Ep. 16: Frontlines in Pediatrics: Simulation, Innovation, and the Future of Child Health

In this episode of the UB Medicine Podcast, Dr. Allison Brashear, dean of the Jacobs School of Medicine and Biomedical Sciences and vice president for health sciences at the University at Buffalo, explores how the future of pediatric care is being shaped through innovation, collaboration, and a deep commitment to improving outcomes for children and families.

Joined by Dr. Benny Joyner, chair of the Department of Pediatrics at the Jacobs School, and Dr. Lucy Mastrandrea, chief of pediatric endocrinology and diabetes, the conversation highlights how advances in technology, clinical care, and medical education are transforming pediatrics across Western New York and beyond.

Together, they explore the evolving landscape of pediatric medicine — from simulation-based training for high-acuity care to technologies transforming diabetes management. The discussion highlights how innovation is improving outcomes while enhancing the patient and family experience.

The episode also highlights the importance of integrating research, care, and education into cohesive, family-centered models. Drs. Joyner and Mastrandrea discuss how collaboration across UB, UBMD Physicians' Group and Golisano Children’s Hospital of Buffalo — along with strong community partnerships — is strengthening pediatric care across the region.

Looking ahead, the conversation addresses the critical role of data, technology and workforce development in shaping the next generation of pediatric care. From predictive analytics in critical care to new approaches in training future clinicians, the episode highlights how UB is positioning itself as a leader in pediatric innovation and discovery.

At its core, this episode is about reimagining what’s possible in children’s health — and how science, collaboration and community-driven care are coming together to build a healthier future for children in Buffalo and beyond.

Transcript

SPEAKER_00 0:03

Hello, everyone, and welcome back to the UB Medicine Podcast. I'm Dr. Allison Bouchier, the Dean of the Jacobs School of Medicine and Biomedical Sciences, and Vice President for Health Sciences at the University at Buffalo. Today we're talking about the future of pediatric care and how innovation is shaping the way we care for children and families, both here in Western York and across the country. Pediatrics is uniquely a dynamic field. It requires us to not only think about the children in front of us, but also about lifelong health, family systems, and the environment in which children grow and develop. And increasingly, innovation in pediatrics is happening at multiple levels. Through technology, we all have our watches, through new models of care, through research, and how we train the next generation of clinicians. At the Jacobs School here at Buffalo, we are thinking about all of these dimensions. We are advancing care for children today while also building the pediatric workforce and systems that will define care of children in the future. Today's conversation will explore what that future looks like and how innovation is taking shape right here in Buffalo. Joining me are two outstanding leaders in pediatric medicine whose work reflects both innovation and impact. Dr. Benny Joyner is the chair of the Department of Pediatrics at the Jacobs School and a nationally recognized leader in pediatric critical care. His work has helped advance simulation-based training, team readiness, and evidence-based approaches to managing complex pediatric conditions, thereby shaping how providers prepare for high acuity care. And also, we're joined by Dr. Lucy Massindrea, Chief of the Division of Endocinology and Diabetes. She is a leading expert in pediatric diabetes and metabolic disorders with a focus on innovative care models that integrate technology, research, and family-centered care. Benny and Lucy, thank you so much for being here. It's a really exciting time in pediatrics, and we're really looking forward to this conversation. So let's start with the really big picture. Pediatric care is evolving rapidly, and in terms of technology treatment and how care is delivered. So, Benny, tell us from your perspective, how do you see the future of pediatric care, what it looks like nationally, and also here, of course, in Western New York.

SPEAKER_02 2:40

Sure. Thank you so much for having us here, Dr. Bashir. And you know, for my, it may sound a little bit trite, but I do think the future of pediatric care is bright. You know, I think that as you've described, there are so many different challenges and so many different opportunities and new research that's coming out. And I think that getting people excited to enter the field of pediatrics is really not that hard. You know, when we have an opportunity to begin the care for kids really at the start of life, the innovations that are happening in the neonatology world at the very beginning of their life, all the way through adolescent medicine and even into adulthood, young adulthood. And so I think it's really exciting to think about all those different opportunities along the way.

