Strengthening the education and training of the nation’s nursing workforce is critical to advancing patient care in an increasing complex health care system.

U.S. Rep. Kathy Castor emphasized the importance of highly skilled nurses during her Feb. 13 tour of the newly renovated USF College of Nursing George and Marian Miller Center for Virtual Learning.

Castor met with USF Health leaders, faculty, students, staff and local media to highlight the Title VIII Nursing Workforce Reauthorization Act that she recently helped introduce in the United States Congress. The legislation would provide federal funding for advanced programs and initiatives to help prepare top-quality nurses – enhancing training that addresses an aging population, diversity, primary and acute care, as well as interprofessional education and practice.

“Nurses work tirelessly to keep our communities healthy, and they need our support,” said Castor during her visit. “This bill, if passed, would help prepare the nurses of tomorrow and provide a pathway to good-paying jobs across the country, especially in our state.”

U.S. Rep. Kathy Castor speaking to USF Health leaders, faculty, staff, students and local media about the Title VII Nursing Workforce Reauthorization Act.

“We appreciate Castor’s efforts of introducing this bill in Congress,” said Charles Lockwood, MD, senior vice president for USF Health and dean of the Morsani College of Medicine “This opportunity would provide much-needed financial support for education and training programs that help prepare top-quality nurses and future faculty as well as minimize the existing nursing shortage across Florida.”

During her visit, Castor toured through the state-of-the-art experiential lab and met with students as they practiced basic health skills learned in the classroom.

U.S. Rep. Kathy Castor met with nursing faculty and students in the newly-renovated experiential lab.

The new space, which includes 12 hospital–like patient rooms, four separate simulation rooms, a skills lab, a community health room and a lab classroom, provides students a more realistic learning environment.

“Our goal was to design a high-fidelity simulation environment where students felt like they’re training in a real-world healthcare facility, and I think we’ve done that,” said Teresa Gore, PhD, associate professor and director of experiential learning in the George & Marian Miller Center for Virtual Learning.

Castor also visited USF College of Nursing on Bull Nurses Week, a student-organized celebration running Feb. 13 through 17. The week-long event recognizes students and their commitment to nursing education, clinical training and community involvement.

U.S. Rep. Kathy Castor meets with USF College of Nursing students as they celebrate Bull Nurses Week.

“Nurses are the backbone of health care,” said Donna Petersen, ScD, senior associate vice president of USF Health, dean of the USF College of Public Health and interim dean of the College of Nursing. “Investing in nurses is an investment in our communities, it’s an investment in our health and our sustainability as a vibrant society.”

To view more photos, click here.

Story by Vjollca Hysenlika, USF Health Communications 
Photos by Jessica Samaniego, USF Nursing Communications

When it comes to simulating a large scale crisis, USF College of Public Health students in the master of science in public health (MSPH) occupational medicine residency program are getting as close to the real deal as possible.

Through a partnership with the James A. Haley Veterans’ Hospital and Clinics in Tampa, students have the opportunity to take part in emergency management preparedness and training. It prepares them for handling a large scale disaster and triage of multiple patients with varying degrees of injuries and illness.

The VA’s “SIM BUS” contains mannequins dressed with mock injuries to fit six different scenarios.

Dr. Ronald Figueredo, COPH occupational medicine resident, examines a patient exposed to a rail car oil shipment explosion. (Photo by Anna Mayor)

The most recent simulation included patients with an array of chemical exposures from chlorine gas to ammonia.

Upon entering the bus, residents are provided information cards noting the status of the patient’s injuries. They utilize critical thinking skills and make decisions on how they would triage the patients, categorizing who needs care first, according to Dr. Eve Hanna, occupational medicine faculty in the Department of Environmental and Occupational Health.

Trainees in the program are resident physicians from the USF Health Morsani College of Medicine. Residents complete clinical rotations at locations in Tampa including the VA, Tampa General Hospital, local private occupational medicine clinics and OSHA.

Occupational medicine is a board certified medical specialty with a focus on worker populations, diagnosis and treatment of work-related injuries, illnesses and exposures.

The simulation training happens twice a year for students in the MSPH occupational medicine residency program.

