Cultivating Simulation Excellence: Inside the Success of Maryland's Simulation Consortium

In this episode of NLN Nursing Edge Unscripted, host Kellie Bryant from the National League for Nursing’s Center for Innovation in Education Excellence is joined by Sabrina Beroz, Monique Davis, and Jasline Moreno. The episode explores the Maryland Clinical Simulation Resource Consortium (MCSRC), a statewide initiative supporting simulation-based nursing education through funding, training, and equipment. Originating in 2015 with a $3.1 million grant, the consortium has expanded to include 30 nursing programs, standardized simulation tools, and professional development pathways for educators. The discussion highlights the importance of needs assessments, stakeholder buy-in, and continuous evaluation in sustaining and growing the initiative. Future plans include immersive virtual reality, objective structured teaching encounters (OSTEs) for faculty evaluation, and endorsement programs to enhance simulation education. MCSRC is a model for other states seeking to establish similar simulation consortia.

Learn more about the Maryland Clinical Simulation Resource Consortium by visiting their website: www.montgomerycollege.edu/MCSRC. 

Dedicated to excellence in nursing, the National League for Nursing is the leading organization for nurse faculty and leaders in nursing education. Find past episodes of the NLN Nursing EDge podcast online. Get instant updates by following the NLN on LinkedIn, Facebook, Instagram, and YouTube. For more information, visit NLN.org.

Transcript

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[Music][Music] Hello everyone. We're here today with another NLN Nursing EDge Unscripted podcast and we have  a great one for you today one that is of interest to me. So today's topic we're going to talk about  a very successful simulation consortium that we have here in Maryland and it is called the Maryland, help me out Sabrina, Maryland Clinical Simulation Resource Consortium. It's, it's a mouthful. MCSRC.  We're going to call it MCSRC. I'm going to have to refer back to that which I was familiar with quite a  few years back and you know having worked in New York and had a simulation Center I know  that we had tried to form a consortium so I know there's a lot involved in creating a consortium  and again, you've been around for a long time very successful so we want to learn more about how do you put a consortium together and tell us a little bit about your MCSRC. So I'm going  to start with, before we get into the discussion, I'd like you to introduce yourselves. So for those  of you who don't know me, my name is Kellie Bryant I'm the director of the Center for Innovation and  Education Excellence at the National League for Nursing and Sabrina, could you tell us a little  bit about yourself? Sure. My name is Sabrina Beroz and I was the original faculty lead for the MCSRC,  was full-time faculty at Montgomery College and then had moved on around 2019 to do work as  a sim educator and educating people inside and outside of George Washington University and now I am kind of freelancing and do do a lot of work with NLN as a simulation consultant.  Yes you do and I appreciate the work that you do with us at NLN. Jasline, I'm gonna pass it to you.  Sure. Hello everyone. My name is Jasline Moreno. I am the current faculty lead of the Maryland Clinical  Simulation Resource Consortium. Kellie, by the end of this podcast you're going to be able to roll it  off just like that. I don't know. I'm off to a rough start. But I had the privilege of working with Sabrina  at Montgomery College and she mentored me into the role of faculty lead. Okay and also you forgot to  mention you're also one of our consultants here at the NLN. I am, you're right. Yeah, I do get work  with Kellie and Raquel over at the NLN. And last but not least, Monique, tell us a little bit about yourself. Hello everyone. I am Dr. Monique Davis I serve as dean of Health Sciences and director of nursing  at Montgomery College and I'll just go ahead and start off by sharing how the consortium began. So  in 2014, the idea came across the state with our previous director Barb Nubile had worked with the  Maryland Higher Education Commission nurse support II program coordinator. Her name was Peg Daw and the  two of them had a conversation about the state of Maryland needing some guidance and support and  funding and equipment and materials for simulation to streamline it throughout the state. So in 2015,  we were awarded just a little over $3 million and those funds came from the Health Services Cost Review  Commission. So the state of Maryland is the only state in our country that requires hospitals to  provide 0.1% of their revenue to nursing education. Part of those funds go directly back to hospitals  to fund their education programs, nurse residency programs, things like that, their competency fairs,  and things like that. The other percentage of those funds are directly spent through the Nurse  Support II Program. And so at the time, there were 23 pre-licensure programs and we're able to submit  grant proposals and it's a competitive grant process. However, the Maryland Clinical Simulation  Resource Consortium, affectionately known as MCSRC, was a state initiative so the $3.1 million  that we received for the five years from 2015 to 2020 was a direct fund source for Montgomery  College to be the host site to offer simulation education and best practices and then simulation  equipment and materials. Over the first 3 years or so we did a evaluation or assessment across the  state