The guest today on Scrubbing In, a medical podcast focused on innovation in the OR, is Bryan Wilent. In this episode, we talk about how his background in the medical field and how having experience in the operating room, collegiate, and research levels has given him a unique perspective in his field. We also discuss how he would define “Quality Intraoperative Neuromonitoring” and exactly how those impacts are unmistakable.

 


 

Todd Schlosser: I’m joined today by Bryan Wilent, our VP of Quality and Clinical Performance. And what I’d like to get to know on you on sort of your journey through healthcare, so where you started post getting your BS in biology, and then kind of moving into the role you have now of Quality and Clinical Performance. Let me ask. When you graduated college, and I believe it was a BS in biology. Correct?

Bryan Wilent: Correct, yes.

Todd Schlosser: What was your day-to-day like? Did you immediately get a job in the healthcare field? Where did you move in from there?

Bryan Wilent: I immediately got a job in the healthcare field, and I wanted to do neuroscience. I did behavioral brain research as a research technician at Hahnemann Hospital in Philadelphia.

Todd Schlosser: Okay.

Bryan Wilent: I was considering going to get a PhD in neuroscience, but I lived in Philadelphia my entire life. I literally hadn’t been on a plane until I was 21 or left Philadelphia.

Todd Schlosser: Oh, wow.

Bryan Wilent: My friend and I decided to move to Southern California. So I still stayed in neuroscience in a biotech company out there, but enjoyed myself living at the beach and getting into outrigger canoeing.

Todd Schlosser: Right.

Bryan Wilent: But eventually I realized I needed to get serious about this neuroscience career I was embarking on. And that’s when I moved back to Philadelphia to obtain my PhD in neuroscience at the University of Pennsylvania.

Todd Schlosser: So you moved from Southern California back to Philadelphia. Were those winters just unbearable when you moved back?

Bryan Wilent: Well, the story gets way worse. I completed my PhD in neuroscience from Penn. It was a really rewarding experience, and I was on that track for an academic neuroscience career. I moved back to Southern California to San Diego to do my
post-doctoral fellowship at a really good neuroscience lab. It was led by a Nobel Prize winner. But I got there, and I realized I wanted to do something, not just basic research. I wanted to impact on the clinical side as well.

Bryan Wilent: When I was completing my post-doctoral fellowship, I had an opportunity to take a faculty position in western PA, but would also be a part of a venture to develop a deep brain stimulation clinic, and that was kind of my opportunity to get on the clinical side, so I moved back from San Diego to northwestern PA, which is tremendously worse than moving back to Philadelphia, in my opinion.

Todd Schlosser: When you say a faculty position, do you mean at the collegiate level?

Bryan Wilent: At the collegiate level, yes.

Todd Schlosser: Okay, so you were actually teaching neuroscience.

Bryan Wilent: I was teaching neuroscience, and I was a part of this venture to start a DBS clinic, deep brain stimulation clinic in northwestern PA. The venture kind of failed from a funding perspective, state funding perspective. And the school had some issues that I didn’t want to kind of commit to long-term. So I had met some neurosurgeons that were based out of Pittsburgh, so I took a job. I kind of resigned from my faculty position. I took a job in Pittsburgh in the field of intraoperative neuromonitoring, and that’s how I fell into neuromonitoring.

Todd Schlosser: Okay, so you went from learning, getting your PhD, to working for a biotech company in San Diego, back to the collegiate level, and then back into the clinical area. How long were you in the clinical area for that stint when you moved to Pittsburgh?

Bryan Wilent: For a year. And I was commuting about 90 miles because we had already bought a house about 60 miles south of Erie, so I was commuting about 90 miles every day to Pittsburgh. And my wife got pregnant, and this was not going to be a sustainable lifestyle. So I went back to academia. I took a job at Lake Erie College of Osteopathic Medicine as a professor there, just because from a work/life balance, commuting in the field of neuromonitoring wasn’t going to work at that time.

Bryan Wilent: So I took that job for that year, sustained us for that year, because the commute was bearable and the schedule was amenable to our life at that time. But our goal was to move back to Philadelphia, and an opportunity with Sentient Medical Systems arose in early 2010. And that’s when I jumped on it, and our family moved back to Philadelphia, where I started working with Sentient.

Todd Schlosser: Yeah. And that’s … You were the VP of Training and Development, correct?

Bryan Wilent: Well, I started off as a clinical manager.

Todd Schlosser: Oh, okay.

Bryan Wilent: So I was the Director of Operations for Pennsylvania, New Jersey, Ohio. And then in 2012, I kind of was promoted to the Director of Education and VP of Education and Training and Quality Assurance.

Todd Schlosser: I’d imagine that was a good fit, having come from that collegiate arena, because you had taught it for so long.