Residents of the COPH’s occupational medical residency program and instructor Dr. Eve Hanna (third from left) take a moment to show some USF school spirit following the simulation training. 

“It’s a higher form of learning,” Dr. Hanna said. “In order for all parts of your mind to be engaged you have to be doing something. In a lecture you’re just sitting there and taking the information in, so once you become an active participant you learn and retain the information better.”

Dr. Theodore Aquino, chief resident of occupational medicine at USF Health Morsani College of Medicine, said that coming from a military background, he’s had experience in dealing with mass casualty scenarios and that in emergency scenarios providers must triage patients to do good for the greater number of people.

“There is no replacement for real world training, but a close runner up would definitely be a simulation,” he said. “We’re taught see one, do one, teach one, so if you can’t necessarily see one or do one in a live scenario, live emergency, or live patient, a simulation is the next best thing,” he said.

Chief resident of occupational medicine at USF, Dr. Theodore Aquino, works to triage patients during the simulation. Trauma categories were defined as immediate care (red), delayed (yellow), minor (green) or expectant (black). 

Dr. Janet Sprehe, program director of simulations at the VA, manages all simulation education.

She said the VA obtained the simulation bus in August of 2015 and it has been used to train USF College of Public Health medical doctors and residents and USF College of Nursing students, as well as University of Tampa nursing students. The bus has been used for trainings across the Tampa Bay area, including at MacDill Air Force Base and the Hillsborough Emergency Management Command Center.

VA nurses, including emergency room and ICU nurses, provide clinical coaching as students make decisions regarding each patient.

“We have had over 700 people utilize the bus in training,” she said. “It’s great to see everyone liking what we’re training them on. Our goal is to keep simulating different types of emergencies to help people be prepared in what they need to do.”

The bus is equipped to provide medical services in the event of a disaster and, according to Sprehe, could be ready for operation within an hour.

Dr. Brandon Dawkins, a senior occupational medicine resident, said the simulation helped him become more familiar with how it feels to make a critical decision that will help to minimize harmful effects.

“It was difficult at first to understand how to balance the varying levels of triage during the simulation,” Dawkins said. “As a clinician one is trained that everyone who presents to the health care system will get the full complement of resources available. This is very different from an emergency or disaster situation as there are more constraints on time and resources. This creates a situation where attempting to give the full complement of resources to a patient without proper triage may result in injury or death that could have been prevented.”

For resident Dr. Dwayne Wilson, the simulation training was a new and helpful experience.

“Basically, preparation is the key to responding to an event, the more you plan, the more you prepare, the more reflexive memory to assess a patient or disaster event, so that’s why I feel this really helps,” he said.

COPH occupational medicine resident, Dr. Dwayne Wilson, checks the pulse of a patient who was exposed to a mixture of bleach and ammonia. 

The occupational medicine residency program at the COPH is a two-year concurrent academic and practicum training program, accredited by the Accreditation Council for Graduate Medical Education.

For more information about the program visit the program’s website or contact Kelly Freedman, program coordinator, at kfreedm1@health.usf.edu.

Photos by Anna Mayor, USF College of Public Health

The USF Health Center for Advanced Medical Learning and Simulation, or CAMLS for short, is gaining  prominent national and state media exposure this week for being at the forefront of advancing simulation in healthcare education.

The CNN Technovations series came to CAMLS in September to capture a trauma/emergency training for a team of physicians, nurses and other health professionals from Lakeland Regional Medical Center.  The simulation scenarios included patients severely injured in a street explosion during a marathon.

The Technovations show “High-Tech Dummies Help Doctors Save Lives” is posted to CNN’s website at http://www.cnn.com/TECH/innovation/archive/.   The program was scheduled to air at  2 p.m. today, Oct. 23, on CNN and again at 3 p.m., Thursday, Oct. 24, on the HLN network.

USF Health trauma surgeon Luis Llerena, medical director of CAMLS Surgical and Interventional Training Center, is interviewed by the Florida Channel crew.

The Florida Channel Crossroads crew visited CAMLS for two days in July, to film a variety of simulation activities in CAMLS  Surgical and Interventional Training Center and its Virtual Patient Care Center for a documentary about the growing use of simulation training in healthcare education.

