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Episode 6 - An Interview with Dr. Pamela Boyers, Associate Vice Chancellor - Clinical Simulation, University Nebraska Medical Center
19 Plays8 days ago
Dr. Pamela Boyers is Associate Vice Chancellor for Clinical Simulation and Assistant Professor, Surgery at the University of Nebraska Medical Center (UNMC). Dr. Boyers’ professional interest is to ensure that healthcare professionals (at all levels of training) are highly prepared to provide the safest possible patient care. This interest includes paying close attention to the well-being of healthcare professionals – and how they learn to work efficiently and effectively in healthcare teams.
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Transcript
Remote Work & Technology
00:00:10
Speaker
Well, Dr. Broyers, thank you for for joining me today. greatly appreciate you making time. I know it's taken us ah a bit of a couple months to to get this scheduled.
00:00:22
Speaker
um How are you doing today? Doing well, thank you, Bob. And you? Not too bad. the ah The weather is a little nicer today and in Washington. The ah humidity is down, so that makes it quite a bit more bearable.
00:00:36
Speaker
Yeah, ah too I'm sitting ah ah here on my farm ah working remotely today. ah Fantastic. um i Actually, it was funny. I was taught i had a call so with somebody yesterday. to It was a video call, and they were in ah somewhere in Alberta um working remotely, but they were running off of a Starlink.
00:00:59
Speaker
I don't know if, and and it was doing video up and down very, very well. i was um It was quite impressive. It's very cool. It's good to hear communication strategies and systems are ah expanding so that more people have access, right?
00:01:15
Speaker
From yeah anywhere, anytime. um So i don't I don't know how your connection is on your farm, but but you can always always switch to Starlink if if you need to. not And i'm i'm not we're not being supported by Starlink in any way, so that wasn't promotion.
00:01:30
Speaker
ah promotion I understand. Thank you.
Journey to America
00:01:34
Speaker
So, look, the re much of the reason i I wanted to have you was when we first met, um you know, getting getting close to two years ago in ah in Tampa ah for the first time in early 23, we were sat sitting next to each other for dinner and ah you shared...
00:01:54
Speaker
um your your background story on kind of how you came to the US and you're working your way through school.
00:02:05
Speaker
um And it wasn't easy, um but it was a fascinating story. And and if you're open to indulging me, i'd I'd love to have you share it again with a larger audience i ah and with as much details as you're comfortable in providing.
00:02:20
Speaker
Well, thank you. i I'll be glad to. I'm not actually used to talking about myself very much. I'm better talking about projects and aspirations and strategic vision, but I'll be glad to share what I can with you.
00:02:34
Speaker
Well, I appreciate that. and and And a lot of people don't like talking about themselves. I'm i'm one of those as well. um But I think, yeah you know, everyone has a story to share. and I think the more you understand about, you know, someone's background, you know, why they're where they are today, it it helps inform a little bit and, and and you know, to better, you know, guide and and figure out how to work with that person moving forward.
00:03:04
Speaker
Well, thank you. Well,
Early Life in England
00:03:05
Speaker
I'll do my best. um Yes, it's been a long journey. um ah As you know, I'm still working and um a lot of people would think I'm pretty crazy.
00:03:15
Speaker
um But strangely enough, even my 80th decade um have been they been some of the most productive years professionally of my life. So I feel very fortunate to have had a long journey.
00:03:27
Speaker
But um my journey started in Portsmouth, England. I was born... ah on the night of February the 28th, 1941. And I think everybody knows what was happening in the world at that time.
00:03:40
Speaker
ah Portsmouth Harbour was being bombed ah pretty significantly that night. It was the night of the Blitz. And... um I therefore came into this world a little early.
00:03:52
Speaker
um And that was the start of my life. and but when you say it When you say you came in a little early, what do you mean by that? so and the the the The bombing and the stress upset my mother and she went into labor a month early.
00:04:06
Speaker
A month early. Okay. why The story is, the family story is that I was born under the kitchen table because everyone was trying to shelter from the bombing and the soot that was coming down the chimneys and so on at the time.
00:04:19
Speaker
So it was a rather, as I understand it, abrupt entry and into a very difficult world at that time. i mean, that is that's that that is something to picture and and and try to you know, mentally see, I mean, being born during, you know, during a ah ah night of the Blitz.
00:04:38
Speaker
Right. yeah Right. And um on the other hand, as difficult a time as that was in the United Kingdom in England, it was a time when everybody was pulling together. So I was raised, even though I was raised in difficult and austere times because of the war, I was raised in a community where everybody was pulling together and being mutually supportive.
00:05:04
Speaker
And in fact, it was somewhat of a matriarchy looking back. i I didn't realize it at the time, but all the men, especially the active men, men who could who fit and active, were away at war.
00:05:17
Speaker
And a lot of us didn't see our fathers, me included, until um I was six years old. And during that your time...
Post-War Childhood
00:05:24
Speaker
Your father your father was in in the war at that, when you were born?
00:05:28
Speaker
Absolutely. He went he was went to war at 21 years old, like so many of the other young men. And the women were left to sort of manage the home front, as they said. And you said you said yeah you didn't meet him for for six years, so well a couple of years after the war ended?
00:05:48
Speaker
Yes, that's... Well, it was a little while after that. A year after the war ended, yes. and was he I guess he was still stationed overseas for a period. That's right. They took a little while to come back.
00:05:59
Speaker
okay So, um you know, it was ah looking back, I didn't realize it at the time because as children, you always think what you experience is normality.
00:06:10
Speaker
um It was a rather extraordinary time to be raised. But it had the advantage of being raised by very strong women and very resourceful women and also managing without a great deal um of belongings or assets.