SPEAKER_00 3:22

Can you tell us a little bit more about your work in simulation? So when I think about simulation, you know, we always think about the anti-CPR doll and simulations a lot more. Tell us about how learners are learning about pediatric care and most specifically in those high acuity situations.

SPEAKER_02 3:39

Yeah, exactly. Everyone always thinks that simulation is about, you know, playing with mannequins or playing with dolls. But really, if anyone's been in medical care or has trained, they've participated in simulation. Simulation is simply how do we allow an individual who's training, who's an expert, experience a high risk, high reward situation and practice so that they can do it effectively every single time. And so we think about all the tools that we have. We have these incredible virtual reality systems that we use for games, you know, that we use for kids. We can use those for you know trainees. You can enter an environment, and that combined with uh artificial intelligence, that's a really new field right now where we're allowing students to enter into a space that they can actually go in, work in those situations that are high risk, make those mistakes, learn from those mistakes, try again, perfect it, and then go and practice, and then go and actually practice medicine on a real patient and do it perfectly.

SPEAKER_00 4:40

So I I don't want to oversimplify, but a pilot goes into a simulation to figure out how to land that plane perfectly every time. Similar kind of thing, right?

SPEAKER_02 4:49

Similar kind of concept. You walk into a space, you learn, you practice, you have an opportunity to get feedback on your performance, and then you run it again, and then you run it again, and until you get to the point where it's actually the way that you want it, so that you can simulate it or you can demonstrate it in real life.

SPEAKER_00 5:05

That's terrific. So now you're a department chair. We're so happy that you joined us from North Carolina. Thank you for uh coming. And you are building a stronger, more connected pediatric ecosystem here in Western New York, and that's across UB, UBMD, the Galistano Children's Hospital, Buffalo. Can you give us a little bit more about kind of your vision for that?

SPEAKER_02 5:29

Yeah, I think that from my perspective as a department chair, you know, what I've said to people over and over again that I think it's our obligation, it's you know, it's our mission to be in the spaces where others can't be. And so in the community, in the educational realm, in the research space, in the clinical space, like we are there to push the boundaries. And so for me, my vision is for you being the Department of Pediatrics to be in the space where others aren't and to lead in those spaces where others are.

SPEAKER_00 5:58

That's terrific. So now, Lucy, your work really highlights the ch the pace of change in chronic disease, and diabetes is a chronic disease. Um, what are some of the breakthroughs in managing pediatric diabetes? I mean, we hear about devices and drugs and bring us up to speed.

SPEAKER_01 6:17

Yeah, thank you, Allison. So I don't think people realize how much has changed in the last even 20 years in my training. We went from insulins where they were given two to three times a day with not a lot of great flexibility to now insulin pumps, which can deliver microunits of insulin, even to be able to take care of the smallest children. We went from blood sugar meters that might take from 10 to 15 minutes to give a result, to now you can get a result within seconds, and also having continuous glucose monitors, which allow families to actually see the blood sugars in real time every five seconds, which creates a lot of comfort for the families because they know what is going on with their child all the time. So things have really, really moved rapidly in the technology space, but also in the treatment space in terms of what we can do to improve diabetes education and diabetes care. And I love what Benny was saying about simulation. This is one of the great fun things about diabetes. Diabetes is a pattern recognition game. You can take all this data and you can sit with medical students and undergraduates and residents and say, let's look at this and say, what's going on? What kind of dose adjustments would we make? What kind of behavioral changes should we make to improve the diabetes care based on all the data that we have?

SPEAKER_00 7:38

And tell us a little bit about how you integrate the clinical research, patient education. I mean, how do you get that truly comprehensive model of care?