The “Medical Mannequins” story is posted to the Florida Channel’s website at http://thefloridachannel.org/programs-coverage/florida-crossroads/.  The 30-minute documentary began  airing on public TV  stations across Florida this week.  In the Tampa Bay market, the piece is scheduled to air at 10:30 AM this Sunday, Oct. 27, on WEDU (the PBS station locally).

The stars of both these shows are the technologically-advanced simulators, but USF Health CAMLS leadership, staff and residents and students play prominent roles.

CNN Technovations multimedia journalist Ryan Bergeron gets a close-up of one of the advanced patient simulators before a team training exercise begins in the USF Health CAMLS Trauma OR.

A Florida Channel videographer films USF residents during a simulated cardiac arrest training exercise in the CAMLS Virtual Patient Care Center

At CAMLS, the student teams respond to a series of patient care scenarios including a mock cardiac arrest

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Working with a mere 18 months of knowledge and training, second-year USF Pharmacy students made life-or-death decisions in only seconds when they participated in a mock cardiac arrest situation designed to show the different phases of care that pharmacists are involved in for patient care.

The afternoon-long exercise was one of the first virtual patient exercises for the pharmacy students and took place March 18 at USF’s Center for Advanced Medical Learning and Simulation (CAMLS) in downtown Tampa.

The goal of the program was to tie in the students’ communications skills and knowledge of transitions of care with health informatics, said Erini Serag-Bolos, PharmD, assistant professor in the College of Pharmacy.

“This is the first opportunity students have had to put all the tools they’ve learned so far to use,” Dr. Serag-Bolos said “The point is to give them more realistic insight into pharmacists’ various roles across time with a patient.”

The exercise included 10 work stations, most of which played out a patient scenario across time, from the patient first entering the emergency room to follow up care in an outpatient setting. The scenario helped students put into practice the many and varying roles a pharmacist would experience with each patient, including counseling, medication reconciliation, involvement in a cardiac arrest code, pharmaceutical calculations and compatibility, and prescription verification.

“When creating this activity, we wanted to expose them early on and the activity really opened up their eyes to various roles a pharmacist could have in different levels of care and settings – all of course while still having fun with their team,” said Aimon Miranda, PharmD, BCPS, assistant professor.

Working in groups of four to five, students spent five minutes at each station, with some students starting with the emergency room station and others starting at various points in between. By the end, each student completed the entire scenario and pieced all the stations together.

“Students dove into critical points of the patient’s history that they could encounter in their job and that focused on error reduction, patient safety, patient-specific management plans, and health informatics,” Dr. Serag-Bolos said.

In addition, several stations featured standardized patients who acted out these medical scenarios.

“Standardized patients provided a different focus and were good opportunities for the students to practice the patient interview skills they have learned,” Dr. Serag-Bolos said.

To demonstrate just how unpredictable a day in the life of a pharmacist may be, one of the stations featured a simulator patient mannequin in cardiac arrest that students had to revive. This mannequin could be injected with medications, had a pulse, and was linked to a monitor that could be pre-programmed with certain heart rhythms that were displayed on a monitor.

With a faculty giving orders and providing condition updates of the patient in distress, the students were required to quickly and accurately prepare the medications needed. The patient code provided the most intense situation for the students to use their communication skills, which is the essence of working in teams, Dr. Serag-Bolos said.

“These students haven’t been trained yet for handling emergency code situations, so this definitely got their feet wet,” she said.

“Having no training in advanced cardiac life support, the students had to rely on knowledge and techniques taught in previous semesters,” said Shyam Gelot, PharmD, BCPS, assistant professor. “The students handled themselves very well and confidently during this stressful simulation.”

“Overall, the students did really well given that they had limited information and were expected to think on their feet at each station. In the code station, some students embraced the situation, despite their nerves, and dove in to help their team during the code,” Dr. Miranda said.

And the students agree.

“The ‘code’ scenario was probably my favorite part, but the most stressful,” said Theresa Trindade, a second-year pharmacy student. “The way I can describe this exercise succinctly is that it was a challenge. It forced us to think on our feet.”

At the end of the exercise, the students met with faculty in a nearby conference room to debrief on how well they performed, their reactions to the emergency, and the success, or failure, of communicating with their peers in order to benefit the patient.