00:06:25
Speaker
And so hey kind of gave me a sturdiness, which I think has helped tremendously in my journey throughout life. And did you do it did you have siblings?
00:06:38
Speaker
I had an a sibling, yes, six six years, seven years after the war, yes. he was Well, actually, that's not true. He was six years younger than me, six and a half years younger.
00:06:50
Speaker
So yes, when my father came back from war, another baby was out. So you were the first. and so when you're your So your father was sent to war 21. How long had your parents been married?
00:07:01
Speaker
Well, what happened in England at that time, people who were engaged a and who knew how serious the war was going to be, and that was the majority of the public, they decided rather than to have long engagements to get married. So a lot of people got married just before the men were deployed overseas.
00:07:21
Speaker
So it was probably a very short engagement of about a few months. And then as the it became more clear what was happening no in in wartime and that there was going to be you know ah parting for some time, ah a lot of couples decided that they would get married ah before before the men were deployed.
00:07:45
Speaker
So what was your life like during the fifty s then? So at that point, you'd be in high school and and going on to early college. Well, um my life, you you know, it i don't I don't quite know how to answer that, but um we were raised during a time when the men were coming back from war and instead of living in communes, everyone was getting more adjusted to living in a house with a mother, father, and if they were lucky and their father returned, and their siblings.
00:08:21
Speaker
And again, these were times when the men were readjusting to come back. and They had been gone as very young men for several years. And I think the adjustment for them was very, very difficult.
00:08:34
Speaker
And nobody recognized that at the time. There was no understanding at the time of um post-traumatic stress or the impact of war on young people. And so they were busy trying to reconstruct their lives.
00:08:48
Speaker
and My father had been a medic in the um in the military and he came back wanting to better himself. So while we were going to high school, and he was um adding credentials to become ah physical therapist. And then ultimately he was involved in osteopathic medicine, but which was just emerging at the time in England.
00:09:10
Speaker
So I don't think as children we knew any different. ah What I can tell you is that we played, when we played out of doors a lot we did in those days, and we played on the bomb sites. They were our playgrounds because so many houses had been bombed and destroyed and the gardens were still there. So we would, they hide and seek and we were pretty carefree because we don't think we fully understood as children the full impact of what had happened.
Influence of Father in Medicine
00:09:40
Speaker
And ah was was was your father being a medic and and staying in medicine, did that influence your career path greatly? i I didn't realize it at the time, but in in hindsight, I believe it did um because he was an innovator in his time. And one of the things he understood, which I think has had a great impact on me, is the mind and body connection and how critical it is not to split the two when you're looking at um humans with illness or otherwise. um
00:10:14
Speaker
and I think that greatly affected me, although again, it's sometimes we realize these things too late to thank them, right?
00:10:25
Speaker
ah did did your Did your mother and father live ah long long lives or ah when when did they pass? um Well, my father passed young. i mean, he came back from war again, like so many people did with you know problems with alcoholism and stress management.
00:10:43
Speaker
And it took a toll on a lot of their lives. um He died in his mid-60s, which was far too young. um But again, I believe it was the effects of wartime and what he'd experienced as a young man.
00:10:59
Speaker
was a very talented man, but you know, lot of these men came back with demons. And um it was hard for him to fight those demons. So um we actually ended up, um I was raised for the rest of my years um with my grandmother.
00:11:15
Speaker
And again, she was the sort of matriarch of the household. She was a very strong, very creative woman. And I inherited a lot of her. she wish She had a great influence on me, let's put it that way.
00:11:28
Speaker
She was intrepid. that That was your your your father's mother or your mother's mother? as mother My mother's mother. Okay. Yes. um So i you know i suppose the lesson is that you sometimes don't know quite who your role models are when you're a child until you look back and you see the journey you've been on and how different people influenced you throughout your life.
00:11:53
Speaker
On that point, I think it's awfully important to thank people while you as when you can. Absolutely. Absolutely. um So there were there was this a story you shared with me on your, and and I don't remember the timing of of and when you first when your your first marriage and when you got married and and coming to the US and and starting school. So I don't know the, I don't remember the timeline of that very well, if if you're if you're comfortable in going into that.
00:12:24
Speaker
Yes, again, um being raised in post-war Britain that in the 50s, there weren't a lot of options open to women professionally. um Again, i I didn't begrudge that. It was just life.
00:12:38
Speaker
um But generally speaking, you had the option to become a teacher or to into nursing or lot of people got married right after high school. If you were very fortunate and you had you know good information,
00:12:50
Speaker
families with influence and money. ah You know, some women were going to university, but that for obvious reasons wasn't going to be my my choice. we weren't I wasn't raised in a family with um a great deal of money or influence.
00:13:04
Speaker
So um after talking with a favorite aunt about it, I decided that I would go into nursing and I got um ah a position in a London hospital and a training hospital and absolutely loved it. I loved everything about it. um I began to find out who I was and what my capabilities were and learned a tremendous amount from patients.
00:13:27
Speaker
So can you can you explain a little bit about what the process was in of becoming it? So there wasn't it wasn't going to nursing school formally. It was kind of like an apprenticeship? No, it was a nursing school. They did have nursing schools, and they were very different, though. You you did...
00:13:45
Speaker
clinical work alongside your education, but it was a very, very good education with very good and dedicated nurses who were the faculty members, as we would call them now, um in this London hospital.
00:13:57
Speaker
And um we so we did a mix of classes and then patient care, classes and patient care. So your patient the patient care was intertwined with your learning um right throughout your training.
00:14:10
Speaker
But i I do feel I had an extremely good training, um learned a tremendous amount about life and about people, especially working in emergency rooms and working at night and working in the ORs.
