of do a comparison. So we can say, Hey, on average, the self recorded data here is the impact that we're able to do on how they behave in terms of frequency of conversations and the outcome of the conversation, which is great. And it's taken us very, very far, but now that for example, EMR data is getting collected everywhere. There is the ability for the organization to not just say yes, the frequency of the conversation have increased. They can actually go back and track the number of those brief intervention that the nurse has done. How many of those has the patient actually follow the terms of a recommendation? So they can literally really track that behavior change all the way to the patient outcome, which is obviously the, kind of the ultimate goal.
Ron Goldman: So that the, again, we're benefiting from kind of this data collection as well. And I think we're also I don't know if you had the same experience, but this virtual human thing is, is really, really interesting in how you know, there's a lot of research there, but it's, it's interesting to see how even in your case, right, and allied health professionals, which has not been an audience that we traditionally work with, how their response to the virtual human, as a, as honestly, a subject of practice right there, they're talking to these virtual customers, a virtual patients that they're interacting with, how it's been universal in terms of the fact that, you know, all of us is real. People are actually more comfortable talking with virtual people and, you know, trying, trying different approaches seeing what works and what doesn't work. We're much more open to feedback on how we're doing from the virtual coach and a virtual patient then from a real person, right. We don't, we don't feel judged, et cetera. So it's really been interesting to see how it continues to be effective on different audiences and outside of healthcare. You know, we do a lot of work in K-12. We do work with native Americans. We do work with parents and there's this universal appeal of these virtual humans that is really helping making the learning, not just, again, fun and engaging, but effective as well.
Meg Sutton: And you know, it is, it is really interesting as well because you can introduce audiences to people and groups and demographics that they may, they may be so far geographically from. But I think it's really great with simulation is that you can bring those groups to them. So if you are in a classroom setting in rural Kansas, you can expose them to groups that they would see in New York city or that they may see in Chicago or other places that re can make that learning come to life and prepare them for once they're outside of the classroom or outside of their own community. It's, it's great exposure.
Ron Goldman: Yeah, you're hitting on something that sometimes gets overlooked, but, but it's critical as a value proposition, which is the kind of the cultural competency and, and, and exactly that, right? The fact that I can expose you to an audience that you will interact with, that you may have no experience talking to ever in your past. And because we all learn through our experiences, how can I give you what we like to call deliberate practice in this specific scenarios and with a specific type of person and personality and condition that you're likely to interact with and may find challenging. You can do that in a virtual environment versus kind of hoping you know, in residency, for example for medical students, their ability to learn is so dependent on who is their kind of mentor, right? And also what cases do they run into.
Ron Goldman: So they might run into a whole, these cases that are really, really relevant and they may not. So it's a little bit of a game of chance. And what simulation allow you to do is to build these scenarios that, you know, because of experience that they're likely to run into and give them that deliberate practice and right, so that that's not, that's very, very valuable right through, you're eliminating the chance element here that they may run into this, and they may have the great mentor to tell them how to deal with this. Just too many chances that we could eliminate as a risk for organization for simulations.
Meg Sutton: It's so true. You know, we have, we have a simulation around talking to I'm talking to a supervisor. So if you're somebody in school or you're early on in your career, you may not have had to receive professional feedback from, from your supervisor. And it's so important that you're prepared for that conversation because sitting at home or sitting in the classroom can anticipate how you would react to me. I think a lot of times people get defensive or they, you know, start thinking through what they're going to say instead of being prepared. So you're so right. The relations can absolutely prepare them for a conversation that otherwise would be really hard to set up and stage in another way. So Ron, you know, as we close out here, talk to us a little bit about what does the future look like for virtual simulation? What trends are you seeing? What are you most excited about? You know, as we, as we move forward into the out years with virtual simulation?
Ron Goldman: Well I think first of all, the future is very bright or, and, and, and very exciting for simulation in healthcare. And, and you can, by the way, define healthcare very broadly because health conversations don't occur just in the primary care office. They happen in schools and they happen at home and they happen into, in the workplace and they happen
Meg Sutton: And today they're happening in our living room. Right, right.
