Telesimulation in healthcare education: A scoping review.

OBJECTIVES: To provide a comprehensive overview on the utilization and effectiveness of telesimulation in healthcare education. DESIGN: A scoping review. DATA SOURCES: A search of five databases including PubMed, Web of Science, Cochrane, EMBASE and ProQuest was conducted between 2000 and 2022. REVIEW METHODS: Arksey and O' Malley's scoping review framework was utilised. Data were narratively synthesised. RESULTS: 29 articles were included. More than half of the publications on telesimulation were borne out of need during the COVID-19 pandemic. Innovation reports were the most prevalent publications followed by descriptive studies. Telesimulation was applied for the delivery of diverse learning content including patient care management, procedural skills and team training. A variety of videoconferencing software and simulation modalities have been used for telesimulation. Telesimulation was generally well-received, despite its technical challenges. Learning effectiveness of telesimulation was evident in quasi-experimental studies. CONCLUSION: Telesimulation has been gaining acceptance as a distance-based simulation education modality. It will continue to evolve and potentially blend with in-person simulation. More rigorous research is warranted to evaluate learning outcomes and establish best practices in telesimulation.

Telesimulation for the Training of Medical Students in Neonatal Resuscitation.

Background: Telesimulation may be an alternative to face-to-face simulation-based training. Therefore, we investigated the effect of a single telesimulation training in inexperienced providers. Methods: First-year medical students were recruited for this prospective observational study. Participants received a low-fidelity mannequin and medical equipment for training purposes. The one-hour telesimulation session was delivered by an experienced trainer and broadcast via a video conference tool, covering all elements of the neonatal resuscitation algorithm. After the telesimulation training, each student underwent a standardized simulated scenario at our Clinical Skills Center. Performance was video-recorded and evaluated by a single neonatologist, using a composite score (maximum: 10 points). Pre- and post-training knowledge was assessed using a 20-question questionnaire. Results: Seven telesimulation sessions were held, with a total of 25 students participating. The median performance score was 6 (5-8). The median time until the first effective ventilation breath was 30.0 s (24.5-41.0) and the median number of effective ventilation breaths out of the first five ventilation attempts was 5 (4-5). Neonatal resuscitation knowledge scores increased significantly. Conclusions: Following a one-hour telesimulation session, students were able to perform most of the initial steps of the neonatal resuscitation algorithm effectively while demonstrating notable mask ventilation skills.

Advancing IR in Underserved Regions: Interventional Radiology Simulation Near and Far.

Simulation facilitates learning by imitating real-world systems or processes utilizing educational tools and models. Various fields, including business, aviation, and education use simulation for training. In healthcare, simulation provides trainees opportunities to develop procedural skills in a safe environment, building their understanding through hands-on interactions and experiences rather than passive didactics. Simulation is classified into low, medium, and high fidelity, based on how closely it mimics real-life experience. Its use in education is a valuable adjunct to instructional support and training with multiple potential benefits. Interventional radiology (IR) trainees can build technical and clinical proficiency prior to working directly on a patient. Simulation promotes experiential learning, constructivist learning, and student centeredness, thus giving students control over their learning and knowledge acquisition. More recently, the creative use of remote simulation has augmented traditional virtual didactic lectures, thereby further engaging international learners and enhancing remote collaboration. Despite the challenges to implementation, the addition of simulation in IR education is proving invaluable to supporting trainees and physicians in underserved regions.

SimUniversity at a distance: a descriptive account of a team-based remote simulation competition for health professions students.

