Gina Shannon, MAT is Director of Human Simulation Education Center, Emory University School of Medicine. In this episode Gina talks about her journery from teaching theater and dance at a college prep school to working as a communication coach and simulated/standardized patient through to her current leadership role. Gina is a strong proponent of experiential learning and as an education leader, she talks about how important it is to "cultivate a team that champions failures, that recognizes mistakes are okay" and "recognizing that our failures or mistakes can also fuel our successes". Her other words of wisdom include: "making sure that you're cultivating work environments that people feel like they can work, ask each other questions, and be able to support one another. If something happens and someone can't come in or do different parts of their work that someone else can pick it up." and "To be an educator, you also have to be a learner and become familiar with how you best learn."

Resources

• Find Your WHY – Simon Sinek
• Simulation in Healthcare
• Association of SP Educators
• Society for Simulation in Healthcare

Hello, listeners, welcome to Educational Landscapes, lessons from leaders. On today's episode, we're going to learn from Gina Shannon, welcome to the show, Gina.

Hello, welcome. Thanks.

Thank you. Thank you. So to begin, what is your educational leadership title or titles?

Great question. My title is Director of Human Simulation Education Center.

And what do you do in your role?

Kind of a mix of two things. So I handle operations of the center, so that's budgeting and all sort of operational things to keep the center running. And then I also am a simulation educator, so I also partner with our faculty to design and implement simulations. I have a team of simulation educators that I work with to help develop better curriculums to make sure that we're meeting the learning objectives and goals for our learners through simulation.

Wonderful. So can you talk a bit about... I know when people hear simulation, people can take it many ways. Can you talk a bit about which area in simulation, because there's people who talk about the different mannequins, then there's human simulations, which do you deal with?

So only humans, for the most part. We do some hybrid simulations. So we partner with the Excel center and do some hybrid simulations, which are perhaps there's a mannequin in the bed as the patient, but there's a family member or embedded participant of some sort that's like a simulation healthcare worker, like a healthcare worker. So we'll do some of those hybrid sims. But overall, I would say 99% of what we're doing is human simulation. So we are working with folks that we call SPs. They can be simulated or standardized patients, but the industry title is SP. That's who I work with primarily. We have about 120 independent contractors who work with us as simulated or standardized patients.

That is a lot of people.

It is a lot of people, yes. I also have a team of six that are full-time staff that we work with too.

Wonderful. So as I think about your role and all these people and operations, SIM educator, what skills do you use in order to be successful in your roles?

It's funny, when I read this question, I was thinking of skills and characteristics. It was kind of those blended together, but patience is definitely a characteristic that I utilize a good bit. Strategy, creativity, kindness, and adaptability. Those were the ones that really stuck out for me. And I think about how I use all of those daily in working with humans.

It's very important. And you're dealing with humans at multiple levels?

All levels. Yes, yes, yes. So we're working with the SPs, the learners, faculty, anyone else who is involved, tech, any of the IT folks. So yeah, we have a lot of different folks that are working in our center. I think it's a perfect example that it takes a whole team to make a lot of things happen in learning.

Indeed, indeed. So I recognize that you probably didn't just start off a director of simulation education. So what was your journey that led to this current role?

Well, it's a long journey because interestingly enough, most people don't... I mean, certainly when I was getting my degrees, simulation was not a degree. Within the last five years there have been more programs, masters programs, simulation programs. But for me, that was not the case and for many who are in my position elsewhere. So getting here is always such a fascinating journey.

I was living in St. Louis, Missouri, and I was teaching theater and dance at a college prep school. I was also working at Wash U, Washington University at their medical school, and I was a communication coach and SP. I started doing a lot more independent communication coaching with their students who were struggling with patient interactions and just struggling with having difficult conversations and also just taking a history. I was doing that in the summers. And then I moved to Atlanta and knew I didn't want to continue in a formal classroom anymore, teaching theater and dance. So I applied to be an SP at Emory, and I sent in my CV and very shortly after that, they called me and said, "Hey, would you be interested in actually working here on a more permanent basis in a part-time trainer position?" So I was like, "Oh, gosh, I don't know, but I'd be happy to come in and I'd love to know more about your center and what you do and how you work and operate." I came in and took a tour of the space and asked some questions about the work.

