International Journal of Healthcare Simulