Background: Medical simulation has been shown to be beneficial to long-term learning (1). A recent systematic review of 21 simulation studies also illuminated its potential role in preventing medical errors (2). Our institution has a robust simulation center with high-fidelity mannequins that all internal medicine residents rotate through on a yearly basis. Each session has about 4 residents and covers 3 cases. Due to social distancing guidelines from COVID-19, our simulation curriculum was halted. We sought to deliver our curriculum fully remotely to internal medicine residents during the pandemic.
Methods: Using Zoom videoconferencing, we connected remote resident learners and an instructor to a simulation technician at the simulation center. Most instructors previously received formal training in simulation instruction and debriefing, but no specific training was done in the use of remote simulation. A brief orientation covered the expectations of the session, online meeting etiquette, and the limitations of remote simulation. The cases began with a case stem presented from the simulation technician’s screen. Next, the learners worked through the scenario by viewing a monitor, interacting with the patient virtually, obtaining a history and physical, requesting work-up, and executing treatment plans. A variety of images and laboratory data were available upon request. A virtual defibrillator was also accessible with the ability to adjust the settings. The instructor maintained a private chat with the simulation technician to modify the clinical status of the patient based on the actions of the learners. After completing the case, the instructor debriefed with the learners. At the close of each session, whether remote or in-person, we requested completion of an anonymous evaluation form. The questions utilized a Likert scale from 1 to 5 with 5 being the most favorable educational experience. Means, standard deviations, and a 2 sample t test assuming unequal variances were performed for each survey question using Excel software (3).
Results: A total of 268 evaluations were included in our analysis. Prior to COVID-19 restrictions, from 7/10/19 to 3/4/20, 162 evaluations for in-person teaching were collected. The remaining 106 evaluations were obtained during remote simulation from 8/12/20 to 4/28/21. Overall, both in-person and remote simulation were rated highly with all scores above 4.85 (Table 1). For 4 out of 5 questions, in-person simulation received statistically higher scores than remote simulation.
Conclusions: Simulation is a valuable tool for teaching internal medicine residents. Residents especially agreed that they were learning skills that are directly applicable to their practice. By transitioning to remote simulation, we adhered to social distancing guidelines while still providing a quality educational experience that received excellent marks. As expected, the fidelity of remote simulation is not as robust as in-person instruction. However, learners can still benefit substantially. Beyond pandemics, remote simulation could bring cognitively engaging learning opportunities to institutions without access to a simulation center such as small residencies or even to global health partners.
