An Expert Conversation About Provider Performance and Preparedness: Virtual Strategies for Improving Provider Training and Care Delivery

The healthcare industry has been in flux for years now, and it’s changed even more over the course of the COVID-19 pandemic. We asked two healthcare leaders, Senior Vice President, Global Child Health & Life Support of American Academy of Pediatrics Janna Patterson, MD, MPH, FAAP and Health Scholars Founder & Chief Medical Officer Brian Gillett, MD, about the state of provider performance and preparedness given this unique time. Take a look.

Health Scholars (HS): Why is performance training so important for healthcare providers?

Janna Patterson (JP): The concept of performance training in healthcare is vital to ensuring positive patient care. In the field of pediatrics, an EMS provider may only experience one or two critically emergent cases in their entire career. Without frequent practice, a provider may not recall or know how to perform the lifesaving skills that are necessary to assess and stabilize a critically ill or injured child.

The American Academy of Pediatrics promotes education and hands-on practice to support high-quality care through low-dose, high-frequency training. Healthcare professionals need to react with confidence and competence when an urgent case comes their way.

Brian Gillett (BG): Continuous performance training is key to maintaining readiness. Practitioners across a variety of occupations enter their professional lives from disparate and siloed training paradigms. And yet we must all come together, often during crisis, to impart seamless, coordinated, and urgent management without flaw or delay. When managing high-stakes clinical situations, everyone needs to be at their best, which requires continuous practice to ensure high-performance. With patient’s lives on the line and an abundance of healthcare simulation technologies, there’s just no longer an excuse to abstain from ongoing performance training.

HS: What doesn’t the general public understand about continuous training for healthcare providers, or what do you believe is a common misperception around provider readiness?

JP: The general public might be surprised to know that healthcare professionals may only be required to spend the equivalent of one week of work in two years to keep their knowledge and skills updated. While a one- or two-day in-person program can be a good way to hear lectures, there’s a lot of time in between those programs when people’s knowledge is fading, and skills are decaying. This has a negative impact on the care we give patients. Data show that continuous training through shorter bites of education better prepares healthcare providers to respond to emergencies effectively.

BG: I think people don’t understand the relative infrequency of various emergency situations and the impact that case frequency has on provider readiness. For example, as an emergency medicine physician, I routinely manage adult cardiac arrests. The high frequency of these encounters keeps the management fresh and readily available in my memory. However, skills rapidly decay when not frequently used. There’s a compelling resuscitation study that showed 70% of the participating clinicians lost proficiency for Advanced Cardiac Life Support (ACLS) 90 days after successfully certifying. Skill decay is part of the human experience. If we don’t use it, we lose it. I personally use pediatric simulations to maintain readiness because the frequency of caring for critically ill children in the emergency department is just too low to maintain a comfortable state of readiness.

HS: Why is provider training typically under-funded or de-prioritized in healthcare organizations?

JP: One of the biggest challenges facing the EMS community is the de-prioritization of their education. Funding varies significantly from state to state and is often used to support new devices and equipment needed for the EMS agency and provider. Getting new gear doesn’t help much if a provider isn’t ready to use it effectively.

BG: In hospital settings there are multiple factors. One challenge is that the return on investment for training has been challenging to quantify, and the value of continuous training is not yet a routine quality metric for health systems. Fortunately, many health systems are adopting value-based healthcare (VBHC) in which tactics around cost, quality and outcomes are transferred to everyone involved in patient care, including insurers, providers, and allied staff. Organizations that have shifted to VBHC see training as their number one priority and are changing the status quo training models.

HS: What has happened to provider training since the pandemic started?

JP: The EMS profession is strained with employee shortages and unprecedented daily increases in calls responding to critically ill patients. Due to pressure from the EMS community, the National Registry of Emergency Medical Technicians (NREMT) voted to waive distributive education limits for the 2021 and 2022 recertification cycles, allowing EMS providers to complete all their required continuing education hours through online formats and modalities. While attendance at in-person training courses have gone down significantly, we have found that other types of education, like virtual reality and online-based education, have increased. ?

BG: Training has markedly declined due to covid’s negative economic impact on hospitals and resultant staffing. Additionally, social distancing constraints further complicate group training paradigms, such as high-fidelity mannequin simulations.

HS: The pandemic has shed light on big problems and propelled new trends. What is Virtual Reality’s role in all of this?

JP: The EMS community has been battling a nationwide staffing crisis that has made it difficult for agencies to fill the pipeline of EMS providers. This crisis inevitably impacts the ability for these providers to receive the proper training needed to perform their job. Virtual reality has great potential to shift the traditional education model through realistic scenarios and immersive technology made available more conveniently and regularly. A learner can complete a scenario in as little as thirty minutes and practice their skills more frequently in a location of their choosing. This new trend in health care education not only benefits the learner through brief practice sessions but also the employment agencies allowing for smaller doses of training more frequently ideally resulting in better retention of key learnings.