00:14:24
Speaker
um I just felt like a sponge soaking it all up. And um again, when I look back, a lot of my lessons were from the patients I took care of, um as well as my colleagues.
00:14:39
Speaker
So how how long did you work at that at that hospital? or And how long how long was nursing school?
Nursing Training & Patient Advocacy
00:14:44
Speaker
i was Well, that was three years at the time. And I stayed on and did an extra year. And then I became what they call an England award sister and a managed a ward of um orthopedic. They had two wings, an orthopedic wing and a gynecological wing.
00:15:00
Speaker
And actually, I was on duty the night. I was getting on night duty the night that Robert F. Kennedy was shot. And um the whole of England was also in shock, as was America.
00:15:13
Speaker
And I remember going around the ward comforting people who were weeping bitterly about what had happened to... where are we Are we talking about ah John F. Kennedy or or Robert?
00:15:24
Speaker
I'm so sorry. I meant John. I retracted that. That was John Kennedy. Well, i mean I mean, both tragedies, but but easy to get confused. and This was JFK, yes. And... and um That was kind of one of those moments that you know stays in your life, in your mind forever about what that was like as a ah not just a national calamity for the United States, but the whole world felt the impact.
00:15:52
Speaker
And so that how did that, um so what was going on in your life at at that time? Well, one of the things that was extremely impactful to me about patient care, and this has totally influenced my career, these were very formative years for me.
00:16:08
Speaker
I hadn't had a background where I'd been exposed to very much of life, apart from my family and the neighborhood. I mean, you were only 22 when JFK was assassinated. That's correct.
00:16:19
Speaker
And um so the thing that impacted me most and very powerfully was that people were getting hurt in the healthcare system.
00:16:32
Speaker
And I can remember those patients absolutely vividly. um One, for example, who was on some very powerful antibiotics too long and who died of a blood disease based, which was a complication from the antibiotics.
00:16:45
Speaker
um i There were some and episodes in the operating room. I was in nursing school at the time the House of God was written. And um you know medicine, not just in the Great Britain, but was very patriarchal and hierarchical.
00:17:04
Speaker
And the surgeons were, you know, the top of the top of the list and they could get away with a lot. um So it was quite, quite, quite a growing up experience sir to be involved in, i suppose, these dramas that were playing out and learn to understand how the world worked and how I wanted to fit into it or not.
00:17:28
Speaker
So those were very, very formative years for me. But in particular, the passion my passion for um working in an environment or being able to be effective in terms of patient care and patient safety, being an advocate for patients was sort of cemented at that point.
00:17:45
Speaker
So just to understand that a little bit better, so when ah medical errors were were occurring at that time, ah was it Was it sloppiness or or or or not attention to detail? And there wasn't any kind of ah review of when a clerical error took place?
00:18:09
Speaker
I think... It was a lot less formal. um I mean, clearly in every profession, there are people who care deeply and different personalities, but I do think at the time, and it's been well described of by others than me, that there was a sort of rather cavalier approach um by the medical profession to patient care.
00:18:30
Speaker
And it's hard to describe, but there can be an arrogance. um in physicians then and even sometimes now where it's it's less so now, now that I think about it, fortunately, um where the patient doesn't get the best care.
00:18:54
Speaker
You know, it's it's a complex construct, Bob, and... um it is It isn't all about bad doctors, as you know, it's about systems and cultures and... So was there was there something was there
00:19:13
Speaker
was there something in the in the system or the time that changed that for the better or or was it just a very gradual improvement process? It's a very difficult question. I think it's been a very slow and very gradual improvement process.
00:19:30
Speaker
um I still think we have a long way to go, both in England and in the United States when it comes to the safety of patients as they traverse through the healthcare system. And um I suppose one of my disappointments is that I haven't been able to make a bigger difference um because we're still dealing at this day and age with far too many avoidable deaths due to medical error.
00:19:54
Speaker
not just in the United States, but in the UK and other civilized countries, as well as you know countries who are less fortunate than us.
Marriage & Move to the US
00:20:05
Speaker
So how long how long did you stay at the ah at the London hospital?
00:20:09
Speaker
I stayed at the London hospital. I'm not very good with dates and times because I've been too busy living and looking looking at the next year rather than the past. But um I was there ah total of five years.
00:20:22
Speaker
And um that was when um I decided to get married, which was a pretty standard thing that you do it that it did at that age in England at the time. And um I went to live down on the South Coast, but I continued working. and So so how did how did you meet this first gentleman?
00:20:41
Speaker
Oh. ah yeah yeah yeah You glossed over that really quickly. Yeah. met I met him. um i was actually, it one weekend when I was nursing?
00:20:52
Speaker
i was thinking I hadn't seen one of my favorite aunts for some time. And she lived a little up to the north of London. So I took the train up and met her. And then when I came came to return, there was a snowstorm.
00:21:06
Speaker
and a really bad snowstorm, which was very unusual in England at the time. And the train was delayed. And so they were heating up. They had these braziers of coals where they were melting the ice on the tracks so that the trains could sort of move forward. And there were a cluster of us there waiting there for some time around this brazier, very, very cold at night.
00:21:31
Speaker
And I got to talking to this handsome man and he became my husband.
00:21:37
Speaker
well um was ah Was this ah ah ah lot a a ah ah long um ah matchmaking or or you got married the next day?
00:21:48
Speaker
No, no. I think it was a couple of years before we got married. Okay. And we had some two fine children and and they um and adopt we adopted a little girl and we're all still very close.
00:22:07
Speaker
So um at and when did you make the transition to the U.S.? I made the transition to the U.S. s in 1975, but it wasn't really an intended transition.
00:22:22
Speaker
um My late husband, he's now my late husband, um and I were very, very involved in Great Britain in the care um people who had psychosomatic illness.
