GSS2022 Sim Wars Preview with Dr. Rod Fontenette

How do you do medical Sim Wars in a pandemic?  Listen to LtCol Rod Fontenette talk about creating a virtual Sim Wars the past two years for GSS.  We are excited to welcome back our top teams from each service for the in person final round at GSS 2022 in Orlando this April 8-10.  

Join us for the best military emergency medicine conference in the world. Amazing speakers, world class labs, Sim Wars finals, and the best networking in the military medical services.

Register today! https://www.gsacep.org/aws/GSACE/pt/sp/conference_home_page?utm_source=Realtime+Email+Digest&utm_medium=Email&utm_campaign=website

Transcript

Torree McGowan: 1:01

My name is Torree McGowan, and I am part of the conference committee for government services ASAP. And we are planning government services symposium 2022, we are super excited to be back together in person. Last year, we had an actually a really good virtual conference. But there is nothing like sitting down and telling old stories. Which is very obvious, because I've just spent about the last hour chatting on zoom with Rod Fanta net, who is one of my very favorite people. And he and I have been talking about all of the wonderful things about deployments and an opportunity to serve this country. So he has also been really involved in creating the GSS this year, and I was hoping that you would share, first of all, who are you Where are you and what's happening in your life? And then tell me about what you've been doing for GSA Sep?

Rod Fontenette: 1:56

Yes, definitely. So right funds and that, glad to be here tonight. So thanks for inviting me. So I am one of the air forces for Emergency Medicine Residency Program Directors. I'm stationed here at Travis Air Force Base in lovely sunny Northern California. And I work clinically and yes, it is our clinically at UC Davis Medical Center. The Air Force is essentially leased me to UC Davis. It's actually two of us, as Lieutenant Colonel Rory Stewart, and I, the two APDS are associate program directors for the Emergency Medicine Residency Program. We have a total of 15 in residence was 16. I guess right now, military em residents partnered with UC Davis 60 residents total. So yeah, so it's been here since it's a one of the Air Force's newest residency programs. We started the summer of 2017, which is when I PCs here from Cincinnati, I was one of the sea stars cadre there in Cincinnati for three and a half years. And then I came here, so it's been absolutely amazing. But as you and I were talking about before, my time in the Air Force is coming, unfortunately to an end, as I'm retiring this upcoming summer, so one July, I'll be transitioning to the civilian side of things. So I will have been in and served my country for 21 years total. So it's been an absolutely amazing ride right to go from airman basic fighter net. to Now here I am retiring as Lieutenant Colonel physician Fontenot. So it's been absolutely amazing. And it's been a great ride. So and with my residents, and all the other residents that I see coming up, it's going to be left in very capable hands. Right. So it's very exciting times. So what am I doing? Yeah, so it's been it's been great. And my residents are absolutely amazing. I love them. So they're going to do great stuff. So what am I doing now for GS a second GSS. So I'm doing the sim wars competition, like the chair of the SIM wars committee. And so we did a virtual similar as last year, which was unique in and of itself. And I must say, right, so I have to give kudos to all the programs that participated last year, because they did something that was unique, right, so having a virtual sim was competition. And so what they did was they actually ran the Sims at their home institutions, recorded all of them. And then we showed them doing the civil wars competition, right. And so it was it was it was fun. It was a lot of fun. It was challenging, to do virtually but just like everyone else had to do, because of the pandemic we had to adapt. Right. And as you know, we always say in the Air Force Flexibility is the key airpower with that was no different than last year with the s'mores competition. So and So this year, fortunately, we have an in person civil wars competition conference in Orlando, the very first portion of the conference will be done virtually. So the I guess the first round or the semi finals round, will be done virtually you grow, record the initial Sims at home, just like we did last year. And then the judges who will be the three consultants, right, so the Air Force, the Army, the Navy consultant will be the judges, and they will pick a team to represent their service in Orlando for the life sim wars competition. And same thing, right. Yeah. So somebody asked me amazing, right, so yeah, so I've already have tapes coming in recordings coming in from the different programs, right. So from the army side of things, we'll have samsi and mamsa. Madigan Army Medical Center will be the two representing the army. On the Air Force side, we'll have Travis Air Force Base, David grant Medical Center slash UC Davis Medical Center will have the team out of Nellis Air Force Base. And then we'll have the team out of Wright Patterson Air Force Base. And on the Navy side, we'll have Portsmouth and the program out in San Diego. So it's gonna be a great time, right? So we'll have all these programs competing against each other, but there could only be one right so there'll be crowned. Yes, yes. Yes. Yes. So and I'm very happy to say right there, my team was actually crowned the champion. PN have the 2021 GSS and was

Torree McGowan: 6:05

compact they were. And they did a great job. They were awesome.