with those 23 pre-licensure programs to see what equipment they already had. And Sabrina Beroz  was very instrumental as the faculty lead in going out and doing those on-site assessments as well as  developing the curriculum for the train the trainer program. So we call them simulation education  leaders and they have three different levels that they can complete. I'll let Sabrina and Jasline  talk a little bit more about the faculty training. But also in those three years, we provided funding  for the schools to receive an adult manikin, a birthing manikin, a toddler and a newborn  manikin so that all the 23 schools across the state would be streamlined. In 2020, we had  this wonderful experience called Covid and our world came to an immediate halt and  the need for simulation and the need for virtual activities just skyrocketed. So I'm sure Sabrina  and Jasline can talk a little bit more about the work that we did in that space and offering forums  and helping the schools to integrate virtual simulations and just offering faculty support  during that most difficult time because we were all trying to figure out how to get this streamlined.  Also during that time, the state of Maryland opened up some additional nursing programs. So to date, we  have 30 pre-licensure programs in the state. All of the schools have received a Pyxis machine. It was  streamlined across the state and now we're working on virtual reality goggles and the software that  goes with that. So not only are we providing what's necessary for education but we're also  innovating as we're going through these processes and integrating those newer technologies into all  of our schools across the state. So one thing I do want to share quickly is your question was how  did this even get started? It took a lot of buy-in. And Sabrina and I went across the state. We met  with all of our stakeholders. We created a steering committee where we had representation from all of  the areas across the state, so from our rural areas, from our urban areas, from our suburban areas. We  included community colleges and universities. We included private schools and historically black  colleges and universities so that we had equal representation or equitable representation across  the state to sit on our steering committee. So those were very instrumental things that  happened in the first three years. In 2020, we got a re-up for additional funds to go from 2020 to 2025  and so we called it MCSRC 2.0. And I'm very, very proud to say that in January we submitted  another grant for MCSRC 3.0. All right. Thank you Monique for that very thorough overview. And like  you said, you know, you are one of the only states that receives that funding to support your  simulation consortium. If only all the states had that same opportunity. So that is wonderful. Sabrina,  I know that, again, you were very instrumental in getting this consortium started. Can you tell me  a little bit about the initial steps that you took because it sounds like there was a needs  assessment that was done first in order to kind of progress this project. Can you tell us a little  bit about that? Sure Kellie. That's a really good question. And I think it's helpful for those  who will listen to this podcast and trying to start their own consortium what are the real  details that you need to do in order... so funding of course is prime. I mean, you need funding in  order to get it started, but after that, we, because we had the funding, our first task was to  do a needs assessment of the state and figure out what is it that they needed for education. I think  what's important going out to each one of those schools was not just say what we can do for you  but what do you need from us so that we understood their needs. And once we collected all  that data and all that information, we took that and developed this curriculum model for the state.  We realized that one size did not fit all that we needed to have these three levels that Monique  talked about so that we knew we had a novice level, we had a confident level, and then we tried to move  everybody up to a leadership slash expert level. So that was kind of the trajectory and   the thought. Now to measure that, back in 2015, you know, we did not have any needs assessment,  formal evidence-based needs assessment in order to do that. So we developed a tool called the  PASS tool so that stands for Program Assessment Survey for Simulation. We used all the standards.  We used the standards from accreditation, the INACSL standards, now the Healthcare Simulation  Standards, and we use at the time in 2015 the National Council came out with their guidelines  for simulation programs. So we put all of that together and then sent it out to simulation  experts like Pam Jeffries, Suzie Kardong-Edgren to just give content validity. We had to do this  so quickly in order to have a train the trainer program, so we did this in the late fall, finished  it in January, put the curriculum together, and then our charge was to have  in the spring, was to have the first train the trainer program, which we did. And those were kind  of those initial steps, really important was that needs assessment so that we weren't just providing  education to people who, say the more competent individual, we weren't giving them the basics and  I think that was key and important to the first step. When we went out ... in order to do  the needs assessment we interviewed all of the simulation coordinators, simulation directors of  all of the programs. So we wanted to have the right person who had knowledge of simulation  in each institution and we were nurse-centric. So I think as others look to start programs they  first have to decide, you know, is it going to be nurse-centric is it going to be interprofessional.  