2020 STRATUS Annual Report

connectivity • creativity • COVID-19



2020 was a prodigious year. When COVID-19 struck, STRATUS was firing on all cylinders. Internal programs were thriving. We had just inaugurated enhancements in our curriculum and faculty development processes. Our research team was hard at work on simulation-based research studies supported by multimillion dollars in grant-funding, with large grants in the pipeline. Our fellowships were flourishing, with 5 active fellows and a wait list of new matriculants. Our operations team, the best in the business, skillfully supporting each of these initiatives. Response to a novel and global coronavirus pandemic was made even more challenging by civil unrest in response to systemic racism and an electoral process unlike any we had ever seen. After suspending normal operations in early March, 2020, in June working with BWH's infection control team, STRATUS became one of the first simulation centers in the country to re-open. Participants began to return and usage quickly increased. Many of the changes made to meet the challenges of 2020 have remained in place. Although we are not back to “normal”, I am proud to say that, even in the setting of our “new-normal”, the STRATUS team is stronger, more resilient, and ready to continue on the steep trajectory that was interrupted when the world became so incredibly disrupted. STRATUS shut down to meet the needs of the hospital and to protect the health of both center staff and participants. As usual, STRATUS methodically pivoted to meet this new challenge. Quickly, we supported more in situ simulations. collaborated on the development of several clinical innovations to meet the needs of patients suffering from this novel and deadly virus. Despite these changes, STRATUS fellowships, research, and consulting activities continued, not missing a step. I am so proud of our incredible team and the work they do in supporting our world-class simulation center. Each one of them contributes to the STRATUS mission of supporting high quality education, cutting-edge research, and advancement of clinical systems, all in the service of saving lives and decreasing suffering. What a year…what a team! Charles Pozner, MD, FSSH Executive Director

We are a place of life-long learning for everyone. The education department in STRATUS is committed to ensuring high quality, tailored, simulation-based education for all of our learners. We strive to support our course directors through curriculum development collaboration, debriefing facilitation, assessment of learning outcomes, while also offering opportunities for faculty development. Deborah Navedo, PhD, Mary Anne M. Kenyon, CPNP FNAP DNP, MPH, MS, RN, ONC Director of Education Professional Development Manager Maggie Ryan, RN, MS Assistant Director of Education

Protective measures to keep STRATUS participants safe STRATUS was able to successfully reopen, welcoming back almost all of our existing programs and adjusting to life in our “new COVID normal\". We continue to conduct courses at capacity, with safety precautions and guidelines in place: We have established room capacities for all of our learning spaces. Working with new and existing course directors, we have modified curriculum to meet all institutional safety guidelines. This has resulted in creative solutions and an enhanced focus on small group learning. We provide ample physical spacing in our skills rooms and arcade, and have PPE and hand sanitizer placed throughout the center. This year, we created and launched a new, user-friendly course intake form with easy-to-use drop down menus that will improve STRATUS's course request process. It is now automated but still uses the same platform as our curriculum development tracking tools. This will streamline processes for both users and staff.

Our faculty are the backbone of our world-class simulation center Dr. Deborah Navedo, STRATUS’s Director of Education, created and implemented a 5-part Instructor Training Series, providing new practice insights and opportunities for faculty growth. When the pandemic struck, our education team adapted the series into an online format and offered it free-of-charge to interested parties, Over 500 participants from 28 countries have attended these seminars. Those who attend all five sessions are eligible to receive a STRATUS-issued Certificate of Attendance.

Rewarding excellence in simulation-based education Each year since 2017, STRATUS has recognized an outstanding BWH faculty member and a trainee who have demonstrated a year-long commitment to high-quality simulation-based education. In 2020, we awarded the Simulator Educator of the Year Award to: Dmitry J. Rabkin, MD, PhD Khanant Desai, MD BWH Department of Radiology BWH Department of Radiology 2019-2020 Faculty Simulation 2019-2020 Resident / Fellow Simulation Educator of the Year Educator of the Year

LMS: Promoting ease of use and quality data Based on feedback from an organization-wide needs assessment, STRATUS will be upgrading our learning management technology. This integrated system will facilitate curriculum development and archiving, program assessment, as well as consolidate our scheduling and data management functions in support of our extensive educational activities. Future plans include development of an e-learning program for our global colleagues. Users can expect to see this upgrade taking shape in the spring of 2021, when we will be piloting several courses. Instructors and participants will enjoy the improved access, transparency, and efficiencies. We are excited to launch this robust online learning platform, enabling STRATUS to expand and streamline our educational services.

