Bridging Two Worlds

My journey into the world of medical simulation began serendipitously in the early 2000s. As a basic scientist at a Harvard Macy program, I found myself intrigued by the potential of simulation technology. I observed students engaging with a simulator, a striking substitute for bedside patient interaction. While others saw clinical scenarios, I envisioned something transformative: students experiencing pharmacology in real-time. Around this time, I joined Ross University School of Medicine formerly in the Caribbean nation of Dominica, where innovation was welcomed. My initial vision was simple: use simulators to demonstrate pharmacological effects in real-time. Showing students the physiological impact of a drug was far more compelling than traditional lectures. This practical demonstration was what I imagined could transform pharmacology education. The turning point came at the Association of American Medical Colleges annual meeting in 2002. Our new dean and I were captivated by the capabilities of a simulation mannequin displayed by a company. After an impromptu demonstration that involved administering epinephrine to the mannequin, our dean's reaction was decisive—“We've got to get one of these.” By early 2003, we had our first simulator. In Dominica, implementing a simulation program meant contending with power outages and tropical storms and maintenance in a tropical climate. Every equipment failure meant days or weeks of waiting for parts. However, these constraints pushed us to be creative, developing low-tech alternatives and backup plans that would later prove invaluable in my career. In those early days, I would stand at the door of our simulation room, hesitating before entering. As a basic scientist with no clinical experience, I felt like an impostor. I had never taken a pulse, auscultated a chest, or started an IV. The sophisticated mannequin lying there represented both possibility and intimidation. My saving grace came through collaboration with Dr Ian Winston, a clinician whose deep understanding of basic science matched his clinical expertise. Together, we created our first case about acute asthma, whimsically named after the Six Million Dollar Man, Steve Austin. I learned clinical skills from Ian, and together, we explored ways to blend basic science with clinical practice in ways that made both meaningful. My “outsider” perspective offered unique insights into teaching clinical concepts. My initial vision was realized with our Steve Austin scenario, as students observed the effects of their treatment, albuterol inhalation, through chest auscultation, oxygen saturation, and pulse. Each successful simulation strengthened my confidence, although the impostor syndrome never completely disappeared. Our program at Ross grew from one simulator to 5, each expansion bringing new challenges and opportunities to innovate. We learned to maximize every resource, run multiple simulators simultaneously, and find creative ways to engage larger groups of students. When I later moved to A.T. Still University School of Osteopathic Medicine in Arizona, I found myself in a different context. This new school embraced simulation with state-of-the-art facilities and 11 simulators built into the curriculum. As Director of Human Simulation, I drew on lessons learned in Dominica: the importance of backup plans, the value of simple solutions, and the power of human connection in teaching. My subsequent role as Education Director for Simulation at Geisinger Commonwealth School of Medicine presented another challenge—a new school but no building. They, too, embraced simulation, and we initially built the program from scratch in borrowed space before moving to a larger facility. My experiences building a simulation program at Ross were invaluable in preparing me for the challenges of starting a program in these new medical schools. In parallel with our local efforts, I became involved with the broader simulation community through conferences and workshops. I co-developed workshops on using simulators in preclinical education and flipped classrooms, sharing insights and learning from others' experiences. These collaborations culminated in presentations and publications, contributing to the growing body of knowledge on simulation in healthcare education. Despite my growing expertise, I still felt like an outsider in this clinically dominated field. In 2012, the Society for Simulation in Healthcare began its Certified Healthcare Simulation Educator program. Being among the inaugural group to earn this certification was more than a professional milestone, it validated my place in the simulation community. Moreover, I realized that my background as a basic scientist was not a limitation but a unique lens through which I could view and enhance simulation education. I've since recertified 3 times and was a member of the Certified Healthcare Simulation Educator Blueprint Review Advisory Team. Creating materials for day-long workshops at annual meetings and helping others prepare for certification gave me deep satisfaction in helping others bridge the same gaps I once faced. The simulation community's acceptance came gradually but meaningfully. I remember the surge of validation when I was first invited to give a plenary talk on simulation at an international education conference. Colleagues from my basic science network began seeking my guidance on simulation education, which was particularly meaningful because they came from people who knew me first as a pharmacologist. When A.T. Still University specifically sought someone with both pharmacology and simulation expertise, I realized I had not just found my place—I had created a unique niche bridging 2 worlds. My journey has reinforced that our most powerful teaching moments often come when we bridge different worlds. Through developing workshops on simulation in preclinical education, I've seen how my dual identity as both basic scientist and simulationist can enrich both domains. What initially seemed like a disadvantage, being a basic scientist in a clinical world, became my unique contribution to healthcare education. Looking back, I did not need to be a clinician to contribute meaningfully to simulation; instead, by embracing my unique perspective, I found ways to help others cross the same bridges I once feared. Each simulator, every institution, and gaining certification were more than professional achievements; they allowed me to call myself a simulationist.