And then I said, "Sure, I'd love to interview." And I interviewed and got a part-time position as a SP trainer, so program coordinator role, and I did that for many years. I moved to full-time. I then became an assistant director. And then in 2016, the director at the time was kind of moving into retirement; was moving to a different role within the center, and I was asked if I would be interested in applying for the director position. And then I got it. So I've been the director for since 2016, which is shocking, but it's gone by so fast. I've been in this role for a while it feels like.

That is an amazing journey when I think as you're talking about theater and then director. I mean, they're linked, but it's an interesting-

Definitely. Yes. Yeah. And my master's is in teaching and learning. So my master's project was around experiential learning and how taking folks who have disabilities, I went to a place where they would... A day camp that folks, older adults who had disabilities, I would do improv with them. So just like how creativity, how we can blend performance to overcome a lot of social and just being able to connect with one another and create. So a lot of my work is around that and around looking at, using experiential learning to develop different daily tasks and roles. And now I'm doing that with learners, medical learners and healthcare learners.

That is amazing. Wonderful. So as you think about the journey that you've had, and you're now in this director role, what do you wish you knew before stepping into... Whether it's this role or when you feel like you had stepped into a leadership...?

I think in particular in this role, something that I felt like I was ready in many ways, but felt like I wasn't ready in other ways. But I'm a firm believer when the door is open, you walk through it. I believe that opportunities are there and they may work out and they may not. But I am a firm believer of walking through the door. One thing that I think I've worked a lot on and wish I would've known, but I'm not sure I would've really... If someone told me this, I'm not sure I would've totally accepted it. But that you're not going to make everyone happy and that it's just no matter what you do, it's just not everyone's going to be happy. And that's okay. That is okay.

Another, something I wish I would've known is that no can be very freeing. As I mentioned before, I'm an improviser, and so "yes and" is a part of my ethical being. However, in many scenarios, no can be just as good as a yes and because it's a yes, and to yourself. And also the third thing that I really feel like I've learned is that when there is a conflict or just a difficult situation, really addressing it right away instead of letting it linger is such an energy efficiency process that it may not be what you want to do. Having a difficult conversation with an SP about their performance or having a conversation with a faculty member about a simulation, why it may not be actually serving the learners in the way we had hoped.

I realized that having those conversations as soon as you can, really helps preserve everyone's time and energy because somebody is mulling over it and thinking about it and agonizing over it. And it's just so much better to have those right away, because that's when you can admit failure or faults or mistakes and be able to move through them and get to a better place sooner versus just repeating it over and over again. Those are things that I wish I would've known. But once again, I'm not sure just knowing myself that if someone would've told me these things, that I would've accepted them. But those are big things that I wish I would've known.

Thank you. I think it's so interesting, as you said, because you're right, I have learned the phrase "yes and" from you, and so to hear you say, yeah. And no is a complete... Is an important lesson.

And it's a hard one.

Yes, yes it is. And I think about the skills and characteristics you said and how much that links to being able to address those different challenges that you may...

Yes. Yeah, definitely.

So as you think about the work that you do, what continuing professional development do you do in order to keep up with the needs of your roles?

I am a big advocate of reading about publications within the field. Human simulation. When I first started, certainly 12 years ago, there wasn't a good bit written on human... I mean, there were certainly books and folks like Peggy Wallace and Rachel Yudkowsky are sort of pioneers... And Howard Barrows. Those are folks who are pioneers in the field and they wrote, but beyond sort of research and things like that, because it is humans and so it can be really hard to measure and to be able to write about. So because that has increased and people are far more champions of this work than there have been in years past. I try to keep up with reading, so at least, I read at least one or two articles a week about another place. It could be a MedEd portal article, but it also could be from JAMA, all the different places. And SSH, they have a journal that I read and in Axle. So I just try to keep up with things that are happening.

I also like staying connected with other folks in the field. I have a group of folks that I meet with once a month. We call ourselves PALS... And we are, oh gosh, now I can't even remember what it stands for, but it's basically simulation leaders. So it's like different folks in simulation director positions throughout the US and we all kind of meet and just talk about the things that we're experiencing, and from hiring SPs, diversifying your programs, to how can we collaborate, how can we work together? The University of Minnesota has a pretty strong online telehealth programs that they do. They were asking for SPs and so I want our SPs to be able to work in other places. So I've been able to connect our SPs to get more work, and they're in Minnesota. That's been a big part of it. And then presenting and attending our annual conference ASPE for SP educators is a major part of it.