Ron Goldman: Yeah. So it's, it's, I think the, this is going to continue to be just a great journey that we're very excited for. I think that some of the trends not to try to to make too many guesses here, but I think one thing that is clear and, and obviously for us, it's great is that the human factor element in driving health outcomes is becoming kind of a common sense and which is, which is good for us. We no longer are in a position where we need to explain to people why it's important to have people learn how to talk and not just what to say. And, but that is, it's obvious that if you look at creating a career path for a, for a nurse or a pharmacy technician, that it's not just about the clinical guidelines and clinical decision making, but it's about their ability to effectively work with patients and coworkers, et cetera.
Ron Goldman: So I think first of all, you're going to continue to see these types of simulations all become equally important. If you look right now, you will see more clinical decision making simulations and a little bit less interpersonal skills, communication simulations. I think you're going to see more of a balance as both of them are critical to the ability of professionals to carry their jobs. So that's one thing thing. The other thing that is, is if you look at how professional development is, has changed over the years and in corporations there is a move that simulation will benefit from, and from looking at it, it is a one time experience. Hey, we need you to learn how to talk to patients about X, or we need you to be able to follow the following medical kind of a process. And we're going to give you an hour experience and that's it.
Ron Goldman: We never going to come back and talk about it. I think that's going to change to kind of an ongoing professional development, right? I mean, learning a skill is never, never done, right. We should all continue to practice and learn. And the same thing is going to happen with simulations that have them being kind of a, let's get it, let's get it done with now and then move on. It will continuously be there as brief experiences that people can engage in whether it's clinical cases or, or communication experiences, so they can get, can keep up to date in their ability to do it effectively, but also so that they can get exposed to additional scenarios, whether they're clinical or interpersonal one would personalities and challenges like even now where we are in this middle of this score on a virus experience, there are very particular conversations that are occurring and are going to start occurring even more between providers and patients within that particular context of anxiety and uncertainty, et cetera.
Ron Goldman: So can we put together a 15, 20-minute experience for a provider so they can take it quickly, get up to date, et cetera. So I think that's another trend that you're going to see instead of a one off, in a way, or trying to get everything done. And then, you know, not really coming back to you that it's going to become part of, kind of the journey and the ongoing professional development of these individuals, right? Just like CME is for and CNE, et cetera, that tend to only cover clinical knowledge. You will see those other human factors, skills become part of that as well. We have seen that already starting, and I think it will become more and more. The other thing is obviously just as technology is getting better and there are technologies from you know, augmented reality to natural language processing, to AI, to other things that allow for experiences to get closer and closer to real life and to give people more modalities of interactions and learning and getting feedback.
Ron Goldman: I think you're going to see more of those becoming more of a commodity versus right. What is right now kind of very specialized and doesn't really happen in, in many cases. So I think you'll see more of that progression and cause there's always better and better ways to do the same thing that these new technologies and the research will allow us to get better at. So I would say those are probably the three and if I have to go far, I would say that you know, at the end of the day, people learn best through practice. And as the efficacy out there shuffles the, this is at least as good, if not better than traditional approaches, and it's not more expensive to build old deliver. I think you would, what I'm betting on in a way, and what I believe is going to happen and why I'm excited about the fact that we are a simulation company, is that stimulation will become the dominant way in which people learn period. And, and in my view, it's not just the healthcare thing. It will happen in K-12 and it will happen in other industries as well. It's more fun. It's more engaging. It's it's more effective. And once we overcome ethicacy price and et cetera, which are things that are already happening, there's no reason why this would not be the dominant way that people learn.
Meg Sutton: Absolutely. And I love that, that it, you know, it could go all the way through your, your entire educational journey from K-12 all the way through your professional career and just become an expectation. That's that's so right, Ron, thank you so much for joining us today. Really appreciate your time. For those of you who are listening, you can find out more about the efficacy studies that, that Ron sited@cognito.com that's K O G N I T o.com. And they will have, you know, more examples of simulation and efficacy studies and more so again, Ron, thank you so much for joining us.
Ron Goldman: Thank you.