BACKGROUND: SimUniversity competition is an innovative Society in Europe for Simulation Applied to Medicine (SESAM) initiative which has existed since 2014, with the aim of creating opportunities for undergraduate healthcare students to take part in a formative educational experience on an international platform. The main educational focus is on promoting non-technical skills such as leadership, situation awareness, decision making, communication, and assertiveness, but also clinical reasoning within a team. In preparation for the 2021 virtual conference, the team designed a new methodology to meet the same mission, and yet be offered remotely. MAIN TEXT: In this article, we describe the way in which we transformed the SimUniversity competition activity from face to face to a remote simulation. We relied on Zoom as the main communication technology to enable the distance component and followed the key elements of pre-briefing, simulation, and debriefing with the students being onsite together in one location and the faculty and simulator technologists in distant locations. Thirty-eight medical and nursing students formed 8 teams from 7 different countries. Two participating teams were based in Germany and one in Italy, Belgium, the Netherlands, Romania, Portugal, and Syria. Each team consisted of between 4 and 5 members and was self-selected to consist of either medical students alone or medical and nursing students together. The SimUniversity faculty team was composed of 5 physician educators, one nurse educator, one paramedic simulation technologist, and one industry simulation technologist. The faculty members facilitated each simulation synchronously in Zoom, while being based in different geographical locations within Europe (Germany, Switzerland, and the Netherlands) and the Middle East (Qatar and Lebanon). CONCLUSION: We conclude that assuming there is access to adequate internet connectivity and minimal technical setup, conducting a remote simulation with virtual debriefing is achievable in supporting team-based learning, particularly when learners and/or faculty members are in distant locations. While the authors do not recommend this method to be superior to a face-to-face experience, we propose this model to be an alternative method to consider when educators are faced with imposed restrictions such as what we faced during the COVID-19 pandemic. We discuss lessons learned and highlight other potential benefits that this method may provide, to consider even when the restrictions are lifted.

At-home medical student simulation: achieving knot-tying proficiency using video-based assessment.

Purpose: Due to the pandemic, we restructured our medical student knot-tying simulation to a virtual format. This study evaluated curriculum feasibility and effectiveness. Methods: Over 4 weeks, second-year medical students (n = 229) viewed a video tutorial (task demonstration, errors, scoring) and self-practiced to proficiency (no critical errors, < 2 min) using at-home suture kits (simple interrupted suture, instrument tie, penrose drain model). Optional virtual tutoring sessions were offered. Students submitted video performance for proficiency verification. Two sets of 14 videos were viewed by two surgeons until inter-rater reliability (IRR) was established. Students scoring "needs remediation" attended virtual remediation sessions. Non-parametric statistics were performed using RStudio. Results: All 229 medical students completed the curriculum within 1-4 h; 1.3% attended an optional tutorial. All videos were assessed: 4.8% "exceeds expectations", 60.7% "meets expectations", and 34.5% "needs remediation." All 79 needing remediation due to critical errors achieved proficiency during 1-h group sessions. IRR Cohen's κ was 0.69 (initial) and 1.0 (ultimate). Task completion time was 56 (47-68) s (median [IQR]); p < 0.01 between all pairs. Students rated the overall curriculum (79.2%) and overall curriculum and video tutorial effectiveness (92.7%) as "agree" or "strongly agree". No definitive preference emerged regarding virtual versus in-person formats; however, 80.2% affirmed wanting other at-home skills curricula. Comments supported home practice as lower stress; remediation students valued direct formative feedback. Conclusions: A completely virtual 1-month knot-tying simulation is feasible and effective in achieving proficiency using video-based assessment and as-needed remediation strategies for a large student class.

Comparison of In-Person and Telesimulation for Critical Care Training during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has disrupted medical education for trainees of all levels. Although telesimulation was initially used to train in resource-limited environments, it may be a reasonable alternative for replicating authentic patient experiences for medical students during the COVID-19 pandemic. It is unclear whether a more passive approach through telesimulation training is as effective as traditional in-person simulation training. OBJECTIVE: Our aim was to evaluate the effectiveness of in-person versus remote simulation training on learners' comfort with managing critical care scenarios. METHODS: This was a prospective observational cohort study assessing the impact of an in-person versus remote simulation course on volunteer fourth-year medical students from February to April 2021 at the University of California San Diego School of Medicine. Precourse and postcourse surveys were performed anonymously using an online secure resource. RESULTS: In the in-person learners, there was statistically significant improvement in learner comfort across all technical, behavioral, and cognitive domains. In remote learners, there was a trend toward improvement in self-reported comfort across technical and cognitive domains in the telesimulation course. However, the only statistically significant improvement in postcourse surveys of telesimulation learners, compared with baseline, was in running codes. Regardless of the training modality, the students had a positive experience with the critical care simulation course, ranking it, on average, 9.6 out of 10 (9.9 in in-person simulation vs. 9.3 in telesimulation; P = 0.06). CONCLUSION: We demonstrated that implementation of a telesimulation-based simulation course focusing on critical care cases is feasible and well received by trainees. Although a telesimulation-based simulation course may not be as effective for remote learners as active in-person participants, our study provided evidence that there was still a trend toward improving provider readiness across technical and cognitive domains when approaching critical care cases.