The Human Factors & Cognitive Engineering Lab brings together a multidisciplinary team of clinicians, engineers, psychologists, computer scientists and educators. We collaboration with scientists and institutions, nationally and internationally. The core mission of our research lab involves the use of cutting-edge technologies to understand and improve clinicians’ performance, with the ultimate goal of enhancing patient safety and improving clinical outcomes. Our research projects have been funded by NASA and the NIH (R01). We employ innovative methodologies, such as machine learning and artificial intelligence, virtual and augmented reality, and digital biomarkers captured through wearable physiological sensors. Roger D. Dias, MD, PhD, MBA Director of Research & Innovation Christian Miccile, MSc Research Assistant

STRATUS offers a 2-year, SAEM-approved Education and Research Fellowship in Medical Simulation. During this hybrid program, fellows learn and practice all aspects of simulation-based education and research, with a primary role in the Human Factors and Cognitive Engineering Lab. Fellows also complete a Master of Science in Health Professions Education at the MGH Institute of Health Professions, and have an appointment as a postdoctoral research fellow at both Brigham and Women’s Hospital and Harvard Medical School. Egide Abahuje, MBBS Sandra Park, MD Research Fellow 20' Research Fellow 22'

Mixed Reality (MR) Care-Delivery Guidance System to Support Medical Event Management on Long Duration Exploration Missions NASA/TRISH | 2020-2022 PI: Roger Dias This project is a collaboration between Brigham and Women’s Hospital, Harvard Medical School, and McMaster University. We are developing a mixed reality platform for emergency medicine training and clinical decision support of astronauts during long duration space missions. Novel Assessments of Technical and Non-Technical Cardiac Surgery Quality NIH/ NHLBI (R01) | 2019-2024 Co-I: Roger Dias This project is a collaboration between Brigham and Women’s Hospital, Harvard Medical School and University of Michigan that aims to use machine learning (computer vision) to develop automated and objective metrics of technical and non- technical skills in cardiac surgery. A Novel Cognition-Based Guidance System to Improve Surgical Safety NIH/NHLBI (R01) | 2020-2024 Site PI: Roger Dias / PD: Marco Zenati The aim of this project is to design, develop and validate an intelligence cognitive- guidance system to support cardiac surgery teams during complex procedures, reducing human errors and improving patient safety in the operating room. Emotional Well-Being Among ED Providers During the COVID-19 Pandemic BWH Department of Emergency Medicine - Esther Khan Seed Grant | 2020-2021 PI: Roger Dias, MD, PhD, MBA / Co-Is: Charles Pozner and Andrew Eyre The aim of this project is to investigate the impact of the COVID-19 pandemic on ED provider well-being and validate digital biomarkers of emotional well-being using objective physiological metrics, such as heart rate variability and EEG. Improved Teamwork to Decrease Errors and Mitigate Their Consequences CRICO | 2019-2021 PIs: Charles Pozner and Madelyn Pearson / Co-I Roger Dias The aim of this project to increase the use of the principles of Crisis Resource Management by all providers at Brigham and Women’s Hospital as a tool to minimize communication errors that often contribute to preventable medical errors.