Unknown: 6:09

As my team, of course they did, right so my residents. So a title to defend, right? We don't take this lightly. Right. And so we recorded our virtual session this past week. And I think they did a very good job, right. And so the judges, though, they will decide, and we'll see who represents the Air Force in Orlando. So I feel very good about my team this year, just like we did last year. So it should be a lot of fun. And I'm excited. So and again, thanks to all the folks that are participating, and all the POCs out at their respective programs, they happen to put this thing together, because this is a, this is a big lift, right. And so it requires everyone's to kind of carry, carry the load and carry the burden. And I think the POC is that each of these programs has done a great job in helping to write the Sims, helping to run the Sims at their home institutions. And then I think plus all of us are going to Orlando to kind of help put this thing together in person, which I think is gonna be a lot of fun. A lot of fun. So, so we'll see about so yeah.

Torree McGowan: 7:06

So tell me a little bit more, because obviously, we are all reinventing the world right now as things are strange. And we are figuring out new ways to do this. So I actually haven't seen anybody else doing a virtual similar apps. Did everybody do the same case? Or did everyone create their own case?

Unknown: 7:27

Yeah, so the team and I, the committee, and I, we like we wrote the cases, right? Because so that when you're doing a sim competition in person person, it's a bit easier, right? Because it's easier to standardize everything because you can go environment, right? You control the cases, you control the flow of the cases, right? And everything can kind of head in the same direction. So it's everyone has the same supplies, right? The timing is about the same, the scenarios, the wording of the scenario is the same, because you kind of controlling it. All right, when it's virtual, right. And you have I think, last year, we had nine programs, right? It's, I think we had eight or nine programs. So having all these different programs run these scenarios, like they each take on their own like flavor, right? So it makes it a little bit challenging, right. Like, I may run a case, right, that may be 20 minutes, right? So for instance, it's a TBI sim, my TBI said maybe 20 minutes, right? Madigan may run the exact same sim that maybe 25 minutes postgame. If we do the exact same sim, that's 35 minutes, right? And it's just like, how do you keep getting longer? What do you add? was different? Right? And so it makes it really hard to standardize it right? And then when you record it, like, I like for the audience to feel like they're part of the scenario, right? So I like for the audience to be able to see the vital signs, right and see all the data that GRC, right. And so being able to record it and show that information, so that way, the audience knows you're not just doing it, because they like go, Well, what's happening now, what are they doing? Now? Why did they do that? Right? They don't have, they don't have the hemodynamics in front of them, like you would in some place to be like, Oh, Baba hypotensive. Let's see how long it takes them to catch that they're hypotensive. Right. And so all those things are a little bit tricky when doing it virtual, because again, I can't control the way all the information is put out there. So but I will say that all the T's because we met like weekly right before folks started recording. And so we were able to kind of hash through like, at this time, like a two minutes into the SIM, this should happen at seven minutes into the SIM, if they haven't done this, this should happen, right? And if they do, because another thing with Sims is that you may plan for the learners to do one thing and then the veer left. Right. And so it's like, okay, well, if they completely go off, they go off the rails, and they do this, how to cover the seminar given the answer, right? And so, again, it's easy if I'm controlling it, but not so much if you have all these other different like people controlling it right. And so just being able to standardize that standardize that. And I think another thing that helped us out tremendously, virtually, is that everyone that like all the POCs of the programs, they wanted to be there, right? And they all had done stuff in Sims, right? So they kind of knew the language of what we're trying to accomplish right with Sims. The exact same thing is holding true for this year, right? Like Jillian Phelps, right? So she's like, she's on it, right? They know what they know how to run Sims, I have Danielle Whitman out in San Diego, right? They know how to run Sims, right? And so it makes it really, really easy. If we all come together, we plan it out. We've kind of run through the cases quite a bit. That Okay, let's make it happen. Right. And so then they call out, and they make it happen. And it's an amazing product. Right? The thing is, though, is that you it still seems it is still being recorded and still virtual. So one of the teams contacted me, she was like, Hey, we recorded our session. The session went great. But then we listened looked at the video, and there was no sound like Ah I'm so sorry. That sounds painful. Like yeah, There was no sound at all. And I was like, that's kind of hard for me to judge. Like, she was like, yeah, now I have to because you know how hard it is to get all these residents together at one time to go over and record the Sims. She was like, now I have to find a completely different team. I can't use it.

