Welcome to this episode of NLN podcast Nursing EDge Unscripted. I am your host Dr. Steven Palazzo, a member of the editorial board for nursing education perspectives. In this episode, we will discuss the process of designing and implementing AI-enabled opiate involved overdose simulation scenarios to aid pre and postlicensure nursing students in learning how to assess, respond to, and manage opiate involved overdoses.
My guests today are Dr. Beth Anne Swan, interim dean at LaSalle University in Philadelphia, Dr. Nicholas Giordano, assistant professor and Laika Steiger, associate dean for clinical practice operations, both from Emory University. We will discuss their research brief, integrating artificial intelligence technology into simulation for pre and postlicensure nursing students. This article can be found in the March April issue of nursing education perspectives. So, welcome. Glad
you're here. Thank you, Steven, for having us. So, let's get started. I think one of the interesting things I found and I'm sure the readers will be interested in is especially those listeners who are not familiar with simulation technology. Walk us through how AI enhanced manikins differ from traditional high-fidelity manikins. I'm really especially curious about what's the difference in terms of learner interaction, faculty training requirements, and the overall
cost investment. It's a great question. So we know high-fidelity manikins today, right, are are have a high level of realism. So they can blink, they have heart sounds, they have lung sounds. There is typically somebody speaking for the patient, either a faculty or a sim tech. So the AI-enhanced manikins adds a different layer to
that. So there's still high fidelity, so it does everything that your regular high-fidelity manikin can do, but then adds on things that make it more autonomous, responsive and a bit more realistic. So typically your scenarios are pre-programmed, you are running them, there's some sort of learner interaction, and your faculty or your sim might change what's happening, right, based on what the learner does. So now you have an AI manikin that is much more a patient and you're having
natural conversation with it. So your patient is responding as if your real patient does. So it's not necessarily pre-programmed. And of course there's some pros and cons to that, right? So often times we're like very ready that the patient is going to say this. These AI-enhanced manikins may say that or they may choose that they want to say something different depending on the day and what that looks like. They are also a bit
more realistic in their movement. So, in the one that we have and that the study that we did, you will tell him to shake the patient's hand and it actually raises up its arm and shakes your hand. So, we have never seen anything like that. Their facial droops and makes it a lot more realistic in terms of when a patient is having a stroke. So just the level of realism is much higher with these AI enhanced manikins than what we have become accustomed to. With that obviously
becomes more training. So now as a faculty you have to design a much more learner centered experience, right? So it's not as clear-cut what may happen. And so you're anticipating what the learner may do, but you're also now anticipating what your patient may do. And as you are in real life, you can't always anticipate
what your patient is going to do. So it makes it for a different experience and the faculty and I have to learn how do you go along with that when your patient isn't doing something and still make it a meaningful experience for your learners. I think the learners have to experience that differently. When we take them from one manikin to the other and they notice the difference, it
is a huge difference. That was one of the things that we really highlighted on in the first round of this study is that your pre-brief is always important, but the pre-brief here is almost even more important because we needed to let it know this is what this manikin can do, which is very different than what they had been accustomed to in the past. So it makes it a much more realistic experience. It does take longer to prepare for a scenario with that. There's more training for
your faculty. And it goes without saying that the cost is definitely more with these manikins than sure with the traditional manikin. So, you really do have to decide, right? Is it the right one based on where you are at your facility and what resources you have? Were students surprised when they first encountered this manikin? Was it like some like how interactive it was? Beth, you want to answer that? You were in the room with
them. I would say yes. They were so as like I said they completed the pre-brief but until you're actually in the room and Emory how is actually talking back to the students the one student kind of jumped back you know he's like oh like he he wasn't ready for somebody to talk back to him or when he when the students the postlicensure scenario was done with our nurse anesthesia
students. And so that opioid scenario is going to involve them ultimately having to intubate Emory how they were asking Emory Hal questions and as as like I said he had a script but he went off script and you know this the one student said that's not what you're supposed to say and it's it's interesting that sounds interesting. In your article, you talk about the return on investment, which is of course a big consideration for
nursing programs. Based on your experience so far, do you feel the investment in the AI enhanced manikins has paid off or would you advise schools to be cautious and wait until the technology and evidence base mature a little bit more? So I think like alluded to this that you know cost is another important distinction and that the AI-enabled manikins are significantly more expensive than the traditional high fidelity
simulators. And in addition to the cost of the equipment, there's ongoing cost related to software and updates and training. So if you think something's going to cost X, you really need to budget for more of that. related to return on investment in simulation. I see that that's always context dependent. Schools with robust simulation infrastructures and dedicated faculty and a clear integration plan are more likely to see value more quickly than programs with limited
resources. So I think that's a consideration in talking about return on investment. Our experience suggests that AI enhanced simulation has strong educational potential particularly for developing clinical judgment, communication and content where maybe faculty expertise might be limited. And it also offers a strategy to extend faculty capacity
which is a growing concern in nursing. But again, I would say that technology is just evolving so rapidly that the most important recommendation is to move forward with being open but intentionally cautious. Schools should do their due diligence, align their per purchases with curricular goals. And I think sometimes when we see a new shiny piece of equipment, it's we want it, we want it, we want it, but have we really considered where it fits with our curricular goals? How scalable is
it? And are there other low-cost AI solutions be before investing in a single high-cost platform? because with everything being evolving so quickly, I'm not saying the equipment is obsolete, but there's so many more solutions now available that may not cost the same. So, I'd say the value is really not in a specific manikin, but it's really in the thoughtful integration of AI supported simulation and really being responsible stewards of resources that each of
our schools has. Well, can I ask then what what got you guys to that place where you decided this was the technology you wanted to use? So we were building a new simulation center, you know, the 70,000 square foot, state-of-the-art state of the science simulation center. And our opening was going to be in the fall of 2022. And some of our faculty and team went to a conference and saw this manikin and came back and said to our dean, "We have to have
it. We have to have it." And so the dean said, "Fine, buy it." Wow. And Emory Hal showed up, I think, three days before our grand opening. and every house kind of became the centerpiece of the opening, of course. And it was this has this is great. Nobody else has it. We have to have it for our opening. And that's kind of how it it went, right? I think it's very relatable then, right?