Wonderful. So you threw in some acronyms in there. What does SSH stand for?

Oh, thank you. Yes, sorry. Gosh, I just lean into that. Just the healthcare, doing all the acronyms. SSH is the Society of Simulation in Healthcare. They're an international association. They have an annual conference. And then ASPE is the Association of SP Educators. That's also an international association that meets annually.

Thank you. Thank you, thank you. So as you think about your experiences to date, what advice would you give someone interested in doing the same type of leadership roles that you have?

So as a leader, just generally, I think the major, major advice I would give is that you need to cultivate a team that champions failures, that recognizes mistakes are okay, we just have to learn from them. And that we don't all have to be hanging out after work together, but we do have to be able to work together. And what does that look like? Communication. Just making sure that you're cultivating work environments that people feel like they can work, ask each other questions, and be able to support one another. If something happens and someone can't come in or do different parts of their work that someone else can pick it up.

I always say we are a constant group project. Everything we do is very much a group project. So when I say a team, it's not just the immediate team, but it's like all the partners and folks that you affiliate with. And you really, that's a big, big part no matter what field you're in, no matter what you're in, that's a part of leadership. I also am a big supporter of leaders come in all shapes and sizes. Just because I have a title does not mean that I have to lead everything that's happening in the center. I have some incredible humans that I work with who are really smart and are proficient in ways that I will never be. Utilizing their talents and allowing them to lead a project or lead something is huge and I don't need to be the head of that.

I need to support them and guide them and coach them if they need it or want it. But other than that, I feel like you want a team that can work together, who can do anything together. As a simulation leader, goes back to the question before about professional development, make friends. I mean, I would not be where I am in my career as a human simulation educator without all of the many people that I have met along the way. I've had such incredible mentoring from folks that have started programs, I've had such an incredible... Gayle Gliva, she's a major figure in simulation, and I had the great honor of writing a book chapter with her.

She was the original SP, she was an SP for Howard Barrows, who is the person who started SP work in the US. She was an SP with him in San Diego, and she's now retired, but she's... To be able to collaborate with her and ask her like, "Hey, what would you recommend in doing this?" I think that SP work is so young. It started in 1963, and so it's a pretty young field when you really think about it. Just being able to find out what other people are doing and how they're doing it, I think that's a major part of simulation is we learn from each other.

Wise words. Thank you for sharing. As you think about the work that you've been doing as a simulation educator, as a leader, how do you support or expand education in your profession or through your roles?

I am very, very involved in the Association of SP Educators. I have been, since 2013, I became involved in the abstract submission subcommittee. So I've been working on that committee of being able to vet all abstracts that come through to be presented at ASPE. And I've served in many different leadership roles within that committee. And it is such a incredible ability to be able to read and understand what other people are doing. So being involved in the association is huge. I also, as I mentioned, wrote a book chapter with Lou Clark, Gayle Gliva and Jamie Pitt. We developed a theoretical framework. It's called the Human Simulation Continuum Model. It's an application that can used when designing simulations. That's been a huge part of continuing my education. I'm a firm believer that you have to do and keep doing.

I've also partnered with faculty here at Emory and written articles about the work that we do. There's an article that's being submitted right now with the School of Nursing and also the physical therapy program. We've been doing an interprofessional simulation for I think upwards of five or six years, and we just submitted a paper on it. So that's been a major part of expanding education. And then beyond that, I really encourage my staff to continue because as I mentioned before, you're only as strong as your team. And I want them to have opportunities to have advancement and expand their education about the field. So I think all of the educators are on a committee or run a committee at ASPE. They're also involved in writing, and so they're partnering with our faculty to submit papers on the research that we're doing with human simulations. So that's a big part for me is providing additional education, not just for me, but for them too.

That is wonderful. And I love the multilayeredness of the education, your continuing education, the education of your team, the education of the broader public by publishing about this amazing framework. So as you think about the amazing things that you've already done, and I'm sure amazing things you'll continue to do, what would you say has been one of your greatest successes thus far?

So when I first came on in 2016 as the director, I really wanted to find a way that we could, as a team, be able to talk about what we do in a really succinct way without it being a long, lengthy mission and vision, but just something that was succinct and that could be a guiding principle for us. And then Simon Sinek, he wrote a book... Oh, gosh, I can't remember the title of his book. But the principle of what he does is that he really is a big promoter of different organizations, companies really finding their why. So why do you get up every day and go to work? Why do you continue to work here for some of the staff? Why do you battle Atlanta traffic to come into work? Why do you decide to spend an hour and a half in your car to come here?