Torree McGowan: 11:21

Because they already know.

Unknown: 11:26

So we recorded I was this past, I think, Tuesday. And I like right before we started recording like the guy Aaron who's like an amazing guy with Sims. And he does amazing like videography and like, like putting stuff together to make it look good putting the vitals so that everyone is just he does an amazing job. Right. So as we're getting ready to call the team, and I was like, yeah, so it's about sound right? But make sure you have really good sound and

Torree McGowan: 11:55

your iPhone.

Unknown: 11:59

You gotta have sound please do cuz I gotta get them back all together again. They're gonna kill me. So maybe you have to have some. Ah, but yeah, but it all it's all coming together nicely. So he should have the video to me here soon. Madigan just sent me their video a few days ago. So yeah, so thanks, samsi. With Jimmy Webb, and those folks, they're about to record there. So it's like the teams have just been doing an absolutely amazing job. So and it's all coming together, right? And the watch it all come together and be like, we pull this off, and we're even in the same place. It's absolutely amazing. It's just great to work with something that you and I was talking about before, right? Like all the different teams, because you have Army, Air Force, Navy, all coming together together to make this thing happen. And I think that's the uniqueness of GSA set, right is that we're so used to like, just making things work no matter where we are. And that's the essence of what's happening with symbols, right? We all come together and just make it work. Right? I'm working with the army and working with the Navy, right? And we all just speak the same language, right? Because these cases are meant to be kind of like enough for forward resource limited right? environment. It was like, Oh, I speak that language. Let's do resource limited, right? It's every day for me, right? Let's just make it happen. Right. And that's what we do with symbols. And it's

Torree McGowan: 13:12

well, and I think you're pointing out something that's really important too, because I mean, we're doing this for a conference. And and it's fun and interesting to watch that happen. And it's kind of fun to have the competition between the residents. But in a year or two, those residents who are going to be out there forward in these bases. So having them have an opportunity to see those types of environments. And to think through those resource limited areas is a tremendous training tool for our residents. Yes, but the other thing that's really interesting, as I'm listening to you talk about creating this and reaching across all of these miles. I'm curious what you think's going to happen in the future of training medics and training, not just emergency medicine physicians, but all of the rest of our team that is so important in that entire chain of evacuation. Because you and I were talking earlier about how important it is that we are all playing off that same sheet of music, and that, that leveraging that simulation that maybe, you know, maybe a small base doesn't have a simulation team, because, you know, the the hospital that I work at on the civilian side doesn't have sim, but somewhere else that does if they're able to support that. And to do that virtually the creation of the cases and the knowledge that is part of the creation of a sim curriculum is huge. Right? What an absolutely fan fascinating area that you guys that you are starting to lean into that maybe you didn't even realize, yeah.