“I thought the exercise was a great hands-on learning experience and was a good opportunity to apply, under a simulated clinical setting, the information I am learning in my lectures and in my readings,” said Phillip Bonet, also a second-year student.

“The most challenging aspect was the patient rooms because we had to figure out the level of care and what was going on with the patient,” Trindade added. “I think my group excelled in certain areas. For example, one of our group members who did the counseling for insulin did a really good job. We were less sure in the patient rooms where we had to make recommendations. I think this was a great learning exercise and showed us all the roles a pharmacist plays in patient care.”

Housed in the CAMLS Virtual Patient Care Center and both virtual inpatient and outpatient pharmacies, the venue provided a state-of-the-art backdrop for the transitions of care exercise. This facility provides an outstanding setting for the interprofessional program that pharmacy students take part in to hone communications skills with students from multiple educational tracks (medicine, nursing, pharmacy, and physical therapy). These exercises offer more realistic views of how interprofessional healthcare teams care for patients, especially those who require multiple visits. To ensure optimal care and reduce hospital readmissions, patients’ therapeutic plans need to be reassessed as their conditions change. All of these reasons reinforce the fact that students should train in teams because they will likely work in teams throughout their careers.

The concept is part of USF College of Pharmacy’s innovative curriculum.

“I decided to attend USF COP because, from the various schools I was exploring, it seemed to me that USF had the most progressive program and would prepare me well for my future in the profession,” Bonet said. “The simulation activity at CAMLS as a second year student is a great example of this.”

Story by Sarah A. Worth, USF Health Office of Communications

Photos and video by Allyn DiVito, USF Health Information Systems

But last October, she toured USF’s soon-to-open Center for Advanced Medical Learning and Simulation (CAMLS). Tour guides for the framed out space promised suites filled with state-of-the-art equipment for learning and practicing a range of medical procedures. They noted how the $38 million facility was the only one of its kind and that the 90,000-square-foot building would bring an unprecedented level of technical and teamwork training, simulation and competence assessment under one roof, as well as significant research and device innovation capability.

Lloyd Ohls and Hayley Suratt practice critical operating room skills at CAMLS.

So when USF asked her to join its CRNA program, her choice was easy, she said.

“CAMLS solidified my decision that USF is where I want to go,” said Marciano, who is currently a nurse at Shands Hospital in Gainesville. “I know the level of education I’ll receive at USF will put me way above other programs. The training I’ll get is incomparable. How can you even compare?”

Marciano is one of 33 students who will start the graduate-level course this fall. This CRNA group is the College of Nursing’s largest since it recently added 13 spaces to the 6-year-old program –a 40 percent increase from last fall. To help meet the demand, the College has added three new graduate level simulation courses and doubled its faculty.

A STRONG REPUTATION FOR QUALITY
In 2011, USF’s CRNA program received a full 10-year reaccreditation from the Council on Accreditation of Nurse Anesthesia Educational Programs. The program’s graduates have an overall licensure exam pass rate of 100 percent with a first-time pass rate of 89 percent. In addition, the program boasts an employment rate of 100 percent for its graduates.

Those milestones, coupled with the move to CAMLS, have pushed the recent surge in growth and meant a spike in the number of applications, said Erik Rauch, DNP, CRNA, assistant professor and director of the Nurse Anesthesia Concentration at the USF College of Nursing.

“Word is definitely getting out about the quality of our program and our connection with CAMLS has really put us in the national spotlight,” Dr. Rauch said. “We’re drawing a lot of interest and have seen a huge increase in the number of applications, especially from beyond our state. Nearly half of this new class of 33 is from outside of Florida, representing nine other states, as well as Guam.”

“The USF College of Nursing is nationally recognized for our cutting-edge research, and innovative educational programs,” said Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN, senior associate vice president for USF Health and dean of the College of Nursing. “We are proud to have one of only 112 accredited nurse anesthesia programs in the nation. With the recent move to USF CAMLS, our nurse anesthesia faculty and students have access to world-class simulation technology, including both civilian and military patient simulators, that establishes USF as the leader for nurse anesthesia education and training in the Southeastern United States.”

