A Q&A with Dr. Jo-Ann Talbot, helping implement SIM technology in emergency medicine
This story is the eighth in a ten-part series on innovation and resiliency in Saint John, published by Enterprise Saint John in advance of the Walrus Talks, an evening of artful conversation on innovation with eight leading thinkers and doers taking place in Saint John on October 26th. For more information, or for tickets, visit the Walrus Talks website. For more information on Enterprise Saint John initiatives, check out the True Growth website.
Dr. Jo-Ann Talbot came to Saint John ten years ago after training in the Emergency Medicine program in Winnipeg, Manitoba. The Dalhousie Medicine satellite campus in Saint John was just getting up and running, and she was excited to be able to work in an academic centre close to her family out East. Together with Dr. Michael Howlett, the department head who developed funding, Dr. Glenn Verheul, who helped to acquire the equipment, and Drs. James French and Jay Mekwan, who came onboard as instructors, the Emergency Medicine Simulation program began. Five years later, the program is doing what it’s meant to be doing, helping med students, residents, and experienced doctors practice high acuity, low frequency events in a simulated setting with dummies that respond to treatment.
Can you tell me a little more about the role you play in this team project?
I am the academic head at the Saint John Regional Hospital Emergency Department. I’m the assistant clinical academic department head, and I lead the continuing professional development program. Continuing professional development is everything after you graduate from residency. There are three blocks as a developing doctor: you become a medical student, then a resident, then the next 30 years, you practise. What we’re doing more and more in all of those phases is we’re incorporating our learning with our other team members, so we do interdisciplinary team building and professional development.
Where does the SIM technology come from and where is it being used elsewhere? I think it’s really exploded in the last 5 years. Before then there were little pockets, the early adopters who had set up in various areas of Canada. Now you will find big SIM centres in every province. I think there’s lots of simulation going on, but this kind of simulation where you build a SIM bay and you bring teams together and do crew resource management with high fidelity simulations, I’m pretty sure we’re the only ones doing it in Saint John and probably there’s only two of us doing it in the province. It’s emergency physicians right now who are interested because we do a lot of high acuity, low frequency events. You don’t see a child come in with a drowning very often. But it’s very high acuity and when that happens, you want to be aware of what you need to do and you want to be able to do it really well. So some of the target areas for simulation are things you don’t really see often, but man oh man when they come, it’s really high intensity and you want to be very good at what you’re doing.
So you mentioned high fidelity simulators. What does that mean, exactly? High fidelity is where you can hook them up to a monitor, the physiology is whatever you program into it, and you can change it on the fly, so you can create a simulation that looks more real life. You’re able to interact with the mannequins much more like a patient, so the patient could verbalize, they could make noises, they can breathe, you can listen to their heart, I can program in heart rates and heart murmurs, I can program in that one lung’s not working well or both lungs are wheezy. You can feel pulses; I don’t have to tell them, “your patient is in cardiac arrest”, I just flick the pulse off and then something happens on the monitor. This is what happens in real life, so you expect them as a team to pick that up. When it’s a high fidelity simulator, it does that for you. Some of them are so high, they talk, they sweat, they cry, they breathe; they do all kinds of stuff, so the higher fidelity, the more realistic it is.
What are some of the applications of the project? It is a big step for skill maintenance and especially in those areas where you don’t see the acute life threatening events very often, when we see it we want to be very comfortable with our approach and that’s one thing that you can get from a simulation program. When we actually are in a high pressure situation in the emergency department, in the resuscitation room, it’s adrenalized, it’s busy, it’s time intense, and then when it’s all over you spent probably sometimes an hour or more with a big group of staff around that child, and meanwhile all the patients waiting in the waiting room continue to stack up. So when you finish that, you have to get to work and catch up with all the things that have been waiting and simmering while you’ve been in there. So there is no time to say, “how’d that go? Why did we not think of this earlier?” You can’t debrief, so those same errors are going to keep happening every time. So simulation actually does this, you stop, you sit down and debrief it and it’s a powerful learning event.
Has there been any research to show that departments that have SIM programs have better patient outcomes? So, the patient outcome research is missing because it’s the hardest thing to do. If you have two paediatric codes a year, it’s hard to study if you’re doing better over time. There are other things that you can show in simulation and our department has been doing some research in this area. You can demonstrate through simulation that your processes are improving, and so we know from large international trials that if you do better CPR on a patient in cardiac arrest, they have a better outcome. So what we can show in our simulation program is that in this scenario, we did better CPR, so you can infer that you’re going to have better outcomes. One of the things I’ve learned when simulating is my physiology in these high stress situations. My heart rate goes up, and my hearing goes down, and I become tunnel visioned, this is normal. I’m focused on a task, and somebody may be right beside me, and say the blood pressure’s 80 on 40, and I do not hear it. And so we teach that, and I’ve told people, if you tell me the blood pressure is 80 on 40 and I do nothing, I didn’t hear you, and so you need to feel empowered to tell me more strongly. So that is the complex sort of team communications that I think you can only train using simulation.
Why did you choose to stay and do this work here in Saint John rather than elsewhere? I came to Saint John partly for family, because I had family in the east. There’s not a lot of places in New Brunswick and Nova Scotia that have academic centres, there’s really only two, Halifax and Saint John, and so part of it was to be in an academic centre. I actually prefer Saint John to Halifax; it’s a beautiful spot. I mean look outside today, the red trees and the blue water and the nice sky, it’s beautiful. It’s a beautiful place to live, it’s a beautiful community to raise your children in, the people are wonderful here, there’s a lot going for this place, right? And that’s why I’m here. There’s no other place in Canada where you can practise in an academic emergency department that has such a community feel to it.
What do you feel is the role of innovation in Saint John?
I think innovation is important, always, and I think you can innovate in all different ways no matter where you are. Because it’s exciting, it gets enthusiasm. Change is necessary, right? We need to change to keep up and if you embrace it, it’s easier than having it happen to you, and innovation is about that, it’s about embracing change and saying “we’re going to do this” in a way that’s exciting and interesting and engaging.
Do you have any advice for anyone who is looking to solve a problem in the community in an innovative way? Yes, you have to work with a lot of different people who think in a lot of different ways. Sometimes we surround ourselves with people who think like we do and then we end up with the same thing that we would think of, whereas it’s much harder to work with people who think differently than us, but we have a better product. You have way better ideas, and I know just this project is beyond something I could have done, and it’s only happened because there’s been people who are interested in the community connection, people who are very interested in the equipment part of it and the technology and people who are interested in the delivery. I think we have experts in all of those areas, and those are very different ways of thinking and they were able to come together.