Al-Balla AS, Pozner C, Parker S, Yule S, Dias R. Development of an Observation-based Rating Tool to Assess Trauma Team Leadership Skills. Journal of the American College of Surgeons. 2020, 231(4), Suppl 2. https://doi.org/10.10.16/j.jamcollsurg.08.622. Chamberlain S, Gonzalez N, Dobiesz V, Edison M, Lin J, Weine S. A Global Health Capstone: An Innovative Educational Approach in a Competency-Based Curriculum for Medical Students. BMC Medical Education, (2020) 20:159 H. M. Conboy, L. R. Kennedy-Metz, G. S. Avrunin, L. A. Clarke, L. J. Osterweil, R. D. Dias, and M. A. Zenati. 2020. Digital Cognitive Aids to Support Adaptation of Surgical Processes to COVID-19 Protective Policies. In 2020 IEEE Conference on Cognitive and Computational Aspects of Situation Management (CogSIMA), Pp. 205-210.Abstract Jamie M Robertson, Roger D Dias, Avni Gupta, Thomas Marshburn, Stuart R Lipsitz, Charles N Pozner, Thomas E Doyle, Douglas S Smink, David M Musson, and Steven Yule. 2020. Medical Event Management for Future Deep Space Exploration Missions to Mars. J Surg Res, 246, Pp. 305-314.Abstract Lauren R Kennedy-Metz, Roger D Dias, Ronald H Stevens, Steven J Yule, and Marco A Zenati. 2020. Analysis of Mirrored Psychophysiological Change of Cardiac Surgery Team Members During Open Surgery. J Surg Educ.Abstract Morris NA, Zimmermann EE, Pozner CN, Henderson GV, Milligan TA. Brain Death Determination: An interprofessional simulation to determine brain death and communicate with families focused Neurology residents. MedEdPORTAL. 2020 Sep 25; 16:10978. Lauren R Kennedy-Metz, Hill L Wolfe, Roger D Dias, Steven J Yule, and Marco A Zenati. 2020. Surgery Task Load Index in Cardiac Surgery: Measuring Cognitive Load Among Teams. Surg Innov, Pp. 1553350620934931.Abstract N. Z. Jia, D. Mejorado, S. Poullados, H. Bae, G. Traverso, R. D. Dias, and N. Hanumara. 2020. Design of a Wearable System to Capture Physiological Data to Monitor Surgeons’ Stress During Surgery. In 2020 42nd Annual International Conference of the IEEE Engineering in Medicine Biology Society (EMBC), Pp. 4539-4542. Publisher's Version L. R. Kennedy-Metz, A. Bizzego, R. D. Dias, C. Furlanello, G. Esposito, and M. A. Zenati. 2020. Autonomic Activity and Surgical Flow Disruptions in Healthcare Providers during Cardiac Surgery. In 2020 IEEE Conference on Cognitive and Computational Aspects of Situation Management (CogSIMA), Pp. 200- 204.Abstract Roger D Dias, Julie A Shah, and Marco A Zenati. 2020. Artificial intelligence in cardiothoracic surgery. Minerva Cardioangiol. Abstract Roger Daglius Dias, Steven J. Yule, and Marco A. Zenati. 2020. Augmented Cognition in the Operating Room. In Digital Surgery, edited by Sam Atallah, Pp. 261–268. Cham: Springer International Publishing. Publisher's VersionAbstract Tayeb B, Basurrah M, Abahuje E, Pozner CN, Miller A, Klainer S, Yule, S, Dias R. Assessing Anesthesia Residents’ Cognitive Load through Digital Biomarkers during a Simulation-Based Crisis Resource Management (CRM) Training. International Anesthesia Research Society, 2020.

In 2020, the Human Factors and Cognitive Engineering Lab was founded and an online Research Seminar was established. Since its inception, STRATUS research seminars have engaged more than 300 participants from over 40 countries. Twice a month, these online meetings feature invited speakers who cover a wide range of research topics on Medical Education, Clinical Simulation, Human Factors, and Cognitive Engineering. Click on any of the images on the following pages to view the 2020 seminars





The STRATUS International Fellowship for Clinical Simulation was impacted, like the rest of the world, by the pandemic. With STRATUS closed to normal operations this spring due to the initial surge of COVID cases in Boston, we were forced to innovate and adapt to continue our fellowship. We quickly converted to on-line virtual fellowship activities, continued integrating fellows in STRATUS team meetings, updating, and archiving of all STRATUS curricula, and were able to engage with regional, national, and international guest speakers in our seminars which was a silver lining in many ways. Valerie Dobiesz, MD, MPH Jil Sharpe International Fellowship Fellowship Program Coordinator Program Director

Wed AlMutairi, MD, SBEM, Reem Alansari, MD, MSc ABHS-EM, Ms-HPed Radiology Emergency Medicine 1st 2-year International Fellow at 1st fellow from Bahrain to graduate STRATUS. Dr. AlMutairi earned her from STRATUS. Dr. Alansari earned Master's degree at MGH IHP. her MSc at Harvard.

Mohammed Basurrah, Abdulrahman Al-Ballaa, MD MBBS, SORL-HNS Trauma Surgery Otolaryngology Presented Trauma Team Created the Leaders Assessment \"Marshmallow Project\", project at the ACS a team based activity Clinical Congress 2020. facilitating debriefing Ahmed Aljaberi, MD practice for fellows. Internal Medicine Created an online platform for medical students at his alma mater, United Arab Emirates University.