BG: The COVID-19 pandemic has had material yet divergent impacts on the role of healthcare-related VR training. Due to social distancing constraints, the need and appetite for distributed training transitioned rapidly to a front-burner priority for clinical educators. Simulation educationalists, now more than ever, need virtual alternatives to in-person simulation training. The in-person simulation paradigm has historically struggled to scale to large learner population needs, and the pandemic has catalyzed exploration of VR as the ideal alternative.?However paradoxically, the pandemic’s negative impact on hardware supply chains has decreased global market demand for VR training in 2020-2021, relative to prediction curves. The demand for healthcare-related virtual solutions will certainly persist well beyond this pandemic. For example, demand for telemental health is taking off even as therapists return to the office. The pandemic was a catalyst for accelerating VR industry growth; and the demand for virtual health is here to stay.

HS: Do you think virtual-first care trends will continue?

JP: I do think that virtual education training will continue. Prior to the pandemic we found the EMS community was desiring more flexibility, engagement and innovation in the way they obtained their education, with less time physically spent in a classroom environment. The pivot in the education trends was evident even at that time and has only been compounded further by the pandemic. I see many more opportunities for growth as it relates to innovation and flexible learning modalities.

BG: Absolutely. We’ve already seen a massive growth in the virtual health industry, with utilization currently sustained at nearly 40% higher levels than before the pandemic. Regulatory shifts have removed barriers and facilitated reimbursement with new telemedicine CPT codes. There also has been increased venture capital focus on telehealth innovation. Lastly, patients and providers have developed an increased level of comfort with the technology. All these factors point to a durable shift towards telemedicine.

Why are you a champion of VR technology for provider training?

JP: I am a champion for VR technology as a learning tool because of the many benefits it brings, including skills retention (especially when completed in conjunction with other types of education like in-person training courses), and the ability to participate in an engaging and innovative format that brings real emergencies to life.

BG: Virtual reality provides the real-to-life reference experience and practice needed to maintain readiness for patient emergencies. The real-to-life practice, afforded through VR, builds provider muscle memory and confidence. Mannequin-based simulation has proven to move the needle towards better clinical performance; however, there’s simply a practical limit to the frequency with which providers can utilize traditional simulation services. Mannequin training requires staffing to operate the equipment, and the number of providers accommodated is constrained by physical space. VR enables this high-yield training anytime, anywhere and as often as the provider needs. VR also readily scales to large learner populations with impressive cost efficiency.

HS: What is the biggest misconception about VR training you want to dispel?

JP: I think one of the biggest misconceptions about VR training is that virtual reality is just for gamers. VR is an extremely engaging and interactive learning tool that can immerse a provider within a real-to-life scenario, allowing them the ability to respond as they would to an emergency in a safe simulated environment.

BG: I’d like for the healthcare workforce to understand VR as a meaningful training tool that is ready for prime time as opposed to a horizon technology or novelty experience. I think organizations also assume that because it is a newer technology it will be expensive and time consuming to integrate. The hardware is just a few hundred dollars and you don’t need a headset for every provider. The training software is about the same cost as eLearning. It’s a super reasonable investment with a low learning curve that saves massive amounts of time.

What’s your goal for using VR to train healthcare providers?

JP: Our goal is to improve an EMS provider’s competency and confidence in how they assess and perform life-saving skills, which ultimately improves patient care.

BG: Our goal is to enable, at scale, the already proven impact of simulation training on preventable error reduction.

HS: Is there anything else you want to share regarding provider preparedness?

JP: VR gives us the opportunity to practice, practice, practice and we know practice and visualization helps us be more prepared for challenging situations. And it’s fun!

BG: Providers have made tremendous self and family sacrifices to serve as stewards for their community’s health and well-being. The pressure on providers to never make a mistake is intense, and it’s emotionally devastating if something goes wrong. We want to be ready for anything and yet at the same time, workloads often constrain availability for continuous training. That’s why high-yield and readily available training tools like VR are so important to maintaining provider preparedness.

For more information about how virtual reality can deliver healthcare providers the skills, competency, and confidence needed to deliver the best care possible, visit healthscholars.com.

About the Experts

Janna Patterson, MD, MPH, FAAP

Senior Vice President, Global Child Health & Life Support American Academy of Pediatrics (AAP)

Under Dr. Patterson’s leadership, AAP has launched a new virtual reality product and textbook for pediatric emergencies, created a newborn training program with the World Health Organization and created a network of immunization champions in Africa and Asia.

Dr. Patterson’s education includes an MD and MPH from the University of Alabama-Birmingham, with graduate medical studies at the University of Washington/Seattle Children's Hospital. She stayed on faculty as a board-certified pediatrician and neonatologist for several years.

Prior to joining the AAP, Dr. Patterson was a Senior Program Officer at the Bill & Melinda Gates Foundation, where she managed a $120 million portfolio of grants on maternal and newborn health. She has published extensively in the peer-reviewed literature in addition to many webinars, workshops and speaking engagements.

About Brian Gillett, MD

Chief Medical Officer, Founder and President, Health Scholars

Dr. Gillett is an Emergency Medicine physician with over two decades of leadership and innovation in healthcare education solutions. As Chief Medical Officer, he oversees clinical education strategies and healthcare direction for the organization.

Prior to co-founding Health Scholars, Dr. Gillett was Founder and Chief Executive at SimCore Technologies, a widely implemented simulation management and quality improvement software, now integrated into Health Scholars’ virtual learning system.

Dr. Gillett is a recognized national leader in immersive training and pedagogical research, having published and lectured extensively in these domains.