From AI agents and holographic patients, to immersive "caves" and smart technology, health care education is evolving rapidly, says Professor of Clinical Frank Guido-Sanz, who joined the University of Miami School of Nursing and Health Studies in January 2025. As associate dean for simulation and research, he leads a veteran team of nurse specialists in simulation and simulation technologists at the school's S.H.A.R.E. Simulation Hospital Advancing Research & Education® (S.H.A.R.E.), a 41,000-square-foot hub for health care innovation, exploration, and education. There they do everything from teaching introductory nursing skills to new students to leading full-scale multi-agency disaster response trainings.
With artificial intelligence (AI) advancing at warp speed, Guido-Sanz and his team have been hard at work envisioning and building S.H.A.R.E. 2.0 through AI integration. "Part of our strategic plan is to continue innovating and bringing in new technology, renovating the S.H.A.R.E. space in equipment and focus," he said. "Our vision for excellence is positioning S.H.A.R.E. as a leader in AI and multimedia adoption and innovation for health care education. A strong foundation of innovation will enable us to evolve quickly and stay at the forefront, even as new technologies emerge rapidly."
To this end, he and his team recently rolled out two new custom AI agents developed in-house, and they are now exploring the incorporation of AI-driven digital twin, hologram, and immersive technology. "We're increasing the realism and putting in our students' hands the technology they may see in the workforce very soon," said Guido-Sanz, an acute care nurse practitioner and a Certified Healthcare Simulation Educator. "The whole team is very engaged in creating and bringing new technology here. We're all vested in this project of positioning ourselves at the forefront technology adoption."
Agents of change
AI has been a priority in Guido-Sanz's vision for S.H.A.R.E. since day one. At a 2025 national SimGHOSTS conference focused on empowering the future of health care simulation education, he and his team saw opportunities to transform his vision into solutions. "We started brainstorming," recalled Guido-Sanz. "Then we involved Roberto Padron from IT to look for a way to create AI agents."
Padron, the school's senior help desk technician, had never built an AI agent before. He began teaching himself using the University-licensed version of Microsoft Copilot. "I like to sink my teeth into anything that's new and is going to make all our lives easier," Padron said.
Along the way he worked closely and continuously with his colleagues at S.H.A.R.E., refining, revising, testing, and debugging the agents. Within six months, custom agents L.A.I.L.A. (Learning AI Liaison Assistant) and A.I.D.A. (Automated Intelligence for Dynamic Assistance) were born. "I was already using AI models to research certain things, so being able to create and tutor those agents and see how they behave in a very restricted environment is awesome," said Padron. "This has been an amazing experience for me."
L.A.I.L.A. is a troubleshooter with a "transparent, user-friendly communication style," designed to help S.H.A.R.E. simulation technicians, support staff, and administrators gain rapid access to standard operating procedures, manuals, and other curated resources.
L.A.I.L.A. has already debuted with students too. In an initiative led by simulation technician Robert Brau, L.A.l.L.A. created an avatar that introduces learners to the simulation space they are entering for a particular scenario, explaining the manikin they'll be using, for example, and describing all the features of the simulation prior to the arrival of a nurse specialist in simulation or faculty member.
A.I.D.A., on the other hand, is more of a behind-the-scenes agent, standardizing a wide range of simulations. Every S.H.A.R.E. nurse specialist in simulation is assigned to develop simulation scenarios for courses, often in conjunction with faculty. "We all disseminate information in very different ways. Technology can solve this problem," said Guido-Sanz.
A.I.D.A. helps S.H.A.R.E. nurse specialists in simulation by creating dynamic health care simulation scenarios that are standardized to the National League for Nursing (NLN) Simulation Scenario Template and aligned with American Association of Colleges of Nursing (AACN) core competencies (Essentials).