Dr. Maryam Alnuaimi and Dr. Ruqya Alzaabi were called back home to UAE after being in Boston for less than two months when STRATUS closed operations. We worked very closely to continue the fellowship albeit at a distance with modules amenable to virtual didactic activities. These events created an additional stressor on our fellows, but they have been incredibly resilient, motivated, and engaged learners despite these unusual circumstances. Fortunately, our fellows were only away a few months before STRATUS resumed operations and they returned safely to Boston. Maryam Al Nuaimi, MD, ABEM Ruqya Alzaabi, MD, ABEM Emergency Medicine Emergency Medicine Developed a checklist-based Developed a pediatric mock code approach to a stable non- debriefing script and assessment communicative patient. metrics.

Throughout these trying times, the faculty and fellows have learned many lessons in flexibility, adapting to virtual and hybrid teaching methods, and our fellows have not only met but exceeded every milestone and fulfilled all fellowship requirements in an exemplary fashion. We are incredibly proud of the simulation education leaders they have become and look forward to the many great successes they will no doubt have in their respective countries. Munaa Dashti, MD, KBEM Asma Arabi, RN, MMEd Emergency Medicine Nursing 1st fellow from Kuwait at STRATUS. 1st Nursing fellow at STRATUS. Interviewed as a medical expert on KTV1 Developed a debriefing game, (Kuwaiti state-run channel) about \"Game of Possibilities\", to foster teamwork, problem solving, and COVID-19. decision making.

The foundation of an excellent simulation center. Simulation operations is an essential component of any successful simulation center. Led by Trevor Anderson, CHSOS, the skill and dedication of our operations team is what enables faculty and researchers to provide the highest quality simulation-based activities employing robust curricula and technologies. They allow our faculty to concentrate on learning, without the worry of the technology and logistics. This is what distinguishes STRATUS from other simulation centers. Trevor Anderson, CHSOS Taylor Driggers Operations Manager Administrative Assistant

Despite the significant aberrations and stresses that 2020 unleashed, the ever- resilient STRATUS operations team continued to function at a very high level. This enabled STRATUS to contribute to the addressing the challenges and has ultimately made STRATUS an even stronger resource for our hospital and the communities whom we serve. Persephone Giannarikas Daniel Guzman, Jr., CHSOS Simulation Specialist Simulation Specialist

Without any hesitation, our operations team took upon risk to their own health, by joining others in supporting the hospital’s overburdened clinical services. Duc La Ari Shoham Simulation Specialist Simulation Specialist

Connecting the world to simulation STRATUS provides simulation-based experiences to a wide variety of external clients. Activities include Fellowships in simulation for international simulationists, educational programs, consulting on simulation center development and expansion, as well as online seminars on simulation theory, human factors, and cognitive engineering. STRATUS also engages with industry on device design, user interfaces, and marketing. Charles Pozner, Sumaira Ahmed Elaine Houle MD, FSSH Director of Strategic Project Manager Executive Director Marketing & Business Development

Building Quality Simulation for the People’s Republic of China Despite travel restrictions related to COVID-19, our 5-year project with the Chengdu First People’s Hospital has continued to progress. We are working in partnership with our colleagues in China who have assembled a team who are building their center and developing an operational infrastructure that will enable them to become a world-class enterprise. This year, the project has concentrated on 4 tasks: developing robust educational programs, faculty training, building a sustainable operational infrastructure, and putting the pieces in place to achieve accreditation by the Society of Simulation in Healthcare. We are looking forward to welcoming our colleagues to train at STRATUS once travel resumes.

Charles Pozner, MD, co-authored an online ventilator refresher course sponsored by CAE Healthcare. Valerie Dobiesz, MD, MPH, participated on a committee that created and implemented BWH's Crisis Standards of Care protocol, ensuring fair allocation of scarce life-saving resources and relieving direct care providers from having to make these decisions in these challenging situations STRATUS transformed one of our classrooms into a workshop to develop an intubation hood to minimize clinician exposure to aerosols during intubations. STRATUS supported the development of a unique protective face mask that uses a commercial scuba mask with a HEPA filter to protect clinicians working in this high-risk environment. STRATUS worked with a team from MIT to reconfigure a single ventilator to ventilate up to four patients simultaneously. Unlike other similar devices, this segregates the ventilation circuits minimizing cross contamination. The center's simulators were used for in-situ and just-in-time training in a variety of clinical settings.

