In this episode of Scrubbing In, the medical podcast powered by SpecialtyCare, we’re having a great conversation with Sonia Zuzek. Sonia Zuzek is the Director of Clinical Education at SpecilatyCare. During our discussion, we talk about Sonia’s career transition from teaching to health care, how learning and education have changed since she entered the industry, and how the improvements she and her team have made to the training program at SpecialtyCare have lead to some stellar results.



Todd Schlosser: So today I’m joined by Sonia Zuzek, our Director of clinical education here at Specialty Care. And I wanted to start off talking to you, Sonia, about your journey through healthcare and where you started in the industry. So when you started out, where did you start out?

Sonia Zuzek: I was actually a teacher, and I know that seems kind of odd because you asked me how did I enter healthcare.

Todd Schlosser: So teacher in public schools?

Sonia Zuzek: Yes, in public schools.

Todd Schlosser: Okay, how long did you do that?

Sonia Zuzek: Four years. And I had always been interested in healthcare but I kind of went a different direction and then it just kept calling me. So I wanted to start a career as a physician’s assistant and went back to school to get my prereqs, and then I needed to get hands-on clinical experience.

Todd Schlosser: Fair enough. Let me ask, so when you became a teacher you got a regular teaching degree, you did that for four years, what prompted that desire to move into healthcare from just straight up education?

Sonia Zuzek: Well, I was at a school that had an emphasis in the sciences and I ended up becoming the lead science teacher in my grade and so it just kept naturally kind of leading me to science and I just knew I wanted to go into healthcare. I wanted to help people, I like helping people – obviously that’s why I was a teacher – but I wanted to do something more medical-related.

Todd Schlosser: Awesome. So four years into teaching you were like, “I want to move into healthcare.” How did you go about making that shift?

Sonia Zuzek: Everybody thought I was crazy.

Todd Schlosser: And was that because you wanted to move into healthcare or because you wanted to switch careers, or just generally people thought you were-

Sonia Zuzek: Just because I was going to switch career. I basically had to reinvent myself from the ground up and people thought that was-

Todd Schlosser: Sure, yeah, any time you change a career, yeah.

Sonia Zuzek: Yeah, it’s a tough thing to do. So how did I go about doing it? I finished off my school year and literally started classes two weeks later and I just started muscling through getting a biology degree in 18 months – which I don’t recommend anyone to do.

Todd Schlosser: So you had to go back to school to get your biology degree?

Sonia Zuzek: Yes.

Todd Schlosser: And then you, I guess, started applying for you said physician assistant positions?

Sonia Zuzek: Right. And you can’t even apply unless you have hands-on medical experience. So they’re very competitive schools, our perfusion schools are that way today as well. And I was still in school when I connected with our company, and I was actually shocked that they wanted to hire me because I wasn’t even trying to just work in doctor’s office filing paper and it was really hard to get a job because they were like, “Oh no, you’re going to leave soon.” And our company reached out and they said, “Are you okay with being in the operating room four feet away from a patient recycling their blood back to them?” And I said, “Oh my God, that’s amazing, that’s exactly what I want to be doing.”

Todd Schlosser: That’s such a specific type of person that wants to do that sort of thing, so that’s perfect, the way it worked out for you. So you I guess took at that opportunity?

Sonia Zuzek: Jumped on it immediately and loved it. My first time in the OR – I mean I’d never worked in the clinic or anything like that – it was like a symphony. The minute we walked in it was just I loved it, everything was just perfect even thought it’s organized chaos in some ways, there’s so many things going on and so many moving parts. And I loved it, I was in love. So then I decided I want to become a surgical PA because I think this is really where I want to be. And I did that for about 20 months before I started applying for schools. And at that time the clinical manger role opened up and I said, “Well what the heck, I’ll go for that as well and see what happens.” And I got that job, and at the time we had about 12, 14 people on our team and we were working in 22 hospitals in Houston. And I loved it and I just had to make a tough decision, I said, “You know what, I’m going to have to go to school for two more years and then come back to where I’m already at? I’m just going to stay where I am.” And I did that for six years and our company just started growing exponentially and there was a need to standardize our education program because back then education was on-the-job training by your team that you were with, which was great but we weren’t standardized across the country as a company.

Todd Schlosser: I’d imagine that’s predominantly hands-on training.