SPEAKER_01 7:47

Well, one of the great things about working in an academic center is that we have these opportunities where research is at the forefront. Our goal is always being on the cutting edge, whether it's through a reading or education of fellows and residents or attending meetings, and then bringing that back to parents and saying, this is what is coming, this is what is here now, and this is what we can do for you to improve diabetes care, improve your relationship to diabetes, improve relationships with your child and how to manage their disease. I will tell you though, as a physician, you have to be super open to what parents are bringing you. I've gotten parents want to know, like, what's going on here with stem cell research? Or I read about this case. And so they keep me humble and keep me motivated to bring to them what is maybe not quite ready for prime time, but the things that I really need to be watching for and giving to my patients.

SPEAKER_00 8:43

Well, you touched on something that is kind of overarching interdisciplinary education and bringing it all together. And I think diabetes, as you mentioned, it is a multi-system and multi-complex disease that really affords itself to innovation and trying to do that at scale. So let's just talk a little bit about research. Let's talk about research data, innovation in that space. And Lucy, we'll start with you. Um, you know, there's the type 1, type 2 diabetes. I think in your space, you probably are getting patients with both, correct? Correct.

SPEAKER_01 9:22

Um, in western New York, we take care of approximately a thousand young adults and pediatric patients with diabetes, and about 85% of those are type 1 diabetes. But we do see a fair amount of type 2 diabetes, in which case we are trying to offer them opportunities to have therapies that will improve their outcomes and help them manage their diabetes for their lifetime. So, in terms of research, we've had really wonderful opportunities here in Western New York to bring therapies that are approved for adults to evaluate them to see if they're safe and efficacious in pediatric patients, and then have the confidence to be able to bring those therapies to the bedside for our patients. By participating in a clinical trial, you know what the pitfalls are going to be. And so you can explain that to families ahead of time and get them comfortable with managing those medications so that those pediatric patients can have better outcomes lifelong.

SPEAKER_00 10:22

That's great. And so there's um continuous glucose monitoring, closed loop systems that are reshaping that. Can you go a little bit deeper on the technology and how that's helping?

SPEAKER_01 10:33

Yeah, sure. So I talked to my patients about diabetes cure. And a cure would be either never having the disease or being able to completely replace the cells that make insulin. We're not there yet. So we talk a lot about technological cure and getting as close as we can for patients not to have to think about their diabetes on a moment-to-moment basis. And that's really what these automated systems are doing. They're having a technology that can measure the glucose in real time and that is communicating with an insulin pump to modulate the delivery of insulin, whether the blood sugar is going up or going down. And we are doing some really, really cool work with my colleagues in the engineering field to try to improve outcomes with this, more predictability, really having the ability to do things and look at those patterns so we can improve care for our patients.

SPEAKER_00 11:28

So, what gaps remain, particularly in the underserved community? Because, you know, you you talked about clinical trials, for example, and technology, and that's the you know, what about the the children who are maybe not able to get those resources as immediately as others?

SPEAKER_01 11:49

Well, I mean, we talked about the big research gap, and that is beta cell replacement therapy. I mean, that's something that is being worked on in the field for sure. Um, I think in terms of gaps in terms of underserved populations, I think as a clinician, really recognizing every day where those challenges are and being open to provide, you know, with a social worker, what can we do to help you? How can we get you to clinics so you can hear about new insulin therapies, so you can hear about new technologies, having our wonderful children's hospital to get the nurses to teach right from the beginning. So I would hope that in Western New York, those gaps are in many ways being overcome. But there are still challenges in terms of acceptance of maybe participation, participation in research trials. Are people willing to because they haven't necessarily heard about what is available? And it's always our job just to educate, educate, educate.

SPEAKER_00 12:48

That's terrific. And so let's pivot a second here to Benny. So we talked about, you know, technology and diabetes, a critical need, and getting kids on the right foot from the start prevents chronic uh illnesses like heart and stroke and kidney disease and eye disease, et cetera. So, Benny, let's talk a little bit about the tools that we're doing using in the critical care space. Um, maybe predictive modeling technologies, where do those come into play?

