In Search of the Perfect Sim Center

Oh the places I have been! I have traveled around the world, literally, in search of the perfect #simulation center. My search has taken me to such places as Italy, Germany, Belgium, Hungary, Canada, United Kingdom, Peru, Mexico, United Arab Emirates (Dubai and Abu Dhabi), Saudi Arabia, Bahrain, Kuwait, Egypt, South Africa, Malaysia, Brunei, Australia, and the United States.

This is how my journey began

I still remember how I first got involved in simulation. It's a story of boy meets girl, they get married, and they have their first child. The year was 2007 and I was working for SAIC in Atlanta, GA, as a contractor to the Centers for Disease Control and Prevention . I was traveling every week from Orlando to Atlanta. Our first son was born and my wife accurately pointed out that SAIC had a pretty big presence right here in Orlando. That led me to meet Beverly Seay who is a legend in the #modelingandsimulation (MS&T) community. I moved to the Seay Business Unit and managed the #medicalsimulation account.

My primary focus at SAIC was with the Online Interactive Virtual Environment (OLIVE), which I call the predecessor to the #metaverse. I was responsible for federal contracts that leveraged the OLIVE platform. When I left SAIC for CAE , my view of the MS&T world expanded. Timing was perfect as CAE was pivoting from products to services with a strong emphasis on expansion into global markets through training centers.

I had the honor, pleasure, and opportunity to understand the design, construction, and operation of a training center. I got to see first hand the development of the CAE Brunei Multi-Purpose Training Center (MPTC). I returned to Brunei many times over the years so I got to witness the entire construction process.

I've seen it all and then some

In my journeys, I was able to visit large simulation centers like Princess Noura University in Saudi Arabia; highly innovative centers like iEXCEL at UNMC in Omaha, Nebraska; military training centers; highly utilized centers; highly specialized centers; beautiful centers; professional society centers; aviation centers; surgical centers; public safety centers; etc. There are still a few I had hoped to visit but never had a chance like the Acibadem center in Istanbul.

Training Needs Analysis (TNA)

Through my experiences and lessons learned working with the Brunei MPTC, I helped to create a consulting arm at Elevate Healthcare that we called Turnkey Solutions. Working with people like Alfredo Perez , Stefan Monk (M?nk) , Amar Patel, DHSc, MBA, MS, NRP, CHSE, FSSH , Amanda ( Mandy ) Wilford , and our architecture partners, RDG Planning & Design , we were able to commercialize our process to design a training center based on needs and growth potential.

When you build or buy a house, what questions are you asked?

If you were to buy or build a house today, a realtor or builder might ask some of the same basic questions:

1. How many square feet?
2. How many floors?
3. How many bedrooms and bathrooms?
4. How many car garage?
5. What Zip Code?
6. What style of home?

This is not very different than the questions a standard architect might ask an academic institution or government agency about their new training or simulation center. Instead of questions about bathrooms, bedrooms, and garage doors, they might ask:

1. How many skills labs?
2. How many simulation rooms?
3. How many classrooms?
4. How many OSCE rooms?
5. How many parking spots?

What if we changed the way we asked questions?

What if instead of asking the quantitative questions above, we approached things a little differently and then used our expertise to translate to the number we required to find the perfect house or build the perfect training center? What if we really got personal to understand the needs of the client? Then we may ask questions like:

1. How big is your family?
2. How long do you plan to be in this house?
3. What are the ages of your children?
4. Do you have any extended family that might eventually live with you?
5. When the kids get older, do you think everyone will have their own car or do you plan to share?
6. Do you like to cook and host dinner parties or prefer to order in or eat out?
7. Do you like going out for entertainment or do you prefer to stay home?

From these questions, we might be able to determine size, number of floors, number of bedrooms but we also focus on growth and long term viability of the property.

Now let's apply that methodology to the training center model:

1. How many and which programs will be utilizing this training center?
2. What is the average daily throughput of students?
3. Are your primarily using simulation for summative or formative assessment?
4. Is there a departmental goal to increase the percent of simulation as part of the curriculum?
5. What is the average size of your cohort?
6. What is the size of your simulation team?
7. Are OSCE's used as part of your curriculum?
8. Do you use cadavers in your curriculum?
9. What areas need to be close by to other areas ("adjacencies")?
10. Do you prefer multi-use rooms that require additional set-up and storage or single-use rooms?

From the answers to these questions, we can help determine the size of the building, the adjacencies, the number and type of rooms, and everything else required to design a training center to meet the needs of the client.