THE ADVANTAGE IS THE TRAINING
Although the young CRNA program has always had simulation built into its curriculum, its new home at CAMLS offers an entirely new environment with more simulation equipment offering greater specialization, including training suites with 20 anesthesia scenarios.

CRNA student Charlotte Symonds uses CAMLS simulation to perfect skills under watchful eyes of CRNA program Director Dr. Erick Rauch and fellow student Chad Koerlin.

“USF nurse anesthesia students train on the most advanced, high-fidelity patient simulation in the nation through CAMLS,” said Rita F. D’Aoust, PhD, ANP-BC, CNE, FAANP, associate dean for Academic Affairs, director for Interprofessional Initiatives at the USF College of Nursing.

“And through CAMLS, our students also have opportunities for interprofessional experiences that will give them a decided advantage when they enter their profession. Training with those additional scenarios will help our graduates feel very comfortable when they get to a real hospital setting and the OR. And it’s not just about the scenarios, but about building and practicing strong communications and teamwork skills that will truly make the difference.”

That is exactly the feeling of Michael Lupari, who is a senior in the USF CRNA program.

“Simulation provides the backbone for training anesthetic providers by creating real-life scenarios for rehearsing common and life-threatening problems without any risk to a real patient,” said Lupari, who was a critical care nurse in Fort Lauderdale before moving to Tampa to attend USF.

“As nursing and medical education changes its paradigm to a competency-based curriculum it has become increasingly important to evaluate ability using simulation. On a much larger scale, the public has been the major impetus for these changes as they demand more qualified and competent providers in the medical industry.  One way to meet these changes head-on is through the use of simulation.”

Joanna Bailey, Lloyd Ohls, Hayley Suratt, and Chad Koerlin build important team communication skills at CAMLS

Bolstering that training are three new simulation courses the College was recently approved for and will incorporate into its curriculum starting Fall 2012.

“These new courses complement our desire to offer a unique simulation addition to our anesthesia didactic courses that are already in place,” Dr. Rauch said. “They will allow students to apply everything they are learning in their courses to a simulation operating room environment prior to ever stepping foot in a real operating room. This is a huge benefit to promoting a higher quality education and preparing the most qualified nurse anesthetists upon graduation, which ultimately equates to higher quality care and patient safety.”

A HIGH-DEMAND JOB OPPORTUNITY
A nurse anesthetist is a nurse who has acquired graduate-level education for the administration of anesthesia and is board certified.

CRNAs practice in every setting in which anesthesia is delivered, from traditional hospital surgical suites and obstetrical delivery rooms to offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists, as well as with the U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities. CRNAs are the sole anesthesia providers in nearly half of all hospitals and more than two-thirds of the rural hospitals in the United States. Nurse anesthetists also serve our country by providing 100 percent of all anesthetics for the United States Army frontline facilities.

“CRNA’s are in high demand and carry a heavy load of responsibility, but they can expect to be compensated accordingly,” Dr. D’Aoust said. “There are great job opportunities, high autonomy and responsibility, and compensation.”

“Not only do CRNA’s provide more than half of the anesthesia in the nation, they are also the main providers of anesthesia care to U.S. military personnel on the front lines,” Dr. Morrison-Beedy said. “At USF, we have veterans and reservist faculty in our nurse anesthesia program who bring their knowledge and skills of military health issues to train CRNA’s in high demand by all the military services.”

Training nurses for all of these environments before they graduate is the differentiating factor for the USF program. And that difference comes directly from CAMLS, Dr. Rauch said.

“Almost everything we do in the classroom will be coupled with simulation training at CAMLS,” he said. “CAMLS is now THE greatest resource in the country for nursing.”

That fact is front and center for incoming student Marciano. She said she knows her choice to go with USF will help her stand out when it comes to finding a job because the program is that much better.

“I have several friends who are heading to CRNA programs all across the country,” she said. “After hearing about my decision and about USF and about CAMLS, now they’re all saying ‘I wish I had known about that!’ “

Story by Sarah A. Worth, USF Health Office of Communications.
Photos by Ashlea Hudak, USF College of Nursing Communications.