Sonia Zuzek: Yes. And it’s hard to remember to teach everything to someone when you’re in the middle of a case with an actual patient. You’ll get in the car and go, “Oh man, I didn’t discuss contraindications with them,” or something. But why should you?
You’re doing patient care.

Todd Schlosser: Sure. You’re focused on that individual case and I’d imagine, after six years of experience, you’re doing some things that you don’t even really think about anymore, they’re sort of muscle memory or things you just always do with everybody. And those are things that the person who’s shadowing you needs to know and you just absolutely don’t even think about it anymore so you don’t have the opportunity to teach it to them.

Sonia Zuzek: Exactly. And so there was a decision made to develop Specialty Care University, and that was late in 2010. And we worked really hard for about four, five months putting together-

Todd Schlosser: I’d imagine the curriculum.

Sonia Zuzek: Curriculum and building out an OR, what you needed in the OR for it to even be an educational place and things like that. And we launched in January of 2011 and it was really exciting. And so I took my experience as a teacher and my experiences as a clinical technician and then also as a manager knowing what these clinical technicians needed, and we built this program to make people confident and strong clinicians but also smart so that they felt good walking in and engaging with a surgeon, so that they didn’t feel like, “Well, I don’t know anything, I’m new.” We wanted to give them enough muscle power that even though they were new they would still have intelligent conversations with the people in the room.

Todd Schlosser: So let me ask you this, on your first day in the OR – and I’d imagine there was some training when you first got hired on as that physician’s assistant … No, there was no training? So you got hired and then you were immediately in the OR?

Sonia Zuzek: Yes, like literally meet me in the lobby of the hospital and then walked me into a pair of scrubs and 20 minutes later I was in an operating room.

Todd Schlosser: Okay, so if you don’t mind let me ask some questions around that. I’m only saying this because I would be incredibly nervous in that situation. I mean obviously you got your degree, it wasn’t like you were just off the street and walked into the OR, but I mean just theorizing, talking about it in the classroom has to be so different than being four feet away from a patient, like you were saying. What was that experience like for you? I would be a ball of nerves, that’s all I’m saying.

Sonia Zuzek: No, I was absolutely excited. I mean sure was I a little bit nervous … Basically I was told, “Stand in this corner and don’t touch anything.”

Todd Schlosser: Right. I mean that’s all I would want to do.

Sonia Zuzek: But I think I was eyes wide open really because there are so many things happening in an operating room. People don’t realize that there’s like six to seven people and they’re all specialized doing fantastic things and it requires all of those persons to make this one event occur. So you’re just kind of watching it all happen and you’re like, “I never realized it was like this.” And I mean just to prep the patient before you make an incision can last up to one hour. Who knew, right?

Todd Schlosser: Yeah, I mean wouldn’t have known that.

Sonia Zuzek: For me, was I nervous? I think I was more nervous once I was let go on my own.

Todd Schlosser: I can see that too because you get so much … I’d imagine the shadowing part of it is you sort of watch them do it for a while and they sort of let you take over a little bit more and more and more and they watch you do it, and then there’s a day where you just go in and you’re by yourself. And I imagine that that day is a little daunting.

Sonia Zuzek: Oh yeah, because then you’re like, “Where’s my person that I can lean on?”

Todd Schlosser: Where is the employee to help me with this, yeah.

Sonia Zuzek: Which is exactly why we started Specialty Care University, that’s the very reason that we did it.

Todd Schlosser: And that was in January of 2011, right?

Sonia Zuzek: Right. And so what we do now is they come in as new hires and we do didactic training in our classroom but we go into the OR and we but put on all of our personal protective equipment and we do full mock surgeries and we do troubleshooting and what could go wrong. We even practice bad days where a surgeon might yell at you and how to have tough skin and still be able to think straight.

Todd Schlosser: Do you have someone in there yelling at them in the training?

Sonia Zuzek: That somebody is me. I mean I don’t get crazy but I try to give them enough stress so that they know what that’s like. You still have to be an ace in the most stressful moments.

Todd Schlosser: I mean there is no more life or death situation than surgery, than in an OR. So I’d imagine, and I’m sure not every surgeon is like this or every situation is like this, I’m sure there are some that are just balloons and happy faces and surgeons are happy because everything is going well, but there are some times I’m sure you’d get very stressed out and it’s hard to control your emotions in those sort of situations. So I’d imagine those sort of things happen.