SPEAKER_02 13:20

I mean, I think that is such an exploding field right now, and I think we look at it in certain populations like neurologic uh critical care and also cardiac critical care, where they actually take this expansive amount of data, and as we're moving toward uh a one unified electronic medical record, and we have all these data and all these uh pieces of information coming in, we can then take those data and utilize AI to allow for some predictive uh analytics to occur. And in many spaces in the cardiac critical care world, there's even programs that almost operate like a stoplight system where it's red, yellow, green. If you're green, you're doing well, there's there's no real concerns, things are progressing along. Yellow, here are some warning signs, and red, here's something that's got to pay attention. And a lot of times, those alerts come before we even recognize them as clinicians. It's because there's so much data flowing in that we can look at it and go, okay, well, this looks like something, but with AI technology, with these predictive analytics, you're able to respond more quickly. So I think that's a really exciting field. And you know, as we think about expanding critical care here in Buffalo, those are the types of tools that we want to bring into play.

SPEAKER_00 14:29

And you did mention a little few words, electronic medical record. And I'd be remiss to not to remind our listeners that all of UBMD, ECMC, and Kleida Health are all going together towards EPIC here in the next little bit, which we think is incredibly exciting, which means a child who is, you know, in the inpatient and seen in one of our UBMD clinics, they will be able to see everything. Um, and there'll be much more seamless care. And it's going to be really a game changer.

SPEAKER_02 15:01

I mean, I think it's not only just for that child, but if you think about the continuum along the age spectrum where you'll have infants, child, adolescents, young adults, older adults. And so I think it really is allows that sort of seamless care.

SPEAKER_00 15:15

And of course, you've worked in an epic environment and it's and it just has multiple, multiple benefits.

SPEAKER_02 15:21

And the ability to gain records if you've gone to another epic shop, that'll be that'll be huge.

SPEAKER_00 15:25

And be able to tell people in real time about research opportunities for sure. So, Benny, can you just touch on how you're cultivating a culture of research and innovation among faculties? I mean, you know, UB has Empire AI, um, New York would like to grow lots of clinical trials, lots of biomedical research. How are we doing that in the pediatric space?

SPEAKER_02 15:46

So, in the pediatric space, especially within UBMD, one, we've tried to create a system and an organization and a structure around which we can have our research funnel. So we have a child maternal health research institute that we're really funneling a lot of our efforts into. And so we have different pillars within that child maternal health research institute that allow focused research to happen, allows coordination of activities, whether it's research support, whether it's biostatistical support, whether it's just even bringing different colleagues together. We're trying to allow membership not only within the department, but also to other department members within the school, but also external to the school. We've had some success in getting other individuals outside of UB and UBMD to apply for membership into that research. So it allows our fellows, our residents to connect with those researchers and allows those junior faculty to have mentorship, you know, by senior faculty in that space as well.

SPEAKER_00 16:42

That's so it's gonna be a game changer, and um we're so glad you're here. Let's just switch a little bit and talk a little bit more about our community and the community that is Western York. Pediatric care just doesn't happen in isolation. It really is connected to the families and the other community systems that support our children. So, how do partnerships with community organizations, health systems, schools help inform pediatric health outcome? It really starts out in the community.

SPEAKER_02 17:14

I mean, the one thing I will say is that as an individual that has a public health uh degree, you know, to me, the community is where it starts, right? The community is the reason that we exist. You talk about, you know, the family systems that are around this. As we talk about Lucy's patients, you know, it's one thing to get that child to engage, but you have to get the entire support network, whether it's the mother, the father, the grandparents, everyone has to buy in. And so for me, community is where it starts. That's why we have volunteer faculty that are on different community organizations. The Erie County Commissioner of Health is a pediatric volunteer faculty member. So Dr. Burstein's been a huge proponent and of pediatric health and really identifying the issues around the community, helping us make those connections, whether it's chronic disease like diabetes or whether it's, you know, making sure that we address the growing concern around lead uh intoxication. So I think our role is to be in that space and to make those connections with communities.