And what is it that you want, what's the purpose. And the purpose of ours was really to, really in the end was to provide equitable simulation education and equipment to all of the programs so  very forward thinking as far as providing that for the state of Maryland for the undergraduate  programs. We did add a few graduate NP programs as we moved on and moved forward. And Jasline will  talk about how she broadened it out further past nursing, nursing-centric. But I think in starting  consortiums, they probably need to know their real purpose. Is it just to do a conference every year?  Os it to do professional development? So they just need to make that decision. We did, also, which  I'm really happy to say we did an evaluation plan, which made a big difference for us those first few  years. We had goals, indicators, who was going to measure, what was going to be measured, and then we  were able to see what kind of impact we would have within the state. So that's kind of how we  started in a nutshell. And I'll let Jasline speak a little bit more to how we moved forward from those  very beginning stages. Thank you Sabrina. So I'll add-on. I think the key, like Sabrina had mentioned,  is continuously having an assessment of what our learners need. I think that's one reason we're  able to sustain and continue to grow. I just, you know, I'm starting to plan for this spring cohort  and we had over 80 applicants and 75 are going to be participating so to have those numbers 10 years  out really talks about our ability to sustain the program. And I think key pieces of that like during  the pandemic, you know, we realized we couldn't have in-person training so we pivoted quickly  and adopted some hybrid models that continues to be very popular with our audiences because we're  spread out across the state. I think that really has helped grow our program and sustain it. We  also realized early on that, you know, although we're nursing-centric we lean heavily on our  simulation operation specialists to continue to, you know, grow simulation within the programs. So  we've offered some training for that population and then really tried to build a community of  practice. That's, you know, something that might have not been the biggest intention early on but now  it's always on the forefront is how do we build this community practice for our educators because  although simulation is growing, there's still that feeling where you're the lone wolf, right.  Many times at your institution you have a few lone wolves at your institution. And so we have expanded. So we've created open forums. I just got off one earlier today where people just come together  and share wins, share challenges, innovation and it really keeps us connected. I see some of the  same faces over and over and it's fabulous. We do our journal clubs, which Sabrina initiated and I'm  continuing to do that and now we have folks that have gone through cell four who are publishing and  we get to have them as our guest and feature their article, which is amazing. We've implemented,  I think Monique this was one of your ideas, sim directors coming together once a semester  in person so that we can have some really open dialogue and talk about where we're going as  a state. So we've been able to really create this community within our state of simulationists who  have the same passion, who have enough opportunity to have dialogue, and really innovate together. We  expanded our curriculum. Initially was cell one through cell three. We've added cell four, which is  all about innovation and it's a yearlong journey where they kind of collaborate with each other  across the state from different programs and you know great things are coming out of that. So that's  some of the examples that we've been able to sustain and grow our entity here. Wow. That is a lot  of moving pieces. You've got a book club and training. And so I guess the question is, for a state or an  area that's trying to start out and start their own you know simulation consortium, are there any  resources, toolkits, or any reference for them? What would you recommend the best tools for them to  get started? So I think I think the first place to start probably are at standards. Just to see  what the standards are. We now have a professional development standard, did not have one until this  recent iteration of the Healthcare Simulation Standards of Best Practice. So I think starting  there to see what is professional development, what is expected, what do the standards say other. I mean,  there's so many resources. There's the standards. There's accreditation standards. Even if you're not  going for accreditation, you can look at those standards. The same for the CHSE. That kind of  brings me back a little bit because we do, I don't know if we still do that, but we were paying for  individuals who sat for the CHSE and if they were successful they were reimbursed for being  successful for achieving that. I don't know if we're going any further with the CHSE-A. We may  be, I imagine, in the future... And I'll let Jasline talk about that if in fact you're  moving in that direction. So there's a lot of resources. All of you simulation associations like  INACSL as well as SSH. So there's several places for them... resources to search for. Is there  anything specific about starting a simulation consortium, the steps to kind of creating one,  things that they should be thinking about, things to include. You know, I was going to say we had,  we're going to have a collaboration across the country for people who had started consortiums and  I think KT Waxman has done that in in California so she would be really a helpful person to talk to  because they've gone from their state all the way to other states on the west coast so that  would be person just looking for individuals and again the purpose. What is the purpose?  