00:22:38
Speaker
And it gets back to that mind-body split that I spoke about earlier in that in England at that time, and I believe it was true in America too, there was far too much e Librium and Valium being doled out um when people were distressed or felt emotional and, um,
00:22:55
Speaker
A pill would solve it. And we didn't believe that. So we spent quite a lot of time actually going to classes. And now i when I started my cycle interest in psychology, went to open universities, were starting in Britain at the time. So while I was raising the children, i was also going to school.
00:23:14
Speaker
And I wanted to learn as much as I could about human behavior because I wanted to be able to make an impact on how people behave. took care of themselves and how they were treated in the healthcare system and also how we could better understand the mind-body connection.
00:23:32
Speaker
So- your your husband Your husband also worked, your first husband worked in healthcare care as well? oh Well, actually without going into too much detail, my first marriage, um my mutual agreement didn't work out.
00:23:44
Speaker
um We remained friends. um He actually married my best friend, which was a good thing. And I was growing so fast and changing so much and wanting to explore the world.
00:23:56
Speaker
And we realized we had very different personalities. And later I fell madly in love with um one of the loves of my life. um I'm lucky enough to have had more than one.
00:24:09
Speaker
And he was a physician and had a deep interest in, we met through this mutual interest in the body-mind connection. And um he was offered a position because we were both somewhat considered pioneers in England on in this in this arena.
00:24:27
Speaker
And In the United States in 1975, the family practice programs were being legislated into universities. And so many of the universities were starting family practice residency training programs.
00:24:42
Speaker
And because we'd been both been involved in training post-graduates in Great Britain at that time, we were asked to come over for a year to the University of North Carolina to help start this program.
00:24:56
Speaker
He was to be the director. And I worked with the medical school in the behavioral medicine arena because they were starting to introduce at that time...
00:25:07
Speaker
um human factors and topics like geriatrics that were being neglected, topics like human sexuality, um nutrition into the curriculum. And there was this sort of movement to bring back the general practitioner or the family doctor as they became known, the family medicine.
00:25:30
Speaker
It was an extraordinary time to be in the United States. It was just post-Vietnam, tremendous amount of social reform occurring. what was this was this your first ah time to the came to the United States, i think it was in because i was working um part-time with an american college in england um and running their clinics and learning a lot about America and American students.
00:26:02
Speaker
And I came over to a student health conference, but came to New Hampshire and Atlanta and was amazed by America at the time, but I never imagined in a month of Sundays that I would end up living here for the rest of my life.
00:26:19
Speaker
So, so when you moved to, to North Carolina in, in 75, um, so you moved with your, with your second husband and, and three children. With my three children. And he was a single parent of two. So we actually had five. Okay.
00:26:35
Speaker
And, uh, Chapel Hill was ah wonderful place to spend a year at that time. We thought we were going back to England and um, We were just, I think the word is entranced by America. We felt very comfortable here.
00:26:53
Speaker
We um enjoyed the American culture, beauty of the country and the energy of the country. There was a lot of energy at that time and still is to sort of um and move forward.
00:27:09
Speaker
And um America, you know, from the Brit's eyes very, innovative country and we enjoyed and appreciated the innovation that was occurring that we could be part of that.
00:27:23
Speaker
So it it was a very, very good year. And then we were about to go back to Great Britain because he had a locum tenens running his practice and they asked us if we would stay on another four to five years.
00:27:37
Speaker
That was a very difficult decision for a number of reasons, family and so on and so forth. But we decided we would. and didn't regret it at all. And just as we were going to move back again, um ohio State University was looking for um you know, somebody to lead their family medicine program or at least be, you know, groomed to be leader of that program. And um we both ended up with jobs in Columbus, Ohio, um in the same fields that we were both working in. I, by then, was deeply involved in what I call behavioral medicine and, they you know, again, the sort of softer aspects of medicine, such as communication skills and
00:28:23
Speaker
you know how to break bad news to patients, how to comfort patients when they were you know dying. And also we were both extremely engaged and involved in the wellbeing of the people who were becoming healthcare professionals or who were already healthcare professionals, recognizing the stress and strain on the people who provide the care.
00:28:50
Speaker
So um we, Ohio State was very interested in not only my husband's skills, but fortunately in mine as well. And we ended up moving, instead of moving back to England, we ended up moving in 1980 to Columbus, Ohio.
00:29:09
Speaker
So just ah as, so so Reagan had just become president. Yes. ah So tell me about that that transition in in the eighty s
00:29:23
Speaker
Well, the transition in the eighty s was you know initially a very exciting one um because Ohio State was a very prestigious university. We'd also left a very good university.
00:29:34
Speaker
We loved North Carolina. Ohio, I think, reminded us a little bit more of the topography of England, so we probably felt a little more at home. here and we ended up buying um a house just a little outside the um outside the city it's not not outside the city anymore um and um we settled it We were settling in, but something really tragic happened.
Loss & Resilience
00:30:01
Speaker
About a year, it was just over a year after we arrived in Columbus, my husband died very suddenly, unexpectedly. He was ah pretty a very healthy man, and um he died very tragically, very suddenly. It wasn't self-inflicted, it was a virus that um attacked his pancreas.
00:30:22
Speaker
And so all of a sudden, I'm very sorry. Yeah, thank you. I was left ah um in a sort of, you haven't term experienced life, I don't think, until you've been widowed in a strange, in a different country, in a strange city and had to, you know, with five children. It was growing up time, let's put it that way.
00:30:44
Speaker
So do you, can you, can you recall the, um the ages of your children at that time? Oh, yes. They were 8, 10, 12, I think 14, 15. Some just going into their teenage years. So really, really busy period.