Bryan Wilent: It was great. Both experiences, the one at Thiel College in northwestern PA and Lake Erie College of Osteopathic Medicine, kind of helped me to develop my didactic skills as an educator. My post-doctoral fellowship helped me as a researcher, which I’m still engaged in now. And all throughout my neuroscience career, it was all electrophysiology in anesthetized animals, which was extremely fortuitous to become intraoperative neuromonitoring, which I was doing the exact same things I was doing in animals for 10 years. Now I’m just doing it in people.

Todd Schlosser: Yeah.

Bryan Wilent: I mean, it’s a little different, but the basic principles are all the same.

Todd Schlosser: So when you made that transition out of clinical back into sort of teaching and managing on the leadership side of things, was that better for your work/life balance?

Bryan Wilent: The work/life balance has always ebbed and flowed with the specific duties and just the nature of my job and the demands at that time, but it’s something that’s important to me and my family. And my wife is a … She was an academic scientist as well.

Todd Schlosser: Okay.

Bryan Wilent: And she took a little back seat on her academic career. She’s a professor of biochemistry at Temple University in Philadelphia.

Todd Schlosser: Wow!

Bryan Wilent: It sounds like she still has a very strenuous career, but she’s on a …

Todd Schlosser: It didn’t sound like much of a back seat.

Bryan Wilent: She’s on a teaching faculty track, as opposed to a research faculty track, which has enabled her to have more time in the summers when the kids are off and things like that. So she’s got a very rewarding career, but she doesn’t have to travel and other things that then can put stress on a family, so we have a nice balance that we’ve achieved in work/life.

Todd Schlosser: That’s perfect. So let me ask this. Since you’ve been on the training and development side of things for so long, since 2009 or so, right? When did you start doing that at Sentient, I should say?

Bryan Wilent: I think I started doing that as soon as I got into the field. As soon as I acquired knowledge, I was trying to pass on that knowledge.

Todd Schlosser: Fair enough.

Bryan Wilent: Formally, I was doing that in 2012.

Todd Schlosser: Okay, so formally and even informally from before that, how has the training programs for IONM or any of the things that you are now over at SpecialtyCare, how have those things changed over time? I’d imagine as new technology comes in, training comes in, that kind of thing.

Bryan Wilent: I would say the biggest thing I’ve seen in the field is that education and training in this field was a bit … Most companies could provide that. They had the resources and kind of buffer to provide that. But as reimbursements have kind of shrunken in the field, the money that’s being allocated to education and training is generally cut. It’s one of the first things they cut. So who’s still investing in their people? Who’s still investing in education and training? And that’s what’s gone down.

Bryan Wilent: And that’s kind of one of the great things about SpecialtyCare. It’s like most companies are kind of getting away from education and training and not allocating monies to it. We’re still highly investing in that because they recognize the importance. That’s the big trend I’ve seen. And just becoming better educators for this field. This field is … I say it’s 20% education, 80% training. It’s really easy to teach somebody how to educate somebody. It’s really hard to teach somebody how to train somebody. It’s a very different skill set.

Bryan Wilent: So investing in not just our leadership that’s doing the education and training but the people in the field who are … giving them the tools and resources, honing those over time, developing those over time, so that the program is kind of a smooth machine of making sure people are going from point A to point B and really developing both the knowledge and the hands-on skills. That whole program that SpecialtyCare has now is amazing, and it’s been really developed by the people that we have here. Cheryl Wiggins and Julia Trott and Kristina Young and Anthony Sestokas, these are the people that have tweaked this program over the years and have really made it what it is.

Todd Schlosser: Awesome. Speaking of that 20% training …

Bryan Wilent: 20% education.

Todd Schlosser: 20% education.

Bryan Wilent: 80% training.

Todd Schlosser: 80% training. The education piece sounds to me like you’re sort of in the classroom, kind of facilitator led, and the training part of that sounds more hands on. Maybe still facilitator led, or maybe guided is a better word. But is that sort of the approach that you guys take at SpecialtyCare when you’re approaching training? You get them as much hands-on as possible?

Bryan Wilent: Yes. And it’s also just … It’s training your brain and your hands to think. It’s training your mind to think in a very fast-paced environment and being able to recognize things. Those are … There’s an education. I know the anatomy of the nervous system, but being able to train to recognize when the signals are … It’s a technical issue or an anesthetic issue or a physiologic issue, that’s experience. That’s conveying that experience.

Bryan Wilent: It’s an education, but it’s a training to, like, visual recognition as well as behavioral skills, just being able to place things exactly in the same way so that noise is reduced. You’re efficiently kind of setting up the case. When your hands and your brain are in sync, everything goes smoother. And that training phase of training your hands to move in concert with your thoughts and to think and move quickly is the real trick to being a really adept and savvy clinical neuroscientist, clinical neurophysiologist.