Mississippi has has a consortium so that would be a place to start. Tennessee has one and and again  a lot of it you know sometimes it just depends on their purpose and and how much they want to  do and what their funding is. We've been able to do so much in our state. Absolutely. And one other  thing that I'm just to dovetail under what Sabrina is sharing, we already had affinity groups in our  state. So the pre-licensure programs for our Deans and directors we meet quarterly and then for our  associate degree programs all of those directors meet monthly. So we had an infrastructure in place  where we already had some commonality and we were already having conversation and having people  together. But the big key that I was most proud of and when we were getting this together  was how we built our steering committee. That steering committee, even though we were looking  at the state as a whole, when looking at this large elephant that we needed to take one bite at a time,  we were able to build that steering committee. And as Sabrina shared, looking what your goals are, how  is this consortium going to benefit us all and what's the buy in or the what's in it for each of  the individual institutions. And so when they saw the training was a benefit and then the equipment  and the materials was a benefit, there was not a hard road to get that buy in. But once they were  onsite and had to get the education, the other piece of it for me was the continued evaluation  of the programs that we offered so that we could continue to make those improvements. So from year  one through now year 15, we've been able to build on this great idea because we have had that  ongoing evaluation. Excellent. And and like you've just demonstrated, you know, you're more than just  providing a training for simulationist. You're doing so much more. You're providing resources  and equipment and not just a one and done type of training. You're actually helping individuals  to you know to advance their simulation training through all these different levels. So one question  I have for you is what's been your impact as the MCSRC...I'm getting better...what has been your  impact, not only for the community colleges, for the simulation field, but just in in general? So I  can speak a little bit to that because during my reign, while when I was there, we did evaluate  based upon that evaluation plan. We did evaluate somewhat a little bit kind of high level as far  as what were they implementing within their programs. And what we found was that they had  started to have the based debriefing methods, they were using a theory to underpin their simulation  program. And if you look at Kirkpatrick's levels of evaluation we looked looked kind of far out at  that level four to see if we had an impact on click and the data that I had collected found  that 70% of the schools that were involved in the MCSRC, now I know there's other other pieces of NCLEX success besides the MCSRC, but 70% of those schools did improve the NCLEX scores that were  involved in the MCSRC. So I think that's a pretty big impact because the purpose of the funding  is to increase the number of graduates and to increase the number of faculty so that in the  end we increase the workforce. And if we can do that and we can show that, you know, through, you  know, them being successful in only one attribute, but, you know, successful in NCLEX then we know that  we have increased the number of nurses who are graduating. Excellent thank you for sharing it.  Jasline, you look like you wanted to make a comment. Yeah, thank you for starting us off Sabrina with  that. So I actually am in my PhD program, the SCORS tool developed by Dr. Kim Leighton and her team,  and just got my data analysis and I'm kind of reviewing that. So I'm living in that you know  data right now and what I saw across the state is that most people are mostly ready to adopt  simulation and I think that's because of the work that we've done. I don't think back when MCSRC  was initiated, so we never really had that opportunity to look at that big level and this  kind of let me know that we've really made an impact here. Eeveryone from administrators to sim  team faculty to sim technicians to clinical instructors. The average, you know, response was that  they're mostly ready. So that really shows that they have been exposed to simulation, they  feel like they're ready. They have the resources ready to adopt so that was one big thing. And then  I just feel more people are open to innovation. I was talking to Monique earlier in the semester  and she was talking, I'm not going to use the word change anymore, it's going to be innovation. Am I  quoting you right Monique? And I think folks are open now, you know, I think they see it as a good  thing and they're not, we know that adoption of any type of new technology, you know, takes time and  it's very it's a very slow process, but I think we're making some progress there with with our  folks because we've done so much with them over the past 10 years. So now they're almost like, well  what's next, you know? I was gonna say that's a perfect segue