00:31:05
Speaker
you know Young kids you know in school. was growing up. I said it was survival time.
00:31:14
Speaker
Yeah, like I can't imagine. um Did you have much, well, and and then you had just moved to, you'd only been to Ohio for a year. So did you did you have much of ah a support system?
00:31:27
Speaker
um We were beginning to develop a support system, but when my husband died, um most of our family at the time was in England, were in England. And all of them were actually, and ah except my brother who was living in New York.
00:31:42
Speaker
And, um Our friends were in North Carolina and England, so it was actually ah very difficult time. um And the other thing, of course, was financially because English physicians do not earn the the same capacity at the same rate as American physicians. so we'd come over on a year sabbatical, which was you know not the highest pay. And we were just beginning to get our our feet under us, both working with this large family when ah catastrophe hit. Well, wait, so so you had to...
00:32:20
Speaker
what Why were you on sabbatical after moving from North Carolina to OSU? No, we weren't on sabbatical then, Bob. We were on sabbatical that first year, but I'm saying that sabbatical pay is fairly low.
00:32:33
Speaker
Right. So we hadn't had much time to accumulate savings. or got ah Got it. Got it. So we were, it was, hmm, I better hunker down here and work hard and.
00:32:48
Speaker
So how did you manage, what, what, mean, how did you manage that? you And you were, ah so you're working full time. i think you, had you had mentioned you, you were going back to school for your, your master's or your PhD at the time.
00:33:01
Speaker
Yes, correct. And, ah well, it was my master's at the time and, um and taking care of five young kids. Yes, and also because of my late husband and my interest in the wellbeing of healthcare professionals, I brought in some extra money by doing counseling in the evenings in a little study that was at the side of our house.
00:33:24
Speaker
So it was, um as i keep calling, I just call it growing up time. It's galvanizing and you have to make a decision. People would say to me, I don't know how you do this. And I'm thinking, and the choices?
00:33:40
Speaker
put What's my choice here? What is what is your choice? I guess you you you just stop and, and hope the kids take care of themselves or you, or you kind of just have to do the best you can.
00:33:51
Speaker
and You know, again, um as long as there's love and um routine, Um, kids can, kids can be amazingly resilient. And they obviously at times like this, you can, families can break apart or get closer.
00:34:08
Speaker
And we were fortunate enough to, you know, become closer. Great, great set of kids. That's great to hear. Um, so.
00:34:24
Speaker
Yeah, i I'm um like, this all took place in your, in your early forties, 81, 82. 39. My husband died. I'm sorry. i was 39.
00:34:35
Speaker
You were 39. um
00:34:39
Speaker
Well, what, so I guess, ah well, you got through that decade somehow. um And I guess the the kids, you know, went on to college or or other careers and, and, and what about yourself?
00:34:54
Speaker
Well, um you know, i I was just terribly fortunate to... i think i can i think what I want to express is what a kind nation America is.
00:35:08
Speaker
Americans are very self-critical, and but it's a very kind nation. People are... people the neighbors were supportive. People were absolutely wonderful.
00:35:20
Speaker
um We were strangers to them, but they rallied around. um I'll never forget he died on March the 31st, 1980. And it was just before Easter.
00:35:32
Speaker
I woke up one morning and there were Easter baskets for all the children outside the back door. And those were acts of kindness that, you know, were extraordinary.
00:35:43
Speaker
So where when you go through difficult patches, it's amazing the goodness that you can experience in people to help you through. i think the interesting thing to me is you can't actually predict who they will be.
00:35:58
Speaker
If you had asked me before my husband died who would step forward, i might have had a guess, but it it was um unbelievably different to what I expected. So kind of in ah in a good way.
New Beginnings with Dave
00:36:13
Speaker
And um so I guess, well, then tell me kind of kind of where your career went from, ah you know, maybe we can fast forward to, say, 1990. And did you did you marry again?
00:36:25
Speaker
I did. i married a man with two children. So we bought this farm where I'm sitting now and we raised seven. it's um a book I've got lots of books I want to write one day, Bob. And of course, you know, i'll never get to it. But one of them is called Three Good Men.
00:36:41
Speaker
i like the idea of that. that's ah ah that you You shouldn't put that off. yeah but I think I think a i think ai can help you write it. but but but The other one is Lessons from the Barn.
00:36:53
Speaker
listen how so do you mind, you can you want to share how you met your third husband? Yeah. Well, I was working in the healthcare care field. I was working at Ohio State and um one of the doctors um thought, and he was totally right, that my boys, three of the boys especially, needed male role models.
00:37:16
Speaker
And so he knew this man who was building and flying um light ultralight airplanes on a field of a farm not too far from where we live now.
00:37:30
Speaker
And that man happened to be Dave. um I was not looking for a husband, believe me. I thought with all these children I was in for the long haul, the five of them.
00:37:42
Speaker
And, um but he um We met briefly, we talked, and I just noticed he had great blue eyes, and yeah but I wasn't really sort into men at that time. I was into hunkering down, raising the family, and you know my work was full-time, plus I was in school.
00:38:01
Speaker
um But um he called me several months later to ask me how I was doing. And actually i wasn't doing very well. I was in bed sick and I felt, gosh, nobody in the world cares how sick I am.
00:38:14
Speaker
um The kids are in school. I'm pretty miserable. So I so asked him when he called, well, do you want the social answer or do you want the truth? And he said, well, you better tell me the truth.
00:38:26
Speaker
So I told him the truth. And he said, sound as if you would like dinner out one night when you're better. And I said, it might be nice. So that's how met and married Dave.