Sonia Zuzek: Yes, and that’s what we learn. So one of the things is you may not have done anything wrong, it’s just really high stakes, high stress. And you have to put yourself in that surgeon’s shoes, that’s their patient ultimately so they might just have a moment where they might say something to somebody and you happen to be that somebody today. But you’ve got to be able … If they’re in a critical moment so are you, so you’ve got to be able to roll through that piece and still do what you’re supposed to be doing for your patient and for your surgeon.

Todd Schlosser: Sort of to be able to scrub out the human element of it and figure out what needs to happen. Because a lot of times – and I learned this a long time ago – but fear can sometimes come across as anger and they’re not really mad at me, they’re just scared that the situation isn’t going the way that it needs to go so how do we get it in that zone, how do we get it back to the safe … Yeah.

Sonia Zuzek: That’s exactly right.

Todd Schlosser: I’m sure that’s a skill that’s very, very hard to teach but it’s very, very important to learn so I’m sorry you have to teach that. Although I bet on some days you’re like, “Yeah, I get to yell at people today.”

Sonia Zuzek: No, I never feel that way. But I prep them, I tell them this is a lot more like basketball practice than it’s going to be school. Because if you think about basketball coaches, what do they do? They find your strengths and your weaknesses, they’ll help you improve upon your weaknesses and really hone in on your strengths. But they might also ruffle your feathers in the process to get that out of you. And so that’s kind of how we teach our SCU class as well. And people kind of look at me when I’m crazy and at the end they’re like, “Oh, I understand why you did it that way now.” So it works.

Todd Schlosser: Some of the teachers that I remember growing up with through high school and college and stuff, the ones I learned the most from and probably have the most respect for now I didn’t really like a lot in the moment. I was like, “Ms. Gerald is the worst!” But I learned so much from her.

Sonia Zuzek: And you still remember her.

Todd Schlosser: Yeah. I mean we’re friends of Facebook, it’s fine. So let me as you this, how has the training that you received as you were moving up through healthcare, how has it changed to where we are now as far as is training is concerned? I mean I realize you started the training program here and you don’t really get much training. It seems like at least the sort of … I mean there are three kind of learning styles and it sounds like you got just straight up kinesthetic, you’re going to do it yourself. And some people are that way but some people are more visual or audio.

Sonia Zuzek: So how has it changed? I’ll tell you. So the old training program, they threw a book at you and they said, “Read it.” And then you went to the OR and someone showed you how to run the machine. But nobody connected the concepts that were in the book to what you were actually doing in the operating room. So you knew maybe how of the process or do something on the machine but you didn’t necessarily know the why, which means you couldn’t have a decent conversation about it and you couldn’t defend yourself necessarily and things like that. So what we’ve done now is we try to address all the learning styles out there. So we obviously still have a binder with information on it but-

Todd Schlosser: Sure, you have to have source material.

Sonia Zuzek: Yeah, of course. So we read … I think today – and I think most people learn like this anyway, even go back as far as you can in history – it’s doing it, role playing it, enacting it. So it’s a lot of simulation in what we do. But during the simulation we talk it out we explain why are we doing this and things like that.

Todd Schlosser: And you guys built a pretty in-depth operating room to train from. I’ve seen it, I’ve taken pictures of it. It’s beautiful, it’s huge. Pretty much every piece of equipment you could ever need is in there. So was that a hard thing to do to start in 2011? Was that one of your big gets at that time?

Sonia Zuzek: It took about seven of us putting that together. So we worked on it, and of course there was always something else that we forgot that we needed to remember. My guess is there’s a lot more than seven people in a real hospital setting making sure that your operating rooms are fully functional.

Todd Schlosser: I’m sure that that’s true, yeah.

Sonia Zuzek: And we still work on it. We’re actually adding pieces to it right now. We’re really excited, we have a simulator coming in so we’re going to start perfusion training in one month, which we haven’t really been able to do. We’ve done a couple of things in perfusion over the last seven and a half years but they’re actually going to be able to come in now and simulate real things going wrong or right in their OR on their equipment and run their equipment and practice those simulations. Which is really cool stuff.

Todd Schlosser: I mean that’s awesome, because you’d rather have those mistakes happen in a training system or a training environment like our OR than in an actual OR.