to my next question, which is  what is the vision and the future for MCSRC? You've done such a great job with everything that you've  been doing this past over a decade. What's next? So I want to start by saying it's just been  a pleasure for all of us to work together and to have the buy in from the stakeholders and it's not  just our faculty and staff at our institutions. It's our hospital partners as well many of our  hospitals have simulation centers so they're able to send their staff for training with us and all  of this all of the hospitals in the state of Maryland have nurse residency programs so  that's another area where we have a consortium. So I think it has been extremely beneficial for us to  say, okay, these are the impacts that we've made in the past now where are we going next? So last year  we had some overage in our budget and they never want us to send grant money back so they would  like for you to spend it. And Sabrina mentioned how we were covering the cost to reimburse people for  their CHSE but we were also able to give them a a flat out stipend for receiving the CHSE and I  believe we gave them I think $1,500 Jasline, So that was like a huge award. So not only did your  CHSE get paid for but then you got just a stipend in because we were super proud of your success. And  so when you have projects and people are doing really well with their work that they're doing  you want to reward them so we advocated in the future to get to increase the honoraria. So the  faculty received $200 for coming to participate in the training. So the training for them is free  and then they were compensated for their time in coming and we advocated to increase from $200 to  $600 for their time. So that's just one thing that we've done to move forward in the future.  Integrating the immersive virtual reality is a huge piece of the puzzle. So in our 3.0 version  of the grant, we have additional funds built in for equipment replacement for the goggles as well as  the software. And then we've integrated additional training and support for not just the nurses but  the nurses who are working in the technician type of roles. Jasline, do you want to talk any  more, talk a little bit more about the as OSTEs? Yeah. Yeah. Yeah. So you know for the past 10 years  we've done a lot of education and we have over 400 educators in the state of Maryland who've  gone through MCSRC training. So I felt like the next thing would be evaluation. You know, we need  to bring them back and kind of do some type of evaluation. So I've done a lot of research and work  in OSTEs, objective structured teaching encounters, which are being used in medical education to  train educators in this role. So I would love, that that's our next big project that we're going to  be embracing over the next 5 years is building OSTEs and then bringing our educators back either  virtually or live to go through them and then see where their gaps are and that might require  additional curriculum. You know, we might realize we need a refresher because folks went through  in 2015. So I think that's going to really help provide us with the information in terms of how we  move forward so I'm really excited about OSTEs. I'm looking at you know if we could have the expertise  with AI exploding right now, AI generated learners and do it you know virtually because logistics  is always challenging to bring people back. So we're exploring that. I did have an opportunity  to pilot an OSTE within MCSRC last semester and it went very well. We also talked about really  building an endorsement for our programs within Maryland. You know SSH accreditation is there,  which is sometimes a lofty goal, so we're looking at INACSL's endorsement program. And you know, can  we really help champion our programs to be able to go through that process and help supplement  in terms of finances, support them through it. So I think over the next 5 years that'd be  exciting to really get our programs through that endorsement through an INACSL and then  maybe get them ready for accreditation. So those are some of the big things in addition to the VR  that we're looking at for the next five years. Wow. And you left off one more important thing. Go ahead Monique.  We want to offer some training for the schools as they're starting to build their standardized  patient pools. So we may not be able to supply them with funding to support hiring standardized  patients, but we do want to offer a curriculum and a framework by which if a school wants to  start out creating their own standardized patient pool that they'll have guidance and support to do  that. Oh my goodness. We have run out of time but I feel like we can go on and on and on. I just want  to say congratulations. You have a very successful simulation consortium that I hope that  other states have the opportunity to duplicate and I'm even amazed at some of the new projects  that you have coming up. We have to invite you back for another podcast for the OSTEs because we want  to hear more about that, but I want to take this moment just to thank you thank you for sharing all  this information about your wonderful consortium hopefully this will be very helpful to others who  may be just starting out who are thinking about starting their own consortium because you really  are a model and an excellent example of of what can be done with a simulation consortium. So thank  you Sabrina, Jasline, and Monique for taking the time out of your busy schedule to come on to this  podcast. We greatly appreciate everything that you shared with us. Thank you Kellie for having us.[Music]