Das D, Lall M, Walker L, Dobiesz V, Lema P, Agrawal P. The Multifaceted Impact of COVID-19 on the Female Academic Emergency Physician: A National Conversation. AEM Education and Training. 2020; 00: 1– 8 Das D, Dobiesz, V, Lall M, Agrawal P. The unique challenges faced by women physicians during the COVID-19 Pandemic. Society of Academic Emergency Medicine (SAEM) PULSE May-June 2020 Dobiesz, V co-published, Unique Risks and Solutions for Equitable Advancement during the Covid-19 Pandemic: Early Experience from Frontline Physicians in Academic Medicine. in NEJM Catalyst. 2020. DOI:10.1056/CAT.20.0268 Madsen T, Dobiesz V, Das D, Sethuraman K, Agrawal P, Zeidan A, Goldberg E, Safdar B, Lall M. Frontline Physicians in Academic Medicine during the COVID-19 Pandemic: The Gender Perspective. NEJM Catalyst Innovations in Care Delivery. 2020 DOI:10.1056/CAT.20.0268

Named to Board of Directors of the Health Professions Conferencing Center for Advanced Medical Learning and Simulation. University of Southern Florida Named to BWH Executive Committee on Teaching and Education Co-authored an online ventilator refresher course sponsored by CAE Healthcare. Named the 2020 Stephen Bohan Faculty Mentor of the Year BWH Department of Emergency Medicine Honored with the 2020 Academy for Women in Academic Emergency Medicine (AWAEM) Momentum Award Named the 2020 Faculty Mentor of the Year for the Harvard Affiliated Emergency Medicine Residency (HAEMR) Program Honored with the Academy for Women in Academic Medicine Research Award Became an Associate Editor for the New England Journal of Medicine Journal Watch

Presented, Investigating Autonomous Crew Performance and Behavioral Skills during In-Flight Medical Event Management at the NASA Human Research IWS Program (January 2020) Presented, The Use of Machine Learning to Assess Physician Competence at the American Board of Medical Specialties (ABMS) - Board of Directors Meeting (February 2020) Presented, Human Factors and Cognitive Engineering in the Cardiac Operating Room at the American Society of Extracorporeal Technology (AmSECT) - 58th International Conference (March 2020) Presented, The Use of Human Factors and Cognitive Engineering to Improve Intraoperative Performance at the 22nd Congresso Paulista de Cirurgia, Brazilian College of Surgeons (August 2020) Presented, Non-Technical Skills Training in Surgery: Teamwork, Leadership, Decision-Making and Communication at the 22nd Congresso Paulista de Cirurgia, Brazilian College of Surgeons (August 2020) Presented, How Can Digital Biomarkers/Measurements Revolutionize Patient Care? at the Digital Biomarkers & Digital Measurements Summit: Fostering the New Age of Health (November 2020) Presented, How Simulation can Help Patient Safety? at the 2nd Multidisciplinary Symposium on Patient Safety and Quality in Surgery (November 2020) Presented, Teaching Non-Technical Skills for the Surgical Team at the 2nd Multidisciplinary Symposium on Patient Safety and Quality in Surgery (November 2020)

Abstract, Faculty Development in Humanistic Interprofessional Education: A Qualitative Analysis of What is Most Important, accepted at National Academy of Practice Annual Conference (March 2020) Published a chapter on Education and Learning Theory in Comprehensive Healthcare Simulation : Anesthesia Presented, Walking the Walk of Psychological Safety: Making the arguments for not using senior trainees, faculty, or staff as SPs, at the Association of Standardized Patient Educators conference (June 2020) Presented, Educational Adjustments to COVID: Adjusting Skills Training While Expanding Into the Virtual, at the 2020 Conference for Education in Medical Simulation at the University of Taipei (October 2020) For the 3rd year, Trevor Anderson, CHSOS, spearheaded the process of obtaining an educational grant from Ethicon, Inc, a subsidiary of Johnson & Johnson, that provides STRATUS with an in-kind donation of over $40,000 of surgical materials to support our programs. This grant enables students, trainees, and others to learn and practice surgical skills in the safe learning environment that our simulation center provides.

Department of Medicine Department of Obstetrics and Gynecology Department of Surgery Department of Medicine Department of Newborn Medicine Department of Orthopedic Surgery Department of Anesthesiology and Department of Radiology Pain Medicine Department of Emergency Medicine Department of Emergency Medicine Senior Vice President, Medical Affairs Senior Vice President, Inpatient and Chief Medical Officer Clinical Services Senior Vice President, Clinical Services President, Brigham and Women's Chief Nursing Officer Physicians Organization Executive Director, Department of Chairman, Department of Emergency Emergency Medicine Medicine