00:38:39
Speaker
And did you ah did he did you up ever go up in the ultralight? no Oh, no. They're they're single single. Now, he did have he's had a number of light aircraft. we When we married, we wondered how we were going to put this blended already blended family together.
00:38:56
Speaker
and that's why we said that's bigger than the brady bunch yes that's right i sat down and um i'm sure i keep thinking people surely aren't interested in all this but the end i need to focus on your questions um what happened was uh he's an airplane fanatic so we bought the farm where my daughter and i could have you know horse each and um the kids would be kept busy on the farm we could see where they were and um He involved the boys a lot in other mechanical things to do with the farm and airplanes, which was wonderful.
00:39:32
Speaker
And um I would go on occasional what I call save my marriage flights. Save your marriage rights. So that that's that was swallowing your fear of flying? Well, you never fly with me. Okay.
00:39:50
Speaker
To me, I'm up in a plane going around in circles thinking, well, this is boring. I need to get back and get busy doing something. and A terrible sickness, right? Yeah. um When ah and I'm sorry, is is Dave still with you?
00:40:08
Speaker
Oh yes. Okay. Very long, very successful marriage, marriage very mutually supportive. we We both feel extraordinarily fortunate to have found one another and without Dave, um I wouldn't be able to do what I still do. he's um knows who I am and is extremely supportive of my of my work. I'm very fortunate.
00:40:32
Speaker
so up ah changed when So when did Nebraska come into the picture?
Building a Simulation Center
00:40:38
Speaker
Well, um I think I've sort of got to retirement age about three times.
00:40:45
Speaker
And um I was working at, I was a chief academic officer at a healthcare, care this large healthcare system in Columbus called Ohio Health.
00:40:58
Speaker
And I still had worked a lot with Ohio State. I had become assistant dean for medical students at Ohio State, and I really enjoyed and valued that job because of my interest in the well-being of healthcare professionals.
00:41:13
Speaker
But I got invited to um Ohio Health to be, at that time, the director of medical education, meaning overseeing the medical students who rotated there, the residency programs and um continuing medical education.
00:41:31
Speaker
And I liked the concept of the broad spectrum from sort of beginning to end of medical education. And again, the opportunity to do impact safety and quality of care through training.
00:41:47
Speaker
So um that was what I did at Ohio Health. And we built one of the very first interprofessional simulation centers there, hospital-based, and got it up and running. and We were doing very similar work to the work that I'm doing in the University of Nebraska Medical Center right now.
00:42:07
Speaker
But it was unique at the time. and um Again, it was about using modeling and simulation to ah like aviation and other you know high risk industries to address quality, safety and cost.
00:42:26
Speaker
And um Jeff Gold, who's the now the president of the University of Nebraska Medical Center, who I believe you met, came down to visit us. He was at that time at the, I think he was provost at the um University of Toledo Medical Center.
00:42:44
Speaker
And he came down to see what we were doing. And he decided that he would like to do something like that in Toledo. And I'd been at Ohio Health 17 years by then. And so I was sort of thinking, should I retire?
00:42:56
Speaker
about the third time or fourth time I've retired or been on the brink of it. And um I went up to Toledo to help him build a really large simulation center there, thinking it was the sort of the be-all and end-all of simulation centers.
00:43:15
Speaker
And I was there for five five years, maybe. And then Jeff left and went to the University of Nebraska Medical Center to be the chancellor there.
00:43:27
Speaker
And um I went out to visit him and he asked if I would consider and working with him to create an even bigger, even more comprehensive center there.
00:43:39
Speaker
And that was um over 10 years ago now. And so I've been going back and forth to Omaha for the last 10 years to help create the center that you visited and where we So you've only been involved in, in Nebraska for 10 years. And, and before that it was a combination of Columbus and Toledo.
00:44:01
Speaker
Correct. And, and I don't, I don't know how far Toledo is from Columbus. Is that what did you relocate for that position or, or you? I had an apartment up there and I went up on Mondays and came back on Fridays and, um,
00:44:18
Speaker
i It was only two and a half hours away, so I could, that was nothing compared to the trip to Omaha.
00:44:26
Speaker
And, well, yeah, so how far is, oh and that and you didn't fully re relocate to Omaha, is that correct? I have ah and an apartment there which is lovely overlooking the Missouri River because I decided if I was going to you know work this hard and um not worry about when to get hotel rooms every time I went out that I would um have an apartment there. And so i go I've been going back and forth for 10 years um to to Omaha.
00:44:55
Speaker
and ah i'm it The apartment also lets my family come and stay with me for weekends and um grandchildren and things like that. So it it it shows them another part of the world.
00:45:12
Speaker
So maybe as you look back a little bit, um maybe over the last 20, 25 years, what what do you feel most proud about from a professional standpoint?
Supporting Healthcare Professionals
00:45:29
Speaker
That's very hard question because I'm mostly outward looking and not inward looking. um You know, Bob, I'm a strange person. i keep thinking...
00:45:45
Speaker
i think i think if I've done anything, I've helped some people get through their medical careers. Everybody underestimates or there's a general underestimation of what it's like to become a healthcare professional and what it's like to be a healthcare professional.
00:46:07
Speaker
And I'm deeply impacted by, you know, how their wellbeing affects patient care outcomes. So I suppose if I'm proud of anything, it's having helped some people along the way. And I really mean that.
00:46:30
Speaker
You know, we have a, yeah you think about every day, that we have a really, really complicated ah healthcare system who in the United States. And and you look at the UK and it seems like NHS is barely, you know, staying together. um And I, you know, i you know, there are no easy answers, of course, but if if you had if you pretend for a moment that you were in charge of of it all, yeah you maybe maybe you were yeah secretary,
00:47:07
Speaker
um
00:47:10
Speaker
You know, what does have to change? what What do we need to fix to make this a ah system that works? Because I do think, you know, there's so many um paradoxes when you think about how do you make healthcare care work from an economic standpoint and from a social standpoint.