It's more than just asking the right questions

I wish it was as easy as creating an online survey and asking the right questions. It's a start, but this approach certainly requires a little more structure, process, tools, and subject matter experts. Just like the example of the home, your current behaviors and approaches may not be ideal. You may have adapted in the past to operating in a smaller space with less than optimal flow. It may have impacted the utilization of the building and the program. This is a perfect time to weigh current practice against industry trends and best practice. Maybe you only use summative assessment but should be using more formative, but historically couldn't because you didn't have the facilities to do so. Maybe you haven't yet been introduced to mixed reality so you can't imagine a mixed reality lab.

It's more than just a TNA

By now, you are probably thinking "that's a bad acronym," and I totally agree. Not just because it may have negative connotation in a different setting but because it doesn't fully capture the full picture. What we soon came to realize is that building a perfect training center was more than just capturing the training needs -

Building the Perfect Training Center is about capturing and analyzing training needs, operational needs, and facility needs.

We realized that we needed to take into account optimization of workflow, analysis of roles and responsibility, review of policies and procedures, flow of learners, safety, security, etc.

What did we find?

I would be lying if I didn't say that it got easier with every analysis because we started to see trends in the data. Our recommendations started to look like somewhat carbon copies with some customization and localization. Ultimately, most sim centers suffered from the same issues and had similar aspirations. Here are some tips to remember when building your next training center:

• There is never enough storage (in room, in hallways, dedicated spaces). The same can probably be said by homeowners. With the change in trend to multi-purpose rooms, you need a place to store the equipment you aren't using at the time in a way that facilitates easy set-up and tear-down.
• Think about the flow. You want to optimize the flow of learners so that you can run multiple simulations or multiple OSCE's at the same time. The trend of having a separate pre-brief area to the debrief area is the equivalent of a theme park creating the preshow, then the ride, followed by the store. You are constantly moving the crowd without long wait times and always engaged.
• Stacking and Adjacencies. When building a multi-story building, consider what spaces need to be near other spaces. Where is your laundry and changing rooms if you have cadaver labs? Is the storage close to the multi-purpose rooms? Where do you need your control rooms?
• Safety and Security. Simulation Centers have a lot of expensive equipment that can easily walk. When dealing with students, you also have a lot of baggage (literally). Your design can help protect personal and center property while also providing a safe environment for your learners. Consider lockers, waiting rooms/lounges, and separating front of house from the back of house.
• Build for you. All too often, I would visit a simulation center that would appear to be a carbon copy of something I had seen before. Sometimes it's because the team toured a simulation center and brought home pictures or sometimes they commissioned an architect of a project they really liked. It's fine to try to replicate something you like or use a firm with experience, as long as you recognize your unique requirements. A nursing program will have different needs than a surgical residency program which will have different needs than a DO school.
• Things are always changing. Let's not fool ourselves into thinking that the way we use simulation won't change in the next 5-10 years. It's already changed so much in the past 3 years during COVID. Don't box yourself into a corner without room to grow and change. Consider products like DIRTT to make it easy to change configurations and expand to meet your needs.
• Technology is not always our friend. One of the biggest recommendations I have is making sure that you work with an A/V Integrator. Your architecture firm likely has a company they like to work with. Things have gotten so complicated but they have also opened up so many new opportunities for automation and optimization.
• One Size Doesn't Fit All. When building your space, you probably don't want four sim rooms that are mirror images of each other. Look for some variety in size and use. I tend to like a mix of small (i.e., patient rooms), medium (i.e. exam rooms), and large (i.e., surgical rooms, ICU, Labor and Delivery).
• Inter Professional Education (IPE). This doesn't happen by accident by co-locating several programs in the same simulation center. Sometimes it's about co-location, sometimes it's about shared spaces, but the ides is how you involve other programs in simulation and training throughout the curriculum. This adds a whole new level of complexity.

Did I ever find what I was looking for?

I don't think we will ever find "The Perfect Simulation Center" because one does not exist that is perfect for everyone, but I hope that those we have helped in the past find that their centers are efficient, highly utilized, have great flow, are safe and secure, and facilitate their style of learning. I find something always gets in the way of implementing your full vision whether it is time, money, schedule, or reality. Don't let perfect be the enemy of good enough. There is always something we wish we could have done better if we just had a little more time and money. Building a center is an exercise in negotiation , prioritization, and trade-offs.

What's next on the horizon?

Of course, I will continue to write weekly though the pending hurricane might impact that goal depending on its path. I am also proud to be an invited guest on The Sim Cafe~ Podcast next month. I hope everyone will tune in then. Until next time, please remember to like, share, and comment as you see fit. If you haven't read my previous blogs, I invite you to check them out on my profile page, Brian Levine, MBA, PMP, CSM , in the featured section.