Unknown: 14:43

Yeah, I know. Right. So this is it is challenging, right. And so And the beauty is that some like it's similar and of itself I love right, because it allows us in a controlled, safe environment environment to work through a bunch of these issues. And getting seems like for instance, when we recorded our sim Tuesday, we had a D nurses, like from our EDI plan, the nurse role, right? So it gets us coming together, right. So it adds a bit more realism to the case, right, versus taking the resident and putting them in the nurse role where like, I don't really know what to do in this role, because this isn't what I normally do, right? But it allows to add realism by saying, Okay, this is the notion of department and this is how this looks and how do you guys work together? And then we debrief right. And so one of the things that we did in this debrief session, after I recorded on Tuesday, was I asked the nurses like, Well, how do you think your weight and how do you think it went? He's like, the closed loop communication was awesome, right? And so that's the thing, like, you don't even think about it, but that's what you're doing, right? It's like, Hey, I'm gonna give 15 Mike's offense, no, okay, I'm gonna give 15 Mike's offense and just kind of working through that thing, right? Because the way we train is how we fight. And so that's what SIMS I think, does it get everybody together? It allows us to work through these things in a safe environment, and then go out and deploy whatever we have to deploy to around the world and fall back on our training. Right. And so, and that's the beauty with Sam's that's what I really doing this. And another thing that I like was seems to especially with what we're doing with GSA seven, some was competition is that is getting everyone out of their silo, right? It's getting the Air Force out of just training with the Air Force getting the Navy out of just running the Navy. And the same thing with the Army is putting all of us together, right. And so all of my deployments, right, I've been deployed with other services. Right? When I was in Afghanistan, my very first deployment I was with, I was with dustoff, right? I was the 1/10. I was with the at first I was with I was when I was 10th. Mountain, right? I was with all these people, and I was the only Air Force person on this file, right? And so learning to speak that lingual the lingo was extremely important, because I'm not used to doing things the way the army do it, right. My deployment when I was in East in the Horn of Africa, and in Djibouti, I was with the Navy, right, so I had to learn to speak the lingo of the Navy. Right. And so I think that's the beauty of GSA service that we interact with all of these different folks that we normally don't see everyday on Travis Air Force Base, right, David grant Medical Center, right. And so it gets us all together to share experiences. And it's okay in our enrol care platform. So many different people will touch this patient as they move through the system. Right? It's nice if we all can train together, right? It's nice if we are considering the same resources, right from the very beginning of this thing, because we get to speak the same language and train and fight the same way. So and I think that's what the sim was competitions are doing is like, Okay, this patient has x, how would the Navy handle this? If they were far forward in their environment? How are the army handling how the Air Force handling? And so when we talk about these cases, right, because the Sims and of itself allows us to work through things, but I think the money of Sims is the debrief, right? That's where the education comes in. So when we do the debrief of The Sims at in Orlando, what I hope and see happening is the Navy reps will speak up and be like, well, you know, for for for us, we would have handled this differently. Because of x, the army will speak up right in the debrief and say, Well, you know, in the army environment, it would be this. And these are some things that we need to think about. Same thing with the Air Force, right. And so these residents are they're just kind of soaking it all up. Right. And so, a lot of this stuff like for my very last deployment, I was in Germany, and one of the things I'm going to talk about some given a 30 minute talk at GSS. What is I'm going to talk about is how do we move patients right? In this type of environment, right? So we train for certain things, but then the life happens, world happens, right? And we and then Afghanistan happened, and we had to evacuate a lot of really sick kiddos, right? So how do we flex to be able to pivot and fly these kids? My smallest at two was a six. So I transported a kid that was two and a half years old, but nine kilos, right? That six is not going to work for that kid. So how do we how do we flex and accommodate this right? And so that's why we all have to speak the same language and be able to lean on one another when these things happen in GSA cell brings us all together. So we can tap into resources. Right. And that's, that's the beauty of it. And that's what I love about it. So

Torree McGowan: 18:58

I am 100% with you. And that's one of my favorite things about why I've been involved for as long as I have and why I'm still involved. And you know, you and I have shared our our worries about after we retire what GSA SEP is home, and it always will be. So unfortunately, you guys aren't getting rid of me salary.