Sonia Zuzek: Correct.

Todd Schlosser: Honestly – I don’t know if they get air in the lines or things like that – it’s better they know how to address that because they’ve had an actual experience where that’s happened here in a safe environment where there were no stakes than it is the first time having it happen somewhere where there are stakes.

Sonia Zuzek: Absolutely.

Todd Schlosser: Oh man, that’s awesome. All right, so what kind of training … Or let me ask this because it sounds like we a lot of new hire type training as well, but we also do continued education, correct?

Sonia Zuzek: Yes.

Todd Schlosser: So what does that look like as far as credentialing or in the healthcare space? I’m not really familiar with what credentialing looks like, so how does that whole process look?

Sonia Zuzek: So there’s probably two different aspects, there’s a credentialing aspect and then there’s also your licensure aspect. For credentialing purposes we do have to maintain a certain amount of continuing education, but not too much. Like they are expecting maybe a few hours a year and things like that in order for us to work in hospitals. But those of our associates that hold licenses like perfusionist or who are board certified like our IONM group with their CNIM certification and things like that. And even our minimally invasive group has an SPD certification. They’re expected to acquire a lot of CEs, usually over a period of five years, and we’re looking at something like at least 40 hours, if not more, the week’s worth of continuing education credits. And they have to maintain those otherwise they can lose their license and can’t perform their job functions.

Todd Schlosser: I guess that sort of makes sense, as technology changes they want to make sure everyone is on the same page as far as that’s concerned.

Sonia Zuzek: Right. And so we offer that in a lot of different ways. So for the IONM group we have a monthly webinar that they can attend live and ask questions and we bring in experts from all over the country, some of them are internal in our own company here at Specialty Care and some of them are outsiders. And they do really cool webinars and they’re educational and they’re usually on very current topics that are happening and what they’re dealing with in the operating rooms, and it can even be political or it’s something medical, it just kind of depends on what’s going on there. And then we also have our Learn Center, which is a learning management system where we’ll house the recorded webinars which they can still attend and get CE credits, as well as for our minimally invasive group we have a ton of courses on there that they can take for continuing education credits as well. And we’re working on that and trying to grow that out as well and hope that we can give more information to our people so that they don’t have to branch out from us necessarily to get what they need to get done for their job.

Todd Schlosser: Now is that something that’s sort of the perfusionist’s or the IONM tech’s responsibility to get those done?

Sonia Zuzek: Yes.

Todd Schlosser: So it’s on them to actually seek those out and get them taken care of?

Sonia Zuzek: Correct.

Todd Schlosser: Whether they work for Specialty Care or not, how would someone go about doing that? I guess Specialty Care provides them, so do they provide them to their employees just at no charge?

Sonia Zuzek: Absolutely, these are all free charge. So for example, for our RNPs, those are our doctors, the remote neuromonitoring physicians, they take courses that are often $400 and up and we’re offering those same CEs to them for free.

Todd Schlosser: So they can just log in to the webinar or whatever medium it is?

Sonia Zuzek: The live webinar or the recorded webinar, either one, and they can get access to that for free.

Todd Schlosser: So I’d imagine if you’re not a Specialty Care employee you can still attend those CEs for continuing education?

Sonia Zuzek: Currently we’re not opening that up to external but we’re looking at that as an opportunity and there’s a lot around that. So we have to get these courses accredited and there’s a whole different avenue we would have to take to get them accredited for outside of our own organization. It’s just not something we’ve done yet.

Todd Schlosser: I’d imagine that process is quite time-consuming.

Sonia Zuzek: It’s very time-consuming.

Todd Schlosser: I’ve worked with accreditation boards in other fields and they’re thorough, to say it that way.

Sonia Zuzek: Yeah, absolutely.

Todd Schlosser: I may be giving you a softball question, but what makes Specialty Care’s training program sort of unique in the industry?

Sonia Zuzek: Oh wow, that’s a great question. Well, I’m going to give you some statistics. So the SCU program for MIS and ATS … Historically, the old way before we had SCU, it was taking new hires 90 days to become independent. And that doesn’t seem like a very long time, but when you start to consider that for a quarter of a year the rest of the team has to cover cases for that one extra individual it might mean no one’s able to take a vacation because they need to have call coverage as well. So until that person becomes independent they can’t take call. And so we’ve been able to shave that down to 45 days or less with SCU. So we’ve cut the training time to independence in half for our clinical technicians. In IONM they’re doing some really amazing stuff. They have to take their board certification exam at the end of their first year of training. The industry standard for that is a 50% pass rate-

Todd Schlosser: So 50% of people don’t pass that?