And we did some work that he had developed on how to do that. As a team, we developed our why and our why is "we enhance human interactions". And for us, that is really our North star. Whenever we feel like as a team, one of us may feel a little off kilter or frustrated by something, you know humans, we just kind of keep going back to that because it's not... When we say human interactions, we don't mean just SPs and learners, their encounter. We mean how do we collaborate with our faculty partners? How do we include the learners in our decision making and case writing, our SPs, are we writing cases and developing simulations that are authentic to patient experiences?

So it's just really, it guides everything we do and why we do it. It's just been a really great North star for us, and it was such a cool process, really hard process. We spent all day developing it. He has some really specific steps and a workbook that you can work through. So it was a really great exercise for all of us because I think we individually developed our why's of why we come in, and then we then as a group reflected and developed the center's why.

So I think that has been one of our biggest successes. I think that, and then I think also success is awesome, and success also comes out of failure. We've had many sort of bumps and mistakes and failures too. And I think we have discovered that those have made us more successful, and those have helped us figure out recentering of, okay, that didn't work. We're a big fan of piloting things, and we have certainly piloted some cases that we were like, "That didn't work, and we are not doing that again." And it was great. And I think that's really important too. So I think those are two things, is just recognizing that our failures or mistakes can also fuel our successes.

I love that. And it makes me think about... I feel like I saw it somewhere where the word fail was written as first attempt in learning.

Oh, that's so good. I love that.

So I like that because it definitely reminds us that failing is an important aspect of success. It's not just everything went well.

Oh, yes.

So as you think about these different things that you've done to help you along the journey to your successes, what would you say are some of your biggest growth opportunities right now?

Well, coming from a performance background, I am always working on things because you never arrive. And I'm a firm believer of that. So one thing that I'm working on currently is being better at delegating. I think for a long time, I believe delegation was just like someone dumping your work on someone else, and that is not right. And I think that's one that I'm working on because I think going back to recognizing that I have team members who are really excellent at developing spreadsheets that can help track data, getting them involved doesn't mean that I'm just handing over the project. It means that I have recognized that that is not a strength I have. However, I have someone on staff who is really good at that, and it will take them half the time it's going to take me and they're going to enjoy it. I think that's delegating, but in a thoughtful way that allows people to utilize their talents and their strengths.

And then also another thing that I've been working on or a growth opportunity for me is finding ways to cultivate joy within my work. So really discovering... You and I have had this conversation about continuing education and going and getting another degree for me. And I think that's where I'm learning is where do I want to continue to grow? I'm very drawn to education, into learning in particular, how we learn. I've been really exploring different programs or certificates that I can go through to just expand that. I think being intentional about carving out time to dedicate to learning a little bit further around those.

Thank you. Thank you. As you reflect on your experiences to date, what do you love most about your work and what you do?

I really believe what we do matters and makes a difference. Patients will be here always. And I think to get our learners opportunities to work with patients and to learn in those environments versus being thrown in without seeing a patient in the clinic versus seeing a patient with us first. I think about all the many palliative care conversations we have constructed and hosted in our center, and how grateful I am that we get to do that work with the palliative care fellows and PICU fellows and all those acute care, those folks who are in those places where they're having palliative care conversations. I think it just matters. What we're doing matters.

Last night we had a little celebration for an SP who's been with our program for 13 years, and she and her husband are moving to Kentucky. And we were talking about the work we do, and I was just really kind of listening to all of the SPs talking. And a lot of the SPs that were there have been with the program longer than I have or have been there... They were one of the first groups that I was a part of hiring. And a lot of them just said, "At the end of the day, I know what I'm doing matters." And that is just, I think that just makes a huge difference. I think we've all encountered some maybe not so great healthcare scenarios. And I think if we can just make sure that we're infusing these principles and ideas with all of the learners that go through Emory's programs, I think it's going to make a difference. We don't get to directly see it always, but I do believe that it makes a difference.

The secret sauce, mattering.

Yeah. Yes. Seriously. Yes.

Thank you. So as you continue to reflect on your experiences to date, what would you say are your passions currently around education? Or what would you say your educational philosophy is?