Additionally, A.I.D.A. can create avatars, write simulation instructions, role-play, produce debriefing analytics, and advance customization for multi-user simulations and remote sessions. Strict parameters prevent "hallucinations," said Padron
"A.I.D.A. grew out of preparing for our Society for Simulation in Healthcare (SSH) reaccreditation," said Guido-Sanz. "These AI agents and video tools support adaptive learning through real-time feedback, and they enable rapid development of instructional and orientation content tailored to clinical procedures and learning objectives."
To bring A.I.D.A.'s situation-appropriate simulation scenarios to virtual life from a template, S.H.A.R.E. licensed d-id.com, an AI-driven video platform that nurse specialist in simulation Michelle Osso investigated. The technology helps create interactive video modules, while online graphic design platform Canva adds visual elements, such as animations and infographics, for clarity and appeal.
"The scenarios have been rolled out. We are pleased and the accreditors were too," said Guido-Sanz. "We had 100 percent passing for SSH reaccreditation."
Although the new agents are enhancing productivity through task automation and continuous learning, Padron remains confident his creations will remain just that. "This is definitely a tool, not a replacement for staff," he said. "All this does is put more time in our hands to do something else."
Guido-Sanz agrees. "AI agents enhance simulation fidelity, provide real-time feedback and guidance, and streamline support for educators and technicians," he said. "We are turning all this curricular mapping into competency-based education. These are like baby steps we're taking to integrate S.H.A.R.E. into our bigger strategic picture."
Prepared to lead
Guido-Sanz has been on the cutting-edge of futuristic innovation for years, gaining experience in AI-driven technologies while working on U.S. Department of Defense-funded grants at the University of Central Florida (UCF) College of Nursing.
There he was co-creator of a now-patented multisensory dynamic wound simulator that blends tactile and digital realities to improve the ability of first responders, military or civilian, to know the correct amount of pressure to apply to a bleeding wound.
As graduate simulation coordinator, he worked on digital twin and hologram initiatives for nurse practitioner programs. "We were the first university in this country to adopt hologram technology from a company called Dr. Hologram," he said, noting that he and his team are now in talks with Dr. Hologram developers to determine how that technology can best be used to help learners at S.H.A.R.E.
"AI-powered holograms have integrated capabilities like large language models and a voice agent," said Guido-Sanz. "Remember Star Trek? It's a little like 'Beam me up, Scotty,' where you materialize. I can record you, and the viewer sees you in three dimensions in the hologram system, and it's interactive. That persona you're creating is powered with AI, so I can ask what time we're going to have lunch, for example, and AI can answer."
Among the active grants Guido-Sanz brought with him when he came to the U last year was a multisite Digital Twin Preceptor study. Human digital twins (HDTs), he explained, are symbolic digital replicas of humans that can serve as a novel research platform to represent, model, and simulate how health care professionals with varying levels of expertise, knowledge, and skill behave, operate, and reason across various contexts. "Clinicians can augment or accelerate their clinical decision-making skills and knowledge development by designing, modeling, and testing HDT supports while caring for actual or simulated patients," stated Guido-Sanz.
Guido-Sanz also helped build an immersive space at UCF, the kind he expects to create soon at S.H.A.R.E. "We need a completely immersive space, driven by artificial intelligence," he said. "The concept is called the 'cave' or 'igloo.' Imagine an iMax theatre, where you project a movie around you, but it also has sounds, smells, whatever you want. You could put floors that vibrate. You could re-create, for example, in a mass shooting scenario, screaming and people running, the smell of blood All of this is reproducible. You are embedded in the simulation."
Guido-Sanz said AI has been shown to enhance educational engagement and innovation, and that is precisely the aim. One way he used an immersive space back at UCF, for example, was in a DOD study on how communication breaks down and impacts patient transfer outcomes in noisy environments, like battlefields.
"We had not only the victim, but also everything projected—gunfire, explosions, the helicopter landing, the sound of the wind, everything," he said. "Your five senses are completely stimulated. The more realistic the simulation, the better prepared the learners are."
