Dr. Vincent Miller (left) and Dr. Nicholas Koch (right).
After a comprehensive internal search and interview process, University of Vermont (UVM) Larner College of Medicine Assistant Professor of Emergency Medicine and alum Nick Koch, M.D., has been named clinical director of the UVM Clinical Simulation Laboratory (CSL). Koch will be the laboratory’s fourth director, replacing former Associate Professor of Anesthesiology Vincent Miller, M.D., who served in the position for five years, from 2016-2021.
The CSL is an important training ground for both burgeoning and current healthcare professionals with the goal of improving quality and safety of care. A collaborative effort between Larner, the UVM College of Nursing and Health Sciences (CNHS), and the UVM Medical Center (UVMMC), it serves as a hub for hands-on, interactive work with Standardized Patients, manikins, and simulated clinical cases for students studying at Larner and CNHS as well as professionals from UVMMC, the UVM Health Network (UVMHN), and beyond.
The role of the CSL clinical director is to provide clinical operations leadership and “promote the interests of the Clinical Simulation Laboratory through community and governmental outreach opportunities—representing the laboratory within UVM, UVMHN, and the community,” explains Larner Senior Associate Dean for Medical Education, Christa Zehle, M.D.
Additionally, says Cate Nicholas, Ed.D., M.S., P.A., director of education and operations for the Clinical Simulation Laboratory, the clinical director “provides oversight on the design, development and implementation of capital projects or programs which result in a change of vision and mission.
The clinical director works closely with Nicholas and reports directly to Zehle.
Miller was named as interim director of clinical simulation on September 1, 2016, succeeding former director Ted James, M.D., who held the position from July 2012 – June 2016. Miller was then named director of clinical simulation in 2019.
When Miller took over after 11 years as a Larner faculty member, he already had plenty of experience in clinical simulation training.
“In 2008, anticipating that simulation would be an integral part of medical training, I presented my idea of a simulation program to my department chair, Dr. Howard Shapiro,” says Miller.
Supportive of his ideas, Shapiro appointed Miller as the Director of Medical Simulation for the Department of Anesthesiology and, says Miller, “With some protected non-clinical time, minimal equipment, and determination, I was able to design and implement a robust anesthesiology resident simulation program.”
Only two years later, Miller was asked to be a member of the Simulation Advisory Board, a group that helped establish the current CSL. Over the next few years, the CSL developed a quality training program targeting reduction of Central-Line Associated Bloodstream Infections (CLABSI), which continues to be required training for UVMMC residents and which resulted in the creation of a dedicated clinician-educator position in the laboratory.
After Miller was appointed interim director in 2016, the lab secured funding to upgrade all its aging simulation equipment over a three-year span of time. Additionally, Miller grew the program, hiring a dedicated physician to teach the CLABSI program, supported efforts to diversify the Standardized Patient Program and simulation manikins, and acted as liaison to the UVM Medical Center Patient Safety Committee.
“Dr. Miller was an important clinical advocate for the CSL who worked collaboratively with UVM Health Network leadership to secure funds to replace necessary equipment,” says Dr. Zehle, M.D., adding, “He recognized the value of simulation education and secured resources to support clinical simulation opportunities for all learners.”
Miller left his positions at CSL, Larner, and UVMMC in July 2021 to pursue other opportunities but is grateful for the experiences his role provided him over the years and for the collaboration with his colleagues. “I will forever be grateful for the opportunity to practice medicine in the area, care for our community, and grow as an individual,” he says.
A New Era
A 2014 graduate of Larner, Koch went on to complete an emergency medicine residency at Maimonides Medical Center in Brooklyn, N.Y. Following residency, he completed additional training as a clinical simulation fellow at Maimonides and returned to Vermont in 2018 to work as an emergency medicine physician at the UVM Medical Center.
Since then, he has been named the Director of Simulation Education for the Division of Emergency Medicine at UVMMC, created the simulation curriculum for the emergency medicine residency program, and has presented at conferences regarding simulation training, including poster presentations titled “High Fidelity Simulation-Based Faculty Development Improves Confidence in Performing and Teaching Transvenous Cardiac Pacing” and “Impact of Simulation Based MCI Event Training on Emergency Medicine Residents.”
Currently, Koch is working on an implicit bias in simulation research project wherein he examines the difference in medical students’ differential diagnoses using a light- versus dark-skinned manikin.
Koch applied for the CSL clinical director position spurred by a passion for simulation-based learning he developed during his own medical education at Larner.
“During my four years of medical school, the robust simulation program became an integral part of my preparation for clinical practice, seeding my professional interests in this educational modality,” he says. “I appreciated the effectiveness in teaching the humanistic side of medical care delivery [that clinical simulation provides], including effective and empathetic verbal and non-verbal communication and bedside demeanor.”
Koch was nominated from among three highly qualified candidates by a search committee including Nicholas, CNHS Director of Simulation Education Nancy Lemieux, MSN, R.N., Associate Professor of Surgery Jesse Moore, M.D., and UVM Medical Center Chief Medical Officer Isabelle Desjardins, M.D.
Koch has big plans for the future of the Clinical Simulation Laboratory and its work with UVMHN, UVMMC, CNHS, and Larner.
“I envision expansion of our existing CLABSI quality improvement initiative using mobile training opportunities for our healthcare workers at affiliate sites,” says Koch. Within UVMMC, Koch hopes to bolster faculty development and quality improvement, specifically in procedural training and introduction of clinical event debriefing after trauma resuscitation, medical codes, and rapid response events.
For students at his medical alma mater, Koch sees opportunities to “increase simulation in courses that currently underutilize simulation,” and use simulation to further meet the diversity, equity, and inclusion initiatives of the College.
Zehle is excited for the future of the laboratory under Koch’s guidance. “Dr. Koch is familiar with the Larner College of Medicine curriculum and understands the value of simulation education in the professional development of both current and future health care providers,” she says. “As the Clinical Simulation Lab continues to expand its services, Dr. Koch and Dr. Nicholas will continue to explore opportunities for expansion of the lab’s impact on learners and our community."