Unknown: 19:20

But you're

Torree McGowan: 19:24

in San Antonio, I got to know the army pretty well. So doing that residency that was joint was was huge, and understanding how the other side works. But having had the opportunity to get to know some Navy personnel and to understand those unique challenges, and how you're exactly right, bringing it back to how do we work together as a patient advocate? And how do we take the very best care of patients because when I was in Afghanistan, we were taking patients from Kandahar who weren't being cared for by Navy, coming into Bagram, which was an Air Force hospital, sending them to alarm C which is mostly staffed by our VA that they're being cared for, you know, Army and route to US Air Force and route to alarm See, how does that all work. And then we usually handed back off to an army hospital with an Air Force in between. And one of the we talked about it earlier, one of the reasons that works is the CPGs. Having those clinical practice guidelines to say this is how we do the business of medicine in the military. But taking those CPGs and actually working through them together and saying this is what my resource constraint is. And this is why this makes it difficult. Or this is how we approach that. I absolutely agree with you there. It's so important. And I think Linda Lawrence was the one who shared the story about being at the GME selection board and watching all of the different specialties you know, they'd sit sit in their little air force, specialty and army specialty and navy specialty and sometimes they'd talk amongst them. And then there would be this group in the back, which was a purple group. And it was all of the different services all intermix together. And that was emergency medicine. And that's the power of what GSA set brings is because we got to know each other through GSA CEP. And so they don't be sitting in the back together, talking about emergency medicine, not air force, or army or navy. But how do we make that military emergency medicine work better. And I think that this similars is such an amazing way to bring that together and make it a little bit more accessible. Because right now, I mean, let's be honest, the money isn't exactly flowing from the central funding, and we're still in continuing resolution. So they're still paying paychecks. I don't know, at this point, they've messed up my pay again, because I've moved units with my guardian. And so I haven't been paid in a couple of months. It's guard, thankfully. So it's not nothing paid for a couple of months active duty. But you know, it's just what happens in the military. Having that opportunity to do this virtually so that people can be involved, even if they don't end up going to Orlando, just that experience is huge, and making that more accessible to more places. So even if you can't travel, to have that experience, and then it's also a little bit easier to get the the boss to pay for it if you're like, but I'm the champion. I'm representing the military. I'm representing the Navy. You gotta send

Unknown: 22:35

me you gotta send me Yes. So essentially exciting to see how many teams show just to have an act, I tell the residents, right, I mean, coming to GS s and attending the conference, as a great way for you to kind of one getting some amazing CME, right, because all the lectures that we're going to be having is gonna be on military specific topics, right. And so just to see, as a resident, what you're heading into, I think is absolutely awesome, right? And the network in there, right? It's absolutely amazing as well, right? Because you will be there with the Army, the Air Force, the Navy, and folks that you don't have exposure to on a regular basis. And then you hear some of these war stories, right. And again, seeing what it is that you go through that you're heading into, right, just hearing about Seacat, and all these different things about emails, and what is that and it's just, it's just a set, right brings all that together. And that's what's so so fun about it. And why asked us to stay around and stuck around for so long and plan on sticking around much longer, right? Because it's the networking, right, and just knowing about what's going on is great. And the consultants are there right at GSA said, or GSS, kind of talking about the lay of the land and write the environment for the Air Force, and Brian for the Navy, the violent army and where we're headed, and just kind of again, see what things are going. And it's just, it's exciting. And that's why I love attending the conference. So

Torree McGowan: 23:56

it's really a lot of fun. And, interestingly, this far end of my career, because I remember going and I love to talking with the consultants and that was huge for me. Now I'm old. But one of the things that was really awesome for me through GSA SEP is when I was looking at getting out and going into the guard, I had Julio, the rate that was available to say, Okay, what is the garden look like? Because there's a whole nother opportunity to continue serving. And that was amazing to have that network built in. And to have access to those. ACEP leaders, the, you know, we have the current president of ASAP and the president elect of ASAP who are primary or secondary members of GSA Sep. How many state chapters can say that?

Unknown: 24:47

Yeah, yep.

Torree McGowan: 24:49

There's a tremendous amount of horsepower and going to GSS. It tends to be a fairly small conference, which some people say is Oh, it's not that huge. But I actually really like these smaller conferences, because you have so much opportunity to get to sit down and have a cup of coffee with these people that you've never had a chance to interact with. I have to say, I'm going to totally fangirl with rich lava tan and the whole airway thing.

Unknown: 25:18

Yes, he's gonna be there doing the airway course, which, you know, I have not gone to his airway course. But

Torree McGowan: 25:24

I never have either because I can't afford it. Right.

Unknown: 25:29

When I read, it's amazing. So I'll definitely be there for that. We're gonna have ultrasound there as well. So

Torree McGowan: 25:35

you're and I'm so excited about that one, too. Yes, ultrasound. The ultrasound. This is an embarrassing story, but I have to share it. So 2018 was the 50th anniversary of ASAP. And I put together the history of military emergency medicine project. Oh, it was so much fun. And I'm such a history nerd. It was so neat to see all of this come together and so Many residents who are now attendings out there doing amazing things were part of that project and brought that together, which by the way is going to be, we are donating all of that to the National Museum of health and medicine. And so that's going to be part of their permanent collection, which is amazing. But one of the things, or one of the pieces that we did, or one of the focus areas was the history of portable ultrasound, because that all started with the military. And Sonosite was incredibly gracious to share with us one of their SonoSite 180s. And then a PDF printout of the actual DARPA letter. That was the grant that gave them the please develop, you know, a portable ultrasound unit for the, you know, for the military. And anyway, the SonoSite rep said, Okay, we'll give you one of those old Sonosite one ATS to display and you can use it as part of this, and then it will donate it as basically a museum piece. And they drop it off with me and I kind of sat there and I said, Wow, this is what I learned

Unknown: 27:08

to use as a resident. This is what I trained on.