SPEAKER_00 18:10

Uh I'd be remiss if I didn't just chime in that Commissioner McDonald is also a pediatrician, our New York health commissioner, who was just on campus a a little bit ago. So yeah, we're really um we are committed to making sure that we're improving the health of our children because that's gonna make our community healthier. And frankly, it's gonna make the cost of care so much less because the burden that will appear 30, 40, 50 years from now from uncontrolled diabetes or lead or asthma or stroke or all the other things will pay off in the future. So let's talk a little bit about medical education. What Benny, what do you think is gonna shape the next generation of pediatric clinicians? How do we get the next Benny joyner?

SPEAKER_02 18:57

I don't know. I don't think you want to do that. But um, I I think that the way to get one, you need to get people excited about pediatrics to really make the connection. I mean, for me, what's so exciting about this, and probably for Lucy as well, is the engagement. It's it's the continuity. Like whenever I look at pediatrics, nothing is the same. I I have a child an infant one minute, and I turn and I have a child the next minute, and then I have a young adult, and they have all three different conditions. And oh, by the way, they have significant others, parents, grandparents that I have to also engage. So I think there's no better way for me to think about how to impact a community overall, how to impact the health of a community by addressing child health. If you have a healthy child, you have healthy adults. If you have a healthy child, you have a mom and a dad that are work that are at work, or that you have a mom and a dad that are at school. Like they are they are contributing in so many different ways. So, how do you get people excited is to think about all the possibilities and all the disease states and all the health that you can impact by being a pediatrician?

SPEAKER_00 20:01

Well, that's perfect. Uh switch to I wanted to ask Lucy about the importance of families. So you just listed off a lot of members of the family. And and Lucy, how do families help us manage chronic diseases like diabetes?

SPEAKER_01 20:15

Yeah, so um, families are the most important. It is the whole key to making sure that that child has everything that they need. You I tell the students when you're a pediatrician, you really have two patients because you have the mom and dad, or the caregiver, and the child. And you want buy-in from everybody. So the really important part about being a pediatrician is number one, I think most of us are educators. I think that's really most of us would have been very good teachers. Benny was a teacher, but that whole idea of sharing the knowledge and sharing how they can manage this. They are have are taking a new big job into their life, not only to take care of their child, but take care of their child's disease. And then the other part of it is really trust. Trust that you want what is best for their child. That even if we you don't agree, that you can arrive at that point where you're really taking care of their child. And I think that that's what students, medical students and residents really like to see is how do you navigate those really tough conversations to build the trust so that that family can do well long term.

SPEAKER_00 21:28

That's wonderful. Well, I'd like to close with one final question for each of you. If there's one key takeaway that you hope our listeners will leave about the future of health in Western New York, particularly as it pertains to pediatrics, what would that be? Lucy, we'll start with you.

SPEAKER_01 21:43

Well, I would say that it's a really exciting time to be in Western New York and to be a physician in Western New York. I mean, we work really hard. All of us work really hard, but I think we're doing a really great job of sharing what is new and exciting. Exciting and how much we really want patients to be healthy, our relationships with community pediatricians, I think will only build that. Um, so I do think that it's a great time to be a doctor, even though it is hard work.

SPEAKER_00 22:15

And Bandy, what's one key takeaway from you hope our listeners will lead with?

SPEAKER_02 22:20

I I think that exactly as Lucy said, there's so much excitement about the growth and and of pediatric care in the region. There you're gonna see so many expansive different areas around adolescent medicine, around genetics, around chronic disease, around you know surgical care, around, you know, critical care. There's gonna be so much that this is a really an exciting time to be a part of this.

SPEAKER_00 22:45

Well, Benny and Lucy, thank you so much. It's been just a pleasure to listen to an inspiring conversation. There's so much that is out there for the future, pediatric care. What stands out is really the innovation, but also bringing that in, the combination of research. It's really truly uh the voice of academic medicine as we know it, and how we're going to improve the lives of the children as well as their families. Here at the Jacobs School, we have a new opportunity to lead in that space by really advancing the care today, but also as we prepare to look towards the future, and the children are our future, as we we all know. Um so thank you so much. I'm Alison Brashir, and this has been UB Medicine Podcast. Thank you for listening, and we look forward to continuing the conversation about innovation, discovery, and the future of healthcare in Western New York at UB.