Todd Schlosser: I’m sure that’s true. Now when … Say, when we have a new higher class come through for IONM, how long does it take to get someone from the point where we pick them up as a new hire maybe to the point where they can actually go into an OR and be a confident member of that team? How long does that process take?

Bryan Wilent: It’s highly variable from person to person.

Todd Schlosser: Okay.

Bryan Wilent: You kind of put a couple adjectives in there, like confident. Confidence comes with time. People are going to develop that confidence at different stages. And you have people coming with varied backgrounds. You have people coming in who’ve … They may have just got a 4.0 in neuroscience, but they’re 22. Their confidence may take a little while. Then you have people who have a doctoral or clinical degree, like chiropracty or audiology. They may be really good on the clinical side, but their neurophysiology knowledge may be limited. Their electrophysiology.

Todd Schlosser: Right.

Bryan Wilent: So everybody comes in with different backgrounds, and everybody kind of has their own kind of pace at which they develop that confidence, which is key because you don’t want anybody in an OR delivering patient care who is not confident in their abilities. That’s a recipe for disaster. So people when they’re kind of judged to be competent and independent, that’s why you need systems in place to ensure we have confidence in them and they have confidence in themselves. And you never rush anybody and put a hard number on it.

Todd Schlosser: Well, sure.

Bryan Wilent: But I would say the range goes from four months to a year for basic procedures, but that’s just your kind of basic procedures, your lower-risk procedures with a limited amount of modalities.

Todd Schlosser: Okay. So when … I imagine, and correct me if I’m wrong obviously, but when they’re in the training that we give them when they come through new hire, there’s a lot of hands on. Is that the case? Is there a lot of hands on, and I know that we have a mock OR. Do they go into that mock OR and actually get to practice?

Bryan Wilent: They go into that mock OR. Then they’re actually going into the operating rooms, kind of observing and starting to …

Todd Schlosser: So like real, live operating rooms?

Bryan Wilent: Yeah.

Todd Schlosser: Okay.

Bryan Wilent: So there’s an initial phase where it’s just didactic. They’re in the classroom. You’re just trying to kind of make sure they can communicate in the OR, aware of the OR, and have a sense of what’s going on, and then you balance the two. You balance the classwork with the operating-room training, and that could be kind of in the virtual OR or in the real OR.

Bryan Wilent: And then they slowly develop their hands-on skills. They have a trainer, who’s kind of guiding them to place needles. And they won’t be alone, but there’s a long time where there’s training wheels on, where that trainer is kind of running behind them while they’re kind of pedaling away and developing those kind of hands-on skills.

Todd Schlosser: So it’s sort of a soft hand-off into you’re on your own. You sort of watch someone …

Bryan Wilent: Yeah.

Todd Schlosser: … do it a bunch, and then they sort of watch you do it a bunch, and then one day you’re …

Bryan Wilent: Exactly.

Todd Schlosser: … sort of feeling confident to do it off on your own?

Bryan Wilent: Uh-huh (affirmative).

Todd Schlosser: Okay. So let me ask this because I’d imagine in an OR, and I realize not every case is a life-or-death situation in an OR, but some are. How do you teach someone to be just calm under that kind of pressure? Because coming from a different background, that would be very daunting for me. I would be very nervous, and that would potentially lead me to forget things or just mess up. So how do you train that?

Bryan Wilent: There are aspects of that you can train. There’s aspects of that you can’t train. But I think regardless of how good your eye may be in a very stressful situation, everybody has the potential for not stepping up in that situation. I mean, there’s a couple elements to this. One, we’re going to do people to make sure that they’re going to step up and deliver the best care they can in a stressful situation. So we’re going to put them through oral exams, things like that, which can be extremely intimidating. People really get nervous when you’re kind of …

Todd Schlosser: Yeah, when you’re put on the spot like that.

Bryan Wilent: Yeah, yeah. But the more you do it, the more you feel that pressure, the better you’re acclimated to handle it in the real world. The other thing is they’re never alone. When they’re in the OR, if things aren’t going well, the stress is getting up, there’s a remote physician or a remote professional, a neurologist, online with them. We have clinical support. I’m online. Tom Epplin, the other person on my team, or even [inaudible 00:14:25], we have a team of people who are just there to … If they can’t figure something out, we’re going to jump on their case, take over their case, help them out …

Todd Schlosser: Oh, wow.

Bryan Wilent: … and kind of guide them through any sort of significant troubleshooting issues.

Todd Schlosser: So like live support?

Bryan Wilent: Yes.

Todd Schlosser: That’s amazing.

Bryan Wilent: As of right now, there’s somebody who’s online in the same way that our remote physicians are online. Just one chat is all it takes, and within five seconds, we’re on that case. We can view the screen and help them out as to like, “Okay, this is a real change, a technical change, a clinical change. Do this. Do that.” So that really … That knowledge really defuses a lot of the stress for people. Even if we can’t help, just being that confirmation that, “Okay, this is a real change. You did the right thing.” That defuses a lot of things and helps a lot.