Torree McGowan: 27:13

Wow, it is solidly a museum piece at this point. My, my ultrasound skills need a little bit of polishing. Andrea's so every time I work with her, she's so kind and she's such a lovely, absolutely lovely human. And she's always just like, let me help you. So I'm really looking forward to my skills getting a little bit better, because they are pretty sketchy, that little tiny screen that was, you know, like the size of an ATM screen. So that's where my skills are and helping they're going to get a little better.

Unknown: 27:52

Yeah, so and you know, ultrasound is crucial to what we do downrange, right, because we don't have like, there's no CT scans at like row twos, right. So most of these places have only ultrasounds plus or minus a portal chest X ray if someone there knows how to use it. So ultrasound even see cat, right, all Seacat teams have ultrasound machines, right? So ultrasound is huge. And what we do in in round care. And so yeah, so having it at the conference, and folks like Andrew Wright, who can sit back and talk about like how to clinically use this thing and apply this thing in a downrange setting in our unique environment is crucial. Right. So So yeah, so having that there but trying to get reborn, but we're going to be discussing reboa there because again in a fall forward setting, right. And Ray can definitely talk more about this than anybody else, right? Because she's probably thrown in more boys than any em die in the US. Right? So having these folks there, not only talk about how to use the thing, but talk about like real world, like, I use this thing down range, right and make it clinically relevant is huge, right? And so we'll have a boy there a GSS, as well. So it's just all these different things. And then someone like the keynote speakers that will be speaking at GSS I think it's an animal and the Navy, that'd be there's going to be talking as well. And it's just the amount of power and resources that they pour into GSS to make this a very valuable conference, I think cannot be overstated. So and then I went along to be there. Right. So I mean, when I first met Linda Lawrence, I was like that spindle. Right? Because I was like she was a set president and she's in Jesse seven is just like all these folks that are there to learn from. It's just It's absolutely amazing. So yeah, so come to the conference, it's gonna be well worth it. I promise you. Well, well worth it.

Torree McGowan: 29:37

Well, Ron, I have had so much fun talking with you today, and I cannot wait to buy your drink in Florida. I hope everybody joins us April 8 through the 10th in Orlando, Florida. We are at the Embassy Suites. And if you click on the link in the show notes that will take you to the registration page. The other thing that we didn't talk about at all, but there's great CME and it's actually some of the cheapest CME you will find out there. All of the labs that we've just been talking about the airway lab, the ultrasound lab and the operational skills lab are included in the price. So if you want to take the airway course from merch Levitan, like I said, this is, this is how it's fitting into my budget. And I cannot wait for the opportunity to to be with these folks. So please join us and again, Rod, thank you so much for all of the work that you've done creating this amazing sim program, and for your incredible contributions to this chapter. Because you just like all of the people bring so much amazing stuff in.

Unknown: 30:46

They had to be come support your favorite team and cheer on your team at GSS though it'd be much appreciated, so come cheer him on.

Torree McGowan: 30:55

I'm not sure who I'm cheering for more because that's where I grew up.

Unknown: 30:59

That's Travis Air Force Base.

Torree McGowan: 31:01

That's where I separate it out of. So Travis.

Unknown: 31:04

Yes. Come on. I'll bring you a t shirt. We have 10 T shirts. We're the winners. Don't forget that right CMC and all these other programs that going down. So come cheer us on.

Torree McGowan: 31:16

CMC Navy, you guys are hearing this and you want to come to this podcast and talk some trash. Email me and we will be happy to get you on here and talk some trash. So Ron again, thank you so much for your time and I can't wait to have a chance to raise a glass with you.

Unknown: 31:37

Let's do it. Let's do it. Can't wait to see