Under the bright lights of the surgical skills laboratory at the USF Health Center for Advanced Medical Learning and Simulation (CAMLS), medical students and surgical residents practice together.  Two learners to each life-sized operating room table, they focus on honing their suturing techniques using cryopreserved aortas.

In another surgical lab, course faculty evaluate vascular surgery fellows as they work through all the tasks needed to repair an abdominal aortic aneurysm, including threading a tiny catheter through a simulated femoral artery.

In the trauma operating room, another group of trainees gathers around a large monitor to observe as an instructor inserts a central line into an endovascular simulator.

Dr. Ian Nordon, a vascular surgery fellow from England, watches the monitor as he uses a simulator to work through some of the critical steps required to repair an abdominal aortic aneurysm.

“This place is unique,” said Dr. Ian Nordon, a vascular surgery fellow who works at a university hospital in London, England.  “I’ve never seen anything like it, certainly not in the United Kingdom system where most of our training is still very much on patients rather than on simulators.”

“Amazing,” said Dr. Erica Mitchell, associate professor of vascular surgery at Oregon Health and Science University.  “A facility with all this space dedicated to learning and assessment of competency is impressive.”

Drs. Nordon and Mitchell were among the participants for one of the first programs offered at CAMLS, a 90,000-square-foot facility encompassing three floors of innovative simulation technology and experiences with education and research excellence under one roof.  The Introduction to Academic Vascular Surgery course, which drew more than 45 medical students and vascular surgeons from across the United States as well as Canada, included simulation exercises and demonstrations on the first day.

Dr. Erica Mitchell observes as a medical student and general surgery resident practice suturing an aorta.

Such tools are needed both to measure the effectiveness of simulation training and optimize its use, Dr. Mitchell said.

Dr. Mitchell holds the rating instrument developed by the Association of Program Directors in Vascular Surgery to assess the performance of basic vascular surgery skills across different levels of trainees.

“The beauty of simulation is that it allows a medical student or junior resident to practice and make mistakes on a machine where no one is hurt, instead of on a human being,” said Dr. Karl Illig, director of the USF Health Division of Vascular Surgery, who co-directed the course with USF’s Dr. Murray Shames.

“But, there’s still a gap between simulation as it exists today and what it could be,” Dr. Illig said. “CAMLS will be a leader in determining how to make simulation training work as well as possible in improving physician competency and patient safety.”

Medical students practice ultrasound-guided central venous catheter placement on a "Blue Phantom" simulator.

While more research is needed to determine whether learning augmented by simulation training is superior to more traditional educational methods, simulation appears to help shorten the learning curve for acquiring competency in basic skills, said Dr. Jason Lee, associate professor and director of the Vascular Surgery Residency and Fellowship Program at Stanford University.

“Simulation seems to accelerate the process of getting trainees from novice to an acceptable skill level” before they begin operating on patients, said Lee, who is studying whether a simulation-based endovascular curriculum improves residents’ performance and clinical outcomes.

USF Health's Dr. Karl Illig (above) and Dr. Murray Shames (below) were course co-directors.

Dr. Pushpinder Sivia, a USF senior vascular surgery fellow who will graduate in July, has visited CAMLS several times since it opened.  In his experience, Dr. Sivia said, simulation is valuable because it allows surgeons to practice complex or new procedures repeatedly. “You can do dry runs in a (risk-free) place like this before tackling a complicated case in the operating room,” he said.

Whether someone is an inexperienced medical student or a physician with years of expertise who needs to update his or her skills, simulation “is the future,” APDVS’s Dr. Mitchell said. “With limits on time for residency training, the increasing emphasis on patient safety and unprecedented public demand for better health outcomes, simulation is becoming increasingly integrated into medical school training programs.”

Course participants gather for a demonstration of central line insertion using a high-fidelity simulator at CAMLS.

More than 30,000 health professionals from around the world are expected to visit USF Health CAMLS each year for education and training activities, from courses on advanced surgical techniques (using state-of-the-art simulators and robots) and interprofessonal team training, to research and innovation for the next generation of medical devices and simulation technology.

Medical students, residents and faculty gown up before entering the CAMLS Surgical Skills Laboratory for simulation exercises.

Photos by Eric Younghans, USF Health Communications