00:47:30
Speaker
And, you know, i i've i I've kind of felt for a while about, um you know, it almost feels like healthcare needs to be a non a fully nonprofit kind of system.
00:47:43
Speaker
But there is the argument to be made about, um well, how do you incentivize pharmaceutical companies to invest money and research if they can't recoup and innovate?
00:47:55
Speaker
Yeah. um and And how do we retain workers, nurses, physicians? I don't know if it's if it's a money issue or not, or if it's a, you know, are they suffering burnout because because they're so short-staffed? And are they so short-staffed because the pay is not good? or is are it are different problems occurring that that's, ah ah you know, putting, I mean, COVID aside, obviously, you know, created a huge dent and I think, you know, caused a lot of burnout.
00:48:28
Speaker
um But, ah but we're still dealing with it. Yeah. Well, if you and I could solve that problem today, we'd probably get the Nobel priest Prize. and But it's so complex, um such a complex system. And that's not just true in the United States. Even the national health system is extremely complex. um I've just returned, for example, from the United Kingdom, and I had a friend there going through surgery.
00:48:56
Speaker
But he he pays into the private system and gets his surgery privately because the waiting list is so long for things like a hip. Well, he's in his 80s, and he didn't want to wait several years. um And um so there's... Several years.
00:49:12
Speaker
Yes. or possibly Potentially, yes. um Or at least a year. Even that you know in your 80s, a year is a long time. And um the truth of the matter is that I left feeling that England was actually a two-tiered system.
00:49:29
Speaker
um There's the National Health Service. And then um I actually visited the centers where he was getting care and the waiting rooms were very full. So... so it's it's ah It's very complex. um The single party system is you know burdened by many, many things um in terms of the trouble is health care keeps developing and getting more complex and more technology can be applied to patients. And the tax, how much can you charge taxpayers to be able to afford, you know,
00:50:03
Speaker
afford that much care without rationing. you you basically rationing isn't done purposefully, but it happens because the priorities have to be decided. And that is a form of rationing, even if it's not called that.
00:50:16
Speaker
So ah it i happen to believe from the, mean, if you look at all of the industries that have improved quality, safety and cost.
00:50:30
Speaker
They have all used modeling and simulation and more recently visualization so that the people who to do their jobs can practice in a safe place, become proficient, develop competencies and not learn on the job as much as they used to be able to when life was simpler.
00:50:51
Speaker
And I really believe that the cost, if you think about patient safety, and if you just take an avoidable death due to medical error, costs the United States over a trillion dollars a year. And those are pre-COVID numbers.
00:51:09
Speaker
um Imagine being able to save that much money and put it back into the system. So I think... The problem isn't necessarily the infrastructure, although it has its problems, I understand. It's how do you provide safe, quality, efficient patient care?
00:51:29
Speaker
And I think healthcare professionals get under supported. And by having centers such as the one in Toledo and and in Ohio and in other places, you're seeing them evolve more now, Tampa and, you know, ah some of these mega simulation centers are evolving. Having a safe place for healthcare professionals to practice isn't only good for patients, but it's good for the healthcare professionals where they can prepare to do anything with anyone at any time.
00:51:59
Speaker
and so my my concept would be to have regional, large regional healthcare professionals so as healthcare simulation centers that are connected to the rural communities so that the rural communities aren't left out.
00:52:18
Speaker
And that's what we're working with Nebraska right now, where we while we have this wonderful training center and it's absolutely incredible thanks to the people of Omaha and Nebraska. And...
00:52:29
Speaker
that it's in the city and if what we're working on is you know this statewide network so that rural practitioners of at any level um of training or learning new technology can connect to us to get the same level of support and care and practice that those who can reach the center on foot can So I think a lot of it in the military find the same, you know, safety and outcomes and preparedness are at the core of everything and in terms of outcomes.
00:53:06
Speaker
So. Well, let's let's let's delve just a little bit deeper into into the medical areas. You mentioned, you know, there are potential savings of a trillion dollars you know annually in the U.S.
00:53:20
Speaker
what What is it that is, and now, you know i don't know ah if addressing those areas are our trivial issues, are process issues, are infrastructure issues, are training issues,
00:53:38
Speaker
um but what is it that's keeping us from
00:53:45
Speaker
addressing and fixing those things in a in a meaningful manner?
Training & Patient Safety
00:53:51
Speaker
is it Is it will? Is it is it something else? Is it bureaucracy? Well, yeah tradition has its place without doubt, and we should always respect tradition.
00:54:04
Speaker
But healthcare care professions education is very traditional in its approach to how to teach people how to become doctors, nurses and others. It is gradually changing, but probably not fast enough.
00:54:17
Speaker
Medicine and healthcare delivery is changing so rapidly. ah New technology is coming out all the time. And when you go into an intensive care unit, you can hardly see the patient.
00:54:29
Speaker
Imagine graduating from nursing school, being in the medical being a medical student and you know not understanding how all that works. You can't understand it all just by reading about it.
00:54:43
Speaker
So there has to be hands-on familiarity with equipment and procedures are so complex now. the whole of medicine has changed. You don't have... um A patient asleep on the table where very rarely where you do a laparoscopy and you have the medical student or the trainee on one side and the experienced surgeon on the other who can guide their hands.
00:55:08
Speaker
It's done minimally and basically. So that while healthcare care has advanced tremendously, so has the technology and how you take care of patients or save patients lives.
00:55:21
Speaker
And it seems inconceivable to me that um we could still consider new training training people on real patients. Has the training not kept up with the advancements?