Todd Schlosser: I’d imagine having that safety net goes miles into … Not even necessarily needing it, just making you feel more confident that if I don’t know what it is, someone is, and we can get them here very quickly.

Bryan Wilent: The key to avoiding kind of sentinel events in healthcare are these safety nets, are these checklists. This is why hospitals have checklists these days, to avoid operating on the wrong side or things like this. And then when things go wrong, you need a checklist or you need support systems in place to make sure that this can be mitigated as best as possible. Yeah.

Todd Schlosser: All right, so in your title is the word quality. So as it relates to IONM, what is that?

Bryan Wilent: I would define quality IONM as providing accurate and actionable diagnostic information to positively impact patient outcomes. So we’re providing a diagnostic service. If there’s an injury to the nervous system, there’s typically a finite amount of time where that injury is reversible. So our goal is to use our tools at our disposal to diagnose that as efficiently as possible, communicate that as efficiently as possible, so the surgeon and the anesthesiology teams have a window of opportunity to intervene such that that injury is reversible and our changes will rebound and the patient will wake up okay. That’s the goal of neuromonitoring.

Bryan Wilent: We don’t want to be predictive. We don’t want to diagnose an injury, and the patient wakes up with an injury. We don’t want to be that. We want to be preventative, and that’s really what quality IONM is, and that’s where the real value of IONM is. So that’s what we really do. That’s what our quality assurance systems are all geared towards. That’s what our research is geared towards. It’s primarily showing that accuracy, that we’re diagnosing things accurately in real time. But then, B, we’re impacting patient outcomes. That’s where the real value is, and that’s what quality IONM is.

Todd Schlosser: That’s awesome. I’d imagine that when you … We work on so many cases every year, right? So I’d imagine that we track all that data, and then all that data can go in towards research, and then that kind of helps discover new techniques and just ways of going about things. Is that something that we track?

Bryan Wilent: Yeah. I mean, right now, in a few months, we’re presenting at the North American Spine Society Meeting, a spine surgeon conference, and our presentation was awarded best paper.

Todd Schlosser: Oh, wow!
Bryan Wilent: And it’s really just about that. It’s showing how you can add this additional tool to what’s typically not used during a certain set of procedures, and when you do this, the accuracy shoots up, and also the impact shoots up. So we’re trying to like … We’re not trying to just be providing this service. We’re trying to set what is the standard. What is the best service, the best IONM that can be provided for patients by being the leaders in the field for our patients and for the surgeons?

Todd Schlosser: Let me ask this. I know that IONM is standard in a lot of procedures, but it’s not in some. And sometimes the patient may have to ask to, I guess, have an IONM specialist in the operating room with them. Is that something that is changing over the course? I mean, I realize IONM is relatively new. It’s not as old as some of the other service lines that SpecialtyCare has, but is that something that’s becoming more prevalent in most surgeries?

Bryan Wilent: I wouldn’t say it’s the … It’s not a lack of awareness of the patients. Most patients are still relatively unaware of neuromonitoring. I think there’s still a lack of awareness of the potential utility of neuromonitoring on a variety of procedures by surgeons. The data out there, the research out there is sparse. So surgeons aren’t necessarily informed on IONM literature. They’re not necessarily informed that IONM can really help with this procedure, and that’s our goal.

Bryan Wilent: The onus is on us to keep promoting neuromonitoring. If there’s a clear value for this service, make sure surgeons know about it. If there’s not, that’s fine. We’ll tell them that as well. But we want to make sure that surgeons are aware of when there’s a true value to our service for their patients.

Todd Schlosser: So can you explain how you quantify a true value of adding an IONM specialist to your operating room?

Bryan Wilent: There’s two key things: accuracy and impact. We can help accurately diagnose this injury, and that if your rate of injury, your rate of morbidity and neurologic sequelae is here, we can help you lower that, improve your patient outcomes by decreasing the incidence of neurologic sequelae or decreasing the unwanted side effects.

Bryan Wilent: There are certain procedures where we can help guide certain things to make that the ideal procedure. They may have less unwanted side effects, such as paresthesias and things like that. So there are various things that we … We will improve patient outcomes. And I think if there’s a procedure where there’s clear data that we improve patient outcomes, I want to inform surgeons that this can help your patients.

Todd Schlosser: Absolutely.

Bryan Wilent: We want to help you help your patients.

Todd Schlosser: Well, Bryan, thank you so much for joining us here on Scrubbing In. I appreciate it. Thank you so much.

Bryan Wilent: No problem.

Todd Schlosser: I appreciate your time.

Bryan Wilent: Thank you.

Todd Schlosser: Have a good one.

Bryan Wilent: All right.