International Journal of Healthcare Simulation

Background:

Ongoing social distancing restrictions have greatly limited opportunities for registrars to attend regional acute medicine teaching. Basing the project on previous work within the trust running simulation via Microsoft Teams (using a one-to-one method of delivery) this project set about opening this up to a much larger group using a ‘choose your own adventure’ (‘CYOA’) format depicted in the children’s television show ‘Knightmare’.

Aims:

The aim of the study was to deliver a simulation-based training course for a large number of participants simultaneously using an online platform.

Method/design:

Scenarios were as follows:

Patient with an exacerbation of COPD

Patient with a life-threatening overdose

Patient presenting with undifferentiated unconsciousness

The clinical room featured an audio-visual set-up for debrief with three cameras and patient observations from Laerdal Learning Application (LLEAP) combined with an audio mix shared via video-stream to VLC media player; then from the host laptop via Teams. Teams used audio mixer input from room via USB. This included phone audio allowing calls to relatives, other specialists, etc. to be heard. Teams accessed from the following locations:

Host (control room)

Faculty (control room)

Faculty (clinical room)

Faculty (debrief room)

Participants (remote) × 14

Teams host laptop was pre-loaded with all scenario information which allowed ECGs, CTs, Toxicology reports to be shared as requested throughout the scenarios. The multi-screen set-up allowed for monitoring of chat from a control room and clinical space meaning all users could access key information shared on screen. Faculty had radio communication to control room for prompts and questions. Scenarios would be led by a member of faculty playing the role of a clinician in the scenario. The scenario would progress with input from the participants via that Teams chat. At key points, the scenario would pause and a question would be put to the group and an option would be voted on to continue. After each scenario, using Teams break-out rooms for debrief allowed the large group of participants to have a more focussed debrief session led by one of the medical faculty.

Implementation outline:

Using the structure of ‘CYOA’ encouraged users to take part in key interventions, whilst chat function within teams allowed for continuous dialogue. Participant feedback stated that the discussion format and expertise within the group was very useful in their training and would have a positive impact on working practice. Faculty found virtual simulation more demanding to facilitate than face-to-face simulation, but feasible to run the session annually.