Well above all, I believe experiential learning is crucial. I'm a big proponent of it, obviously. I really think that learning, especially in this field is doing, and I think that you have to practice the skill. As a former dancer, I think about how many times I would have to do something to develop the muscle memory of it. And that is like... Sometimes you heard the music and you did the steps, you followed the steps, but maybe you were off a little bit. But the moment that you have done it so many times and you become connected to yourself, but also to the higher world of creativity. And I think that the more we allow our learners to be able to practice these skills with patients, clinical skills with patients, the better they're going to be when they go out into the field and the more adaptable they're going to be.

So they're going to be hit with all kinds of different scenarios that we may not have practiced here in our center. However, they can go back to the foundations and roots of what they learned and tap into those spaces to be able to be adaptable and connect. And I think it's just like dancing where you are stumbling through, there's constant mistakes and failures, and then it connects. Then there's this "aha" moment where it connects in your body and in your mind. And that I think experiential learning can do those things for learners. It makes such a difference because you can talk through a case, but until you figure out how to ask the questions from your patient to figure out what is your differential and rule out by doing a physical exam, I mean, you can't do that on paper. So yeah, I think it's just using experiential learning to improve growth.

So important. And as you were talking, I was thinking about that adaptability and finding the foundation; how important that is. But I feel like somewhere along the way, sometimes because we add so many things, we forget to go back to those foundations in order for those to become, as you said, the inbuilt skills that can then be applied.

Yes, yes. Because we want it in their bodies. We want them to be able to trust themselves in their next steps.

You're now making me think, I know I've read it somewhere, embodied learning, but now I'm not sure.

If you find anything, let me know. Oh, I'm into it. Yes.

Will do. Will do. But yeah, that brought that memory. I was like, I read that somewhere. I wonder if it is closely linked with experiential learning. But yes, I will definitely get that to you. Thank you. So I know we've spoken a lot about work, your career, but we know you are more than what you do. So what are some things you do outside of work to help you maintain joy in life and practice?

So as no surprise, I like working with my hands, so I love gardening. We have seven raised garden beds on our property, and then we have this beautiful 30 year old fig tree. We do a lot of preserving and harvesting and yeah, it's just such a cool, oh my gosh, such a cool process that you put a seed in the ground and if you nurture, it'll grow. And what it can grow is just remarkable. Hiking, I love moving. So we do a good bit of hiking. We're soon to go to Cloudland Canyon and Little Canyon to go hiking. Those are in Tennessee on the Tennessee, Alabama, and Georgia border. I'm also, love creating with my hands. So from building raised beds to, I'm now dabbling in clay and kind of doing some impressions of fig leaves. I'm really interested in preserving the sort of leaves within our different crops and things like that, and being able to preserve them in clay and kind of create bowls and things like that. So yeah, I paint all kinds of things.

Definitely the hands. Definitely the hands.

Yes. Yes, it is. It's definitely being able to create something with my hands that is... Yeah.

As a fellow gardener, I'm always curious, you talked about preserving stuff. What do you like to grow right now?

So right now our fall crops are, we have radishes, which are so easy to grow. And in Georgia it's very easy. We also, kale and collard greens are always in our beds. We have green chives that have been really doing well. Carrots and sweet potatoes are right now what we're growing. And then we have lots of herbs, which has been a newer project, is I've been drying our herbs so that we can keep them longer. I've been doing a lot more of that. That's what we currently have. The peppers are still going strong. We have eggplant that are still going strong from the summer, and some of our tomatoes are still coming in. So it's been interesting... This year has been a really interesting cropping.

Great, great, great. Well, thank you for indulging that additional part for me as a fellow gardening geek. So those were the core questions I had for you, but before I let you go, any last words of wisdom for aspiring educators or education leaders?

Yes. To be an educator, you also have to be a learner and become familiar with how you best learn. And that's a question I ask almost every candidate from SP to staff is like, how do you best learn? And that's a question that I don't think we always think about, but I think it's something that helps us also connect with one another. And I think that becomes our communication skills. So I think if you are interested in education, think about how you learn and explore those avenues. Also, it's hard. I used to say being a teacher in a classroom was probably the hardest work I've ever done. And I think you have to be willing to fail, and it's okay. It's okay. And just allowing yourself to do that and be able to grow from it is such a gift.

Indeed. And thank you for the gift that you were to us on today's episode.

Thank you. This was so much fun. Thank you.

You're most welcome.