Sonia Zuzek: That’s correct, exactly. And for the last probably I’d say seven to eight years we were looking at an 85% pass rate here at Specialty.

Todd Schlosser: Oh well that’s great.

Sonia Zuzek: So our training program really was prepping people. And then, after their normal initial training, they do a CNIM prep course just to get people ready. Well, we’ve recently launched a new platform that we’re using. It’s an outsourced party, but they use the brain science on how to teach people. And so it’s customized, you kind of go in your first few times and develop a baseline for yourself. So your experience will be different than mine because it understands what I know and what I don’t know and it’s going to focus and hone in on teaching me what I need to know. And they’ve use that the last maybe three or four months and they’re now at a 100% pass rate for the CNIM board certification exam, which is really impressive.

Todd Schlosser: That is very impressive. How many months has that been that you haven’t had someone not pass?

Sonia Zuzek: That I cannot answer, Julie probably has that answer [crosstalk 00:19:48].

Todd Schlosser: Okay, fair enough. But still improving it from 50% pass rate to a 100% pass rate-

Sonia Zuzek: Or even to 85%-

Todd Schlosser: And even at 85 I was like, “Wow, 85%!?” That’s amazing.

Sonia Zuzek: It is amazing. And so those are big differentiators for us. I’ve heard from people that there’s nothing else out there like our programs. So I think that we might have the best programs. As a matter of fact I think we can say with confidence, we have the best training programs out there.

Todd Schlosser: So you mentioned that we’re about to start perfusion training a moment ago. So what does that process look like? How long will that training be? When will that start? I think you said in about a month, right?

Sonia Zuzek: Correct, yes. So we’re actually really excited about it. We’re realizing now with our other training programs we have enough data to see that we’re making an investment in our associates. And that’s really what education is, it’s an investment. Why wouldn’t we want these people who are working, doing these amazing things, to feel good about what they know that they’re doing? And that’s just going to make them stronger clinicians, it’s going to make them more confident in the OR, they’re going to have better conversations with their surgeons and their anesthesiologists and things like that. So one thing we haven’t been doing was with our perfusion new hires, whether they’re experienced or not, we haven’t been giving them that save level of introduction, that same level of onboarding into the Specialty Care version of their job. And so we’re going to start doing that. They’ll actually come in for new hire and then they’ll spend another two days here with us and they’re going to do a combination of some hands-on training just to understand the systems like our data system that we’re working on and tracking and collecting all of that-

Todd Schlosser: And data is very important at Specialty Care.

Sonia Zuzek: Yeah, EMR stuff and things like that. But they’re also going to go into the OR and do simulations and practice things breaking or going wrong, oxygenator failure and things like that. So those are things that you would think in perfusion school you’re getting a lot of exposure to, and you may get some exposure but you’re not getting enough. And so what’s happening is these new hires, the first time they’re actually experiencing these critical events is with a real patient. So why not give them an opportunity to do that in an OR where they’re not going to have to worry about the patient ultimately? They can just practice what they need to do and stuff like that. These are the beginning stages of this course, we may actually extend it out another day or two depending on what gaps we see are still there and things like that. But we’re really excited about it.

Todd Schlosser: That’s awesome. And it starts in about a month?

Sonia Zuzek: Yes, and it’s for both experienced and non-experienced perfusionist.

Todd Schlosser: So straight out of school and people who are coming on who have had 10 years or more in the industry.

Sonia Zuzek: Correct.

Todd Schlosser: Awesome. Well I think due to time we’re going to end it there. But I wanted to thank you very much Sonia for coming out and I guess sharing your successes with us. I learned a lot today. I’m sort of new to the industry so it was great to talk to you about all that stuff. So thank you very much.

Sonia Zuzek: Yeah, it’s exciting. We appreciate that you guys had us.

Todd Schlosser: Yeah, absolutely. We should do it again some time.

Sonia Zuzek: Absolutely.

Todd Schlosser: Thank you very much.