Because this is what's going to happen. I'm going to go downstairs after this podcast and talk to my simulation director and say, "Look into this. I want one of these AI manikins." So, I mean, I think that's kind of how those things start, right? You get interested in something, the new technology, it's shiny and new. Sometimes it doesn't go the right way because it we don't really need it. And sometimes it turns out to be a great thing, which sounds like from your work,
this is turning out to be a great thing. So, I'll defer to Laika and Nick since they're in memory. I was going to add that I think you're absolutely right because it happens all the time.
We all go to conferences and we wowed like we are like oh this is great we need to have this and we think that we have so many ways that we can use it right and then you you get into it and you think about oh do we really can we really use this right what does that look like so I do think our recommendation is you know sometimes you have to pause and look at that but I think even for us the the advertising and the marketing that we were able to do with that right the ability that
we were able to say, hey, we do have something, right, that can possibly make a big educational impact to our learners and to others and and look at what Emory is doing with simulation and others. I think that alone is is a good ROI,
right? to be able to show that we are always looking at and always investing in things that are going to be helpful for their education and for other faculty to notice that yeah you know what Emory is willing to invest in things as it makes sense to the program and that makes me think of your comment Dr. Palazzo around the evidence base and I think this gives a lot of credit to you know Dean Swan and Dean Steiger at the time like we have the infrastructure to do some really
cool research in a way that other institutions other teams may not be able to build study around this kind of new technology and expect to just be plopped in and you know figure it out on the
fly. And so this you know article is really I think a nice roadmap for others and for our own team when we think about the future direction of whether it's this technology or other AI-enabled technologies and simulation the future how could we really be purposeful once we have these kind of really cool innovative devices in our education space and engage team members to look at you know not only learner relevant outcomes around knowledge and attitudes in certain
simulation experiences just like we would with high fidelity simulation but also what does that look like for their experience? You know, what do they like? What don't they like? And I just feel so privileged that we had the resources, time, and expertise as a collected team to come together and design a study around it. And you know, that's just step one of a long series of studies we'll be doing in the simulation space. And soon we may be asking the manikin's experience,
right? From their perspective, that'd be an interesting good study, right? Looking ahead, how do you see this technology being used moving forward in your program? And based on the students survey results, what specific changes have you made or are planning to make and how the AI manikins are implemented in teaching and learning?
So I think we had a lot of good feedback and when we looked at the results that the study was done on both prelicensure students and postlicensure students and I think one of the the big lessons that we had out of that is that ensuring as we know it's a best practice that the technology matches the learner where they are at right and that it's going to be the best learning experience for them and so for us realizing that we needed to focus it more on our postlicensure students
who were ready for that level of learning, right? Who we were expecting to have more of those conversations or even with our pre-licensure students who are further along in the program. So, taking early students in in their first semester or second semester who are just getting used to what this looks like and how do you have a conversation and take care of the patient and
do all of that. Now, we threw in this sort of unpredictability with the manikin and so focusing it more on our postlicensure programs and looking at it from there. Outside of that, I think that, you know, we talked a little bit today that we see today that there are options where you can take virtually any of your manikins and add AI to them, right? There's a whole host of other ways that
this can be done. And so we realize that some of the functionality in AI, that conversation piece is critical, not necessarily with that AI manikin, but that there are other ways that we can look at it and say that we need to be adding some more of that natural conversation with almost all of the scenarios that we do. And so how do we make that happen in all of our scenarios and simulations for the students? Perhaps not with the manikin that
goes along with it. Yeah. I think another thing we're kind of intentionally thinking about is always having the curricular guide how we're using the technology that the technology is supporting learning rather than adding any cognitive overload that may be unrelated to the curriculum, the content we're trying to teach. Because it's a lot to it's a lot to take in. there's a lot of stimuli happening and it could lead to some cognitive
overload. That's that's a good point. Yeah, it sometimes the new shiny thing is not the best, but it sounds like you've utilized it in a very intentional purposeful way and that you've you know you've collected data on the experience and moving forward you have a clear picture at least for now what you want to do with the information and how you want to take this forward. So, great great conversation. I'm so glad you joined us.
I appreciate the time and expertise that you all have shared with us and you know this is a great stepping stone for some schools to look into how to augment or enhance their simulation. To our listeners, if you had not had the opportunity, please look for the author's work, Integrating Artificial Intelligence Technology into Simulation for Pre- and Postlicensure Nursing Students.
This article can be found in the March April issue of Nursing Education Perspectives and I hope that you all will take a look at it and and thank you the three of you for joining us. I appreciate you taking some time out of of course what are your busy day and busy weeks. So appreciate you spending some time with us. Thank you for including us and thank you for sharing this work.