Re-thinking simulation in the Covid-era

Authors:

Catarina Couto, Education Fellow St Michael’s NICU

Beth Osmond, lead for simulation

We’re only halfway through 2020, but already it feels inevitable that this year will be remembered for the way a tiny pathogen (aka COVID-19) has forced us to change the way we live our personal, professional and social lives. With social distancing still in place for the forceable future, we have needed to adapt our mode of delivering teaching. While traditional formats are quite easy to be delivered in this highly connected world (we have recently started sharing some of our teaching on an online platform alongside North Bristol NICU) providing simulation experience is undoubtedly more challenging.

Our team brainstormed ideas on how to run a simulation session entirely online. We tested out the waters of online meetings with a neonatal quiz, which got great feedback from our staff.

Traditional point of care simulation, when done well, has sufficient fidelity to create an immersive experience for participants to encourage decision-making and behaviours to be as realistic as possible. This is very difficult, if not impossible, to recreate in an online experience.

Challenges and constraints will often present opportunities to have a different approach. One of our grid trainees suggested that the online experience could be used in a “Choose Your Own Adventure” simulation.

When planning the session, we considered what we wanted the participants to learn from the experience. We used videos of a simulated clinical scenario with a deteriorating patient with introductions from a facilitator. The team of online participants then had time to discuss and decide on a course of action from two potential options. We felt that both options should be equally reasonable so as not to induce participants to error. We also recognised the educational benefit of having the participants watch a video of effective teamwork and good clinical practice. They were then showed the video for the option they chose.

As is often the case with simulation, less is more. We quickly realised that what could on first glance be viewed as a simplistic choice, when discussed in detail as a multidisciplinary team can throw up complexities as the team have time to consider the question from multiple viewpoints – a huge advantage of this format. We observed this promoting critical thinking as the team considered different perspectives. The de-brief was built in to the scenario as we progressed. As facilitators, we did not need to speak much beyond the pre-designed script for the video introduction. The participants de-briefed themselves – very effectively.

Instead of having the usual hierarchical team organisation, we decided to dispense with the leadership role and have participants contribute equally, with their own set of skills and knowledge, to the decision making process. This structure helps junior staff members, who might otherwise not feel involved, consider the challenges of decision making. We also hope to empower our colleagues with clinical knowledge and confidence to contribute in a real life emergency.

Our first “Choose Your Own Adventure” simulation took place in June 2020 and received great feedback.

Participants fed-back that they learned how there can be different reasonable approaches to a clinical situation. They learned the importance of teamwork and discussion to overcome these challenges.

Here is some of the feedback we received:

“It’s difficult to replicate the clinical setting but I thought the approach was innovative. It sparked discussion and debate. I enjoyed it and felt I gained as much if not more than face to face sims.”

“It was a relatable topic area, utilising each other’s previous experiences and knowledge base. The safe and relaxed environment enhanced team work and collaboration across disciplines.”

The simulation team felt it was a fluid, fun and relaxed experience. We were delighted with the team dynamic and felt everyone engaged in a respectful discussion of the management of an unexpected event.

While this type of simulation cannot replace the traditional format, we feel it complements it and intend to keep running these sessions parallel to our simulations on the unit. Once filmed, the session is complete and can be run remotely with little preparation required. By having to rethink the norm, we found a format that works well for us and the participants.

We’re happy to share the blueprint of the simulations we have designed so far with other simulation teams 😊

We are very grateful to Alex Doerr, Maddie Gould, Louise Bridge, Katie Hunt and Paul Cawley for the help they provided, and also want to thank all the participants so far for their valuable feedback.

St Mike’s Simulation Team 2020 – Adele Farrow, Asha Persaud, Carolyn Donovan, Catarina Couto, Elizabeth Osmond