00:55:35
Speaker
Well, I think we're talking about training everywhere, not education everywhere, aren't we? You know, there's some some schools are still very traditional where you you know learn knowledge and you take an exam and you pass the exam and you move on to the next level.
00:55:52
Speaker
And there's a gradual changing going on, but I'd like to see it happen faster in education and training in general. because the technology is there. you know, we can create scenarios. We can put people under pressure. we can They can get familiar with equipment. They can develop proficiencies in safe settings and safe environments without the potential of harming a patient.
00:56:21
Speaker
And that includes communication and handoffs. And i mean, medical errors is a big topic, but... You know, you've got accurate diagnoses, delayed diagnoses. You've got the transition between healthcare teams, communication skills.
00:56:39
Speaker
It's not just about doing things to people. It's about helping people through the system and that can all be practiced and perfected.
00:56:52
Speaker
it Is there something i that's not being done well to address the the shortage issue? Is it, you know... The shortage of... um of Of staff, of of physicians, of nurses, of of people going into a business career. Or is that misunderstood? is that not not an issue?
00:57:17
Speaker
Oh, I think it's a huge issue. I mean... And covid COVID was, you know, obviously an extraordinarily extraordinary, had an extraordinary impact on healthcare professionals. um I had a, um I get little notes sometimes from some of the people who were trainees when I was at Ohio State or in Toledo.
00:57:42
Speaker
And one of them was very heartfelt the other day. He just said he lost so many friends, patients and during COVID. that he absolutely burned out and he's now left medicine and he's become a writer.
00:57:59
Speaker
But it he the words he used was it took out his took away his soul, which sounds very dramatic, but he's a very level-headed scientific man. And I believe that he's the sort of the tip of the iceberg, um that what healthcare professionals went through during COVID, you know on top of an already challenging system,
00:58:22
Speaker
was devastating to the to the health professions. um And then I do think that in turn has led to you know understaffing and finance hospitals and financial situations and all of the things that come together to new create a situation of you know health profession shortage or worse, even well as bad, low in morale.
00:58:52
Speaker
do you Do you think, I mean, from a financial perspective, does does healthcare care need to be a fully nonprofit industry?
Innovation in Healthcare Systems
00:59:00
Speaker
is the is the way it's being run It doesn't seem like the way it's being run today is working, but I'm also not not hearing or seeing ah any any solutions coming forth. I'm just i'm just concerned about it was some it it breaking down at some point. know Yeah.
00:59:18
Speaker
Well, I don't want to sound too political, but I am, it's going to sound political, but I don't know that government run entities ever really work.
00:59:31
Speaker
So I think in healthcare, care we need innovation. We need forward thinking. We need entrepreneurship. We need fresh blood, fresh life.
00:59:44
Speaker
not something that's too bureaucratic. I mean, you have to have guidelines and standards, obviously, but it would worry me to think of a single party payer, but that might be just because of my biases because of having lived and worked in one.
01:00:03
Speaker
But it's, well, it seems though that the, I mean, the cost of health insurance continues to go up. And, you know, I, I, at this point, it feels like you have it for, in case of a, of a of a ah try to stop catastrophic situation.
01:00:20
Speaker
um But we're not, we're not able to keep it in check. I just don't know what model is going to work at, you know, what could a could a community based, you know, hospital healthcare system,
01:00:34
Speaker
i financially work if it was just based on ah on the on the local population paying out of pocket or or what have you?
01:00:45
Speaker
Well, this has to be seen and discussed, I think, in the context of how healthcare is being delivered. um you know, from where me and my colleagues and I stand, we see the delivery of healthcare changing very, very rapidly.
01:01:03
Speaker
And they're will probably for a long, long time always be a need for intensive care in, you know, facilities like the hospital, the, the university and other hospitals.
01:01:16
Speaker
An awful lot of healthcare care now is being delivered remotely and um in the home. So any decisions about the, how healthcare care is going to be delivered in a cost effective way where, you know, medical errors are at a minimum needs to be looked in the context of how rapidly healthcare care is changing. I mean, and, and, and also in light of the rural urban digital divide.
01:01:49
Speaker
So
01:01:53
Speaker
I don't have all the answers, but I do know that healthcare training has to be relevant for the times and that technology is advancing dramatically in healthcare. care mean, we're seeing mini surgical robots and we're seeing evidence that those can be you know sent to ah rural community and operated from a tertiary, you know, a city a hospital, a city hospital.
01:02:24
Speaker
and We're still seeing so much change. We be very cautious and very careful. And my belief, my strong belief is that it's all in the training and constant upskilling wherever the healthcare is provided, which is why I'm so passionate about modeling simulation and visualization to not only train, but also to you know enhance patient care, the provision of patient care.
01:02:56
Speaker
the more we put in the hands of patients to the better, really. Yeah. so As long as they have good guidance and good counsel and competent people who take care of, you know, do do take care of them as needed. But competence is everything.
01:03:17
Speaker
Well, Pam, Dr. Boyer's, You know, I don't think we're gonna solve it today, unfortunately, but I wanna thank you so much for for your time and and being, you know, as open as you have been. um It's, ah you know, you've you've you've had an extraordinary career. It's not over yet by any means.
01:03:38
Speaker
um And, but, you know, your your insight and and your opinion is is highly appreciated and and important.
01:03:49
Speaker
Well, thank you. i just hope that um if anybody listens that um they understand that, you know, if you have a passion about something and you really care about what you do, it's amazing, you know, how doors will open for you to you know, help you with with other good people around you solve, try to solve problems, societal problems.
01:04:17
Speaker
Dr. Boris, thank you very much. um And I look forward to seeing you and next time. And then enjoy the rest of the day.