Safe training in the current clinical workplace requires careful participant proximity management. Delivering simulation in a confined clinical environment can impact scenario fidelity and affect psychological safety 
. A portable audio-visual (AV) streaming system enables audiences to observe and contribute to debriefing without compromising simulation fidelity.
The aim of the study was to assess the practical efficacy of a portable AV streaming solution to enable real-time in situ
simulation, including to a dispersed audience.
The Scotia Medical Observation and Training System (smots™) offers a portable AV solution with flexibility, through the addition of cameras and microphones as required, to create bespoke simulation viewing. Smots™ was incorporated into the in situ
simulation educational programme within an acute trust at least weekly over a 10-month period. It was concurrently deployed at our partner Nightingale facility to run simulation as part of an induction programme for new staff. Feedback from delivery users and scenario participants was collated and analysed.
Smots™ was an effective platform to meet our aims. Delivery users reported smots™ to be reliable in streaming the AV footage to a target audience in a remote debriefing room. The system was compact, easily transportable and had a low burden of training to achieve user competence. Participant feedback was positive, in that the system provided good AV clarity and narration, thereby enabling a successful training evolution. Smots™ offers a reliable capability to stream simulation scenarios to an alternative viewing area with the ability to be relocated as needed. Local wireless broadcasting range is finite and may limit users’ ability to stream information to discrete departments within a larger trust. Mitigation is possible using a secondary streaming platform or integrating it into a secure internal Wi-Fi or ethernet network. Assistance from trust information technology departments is recommended and this capability is something our team will consider as a future option. Expanding connectivity is an effect multiplier, offering distanced, streamed training across trusts and regions, as well as the inclusion of participants working from home. The portable nature of this smots™ solution offers flexibility for rapid deployment to areas of novel clinical capability and community partnerships. This system has proved exceptionally useful during a prolonged period of social distancing, enabling ongoing high-efficacy in situ
simulation training to a larger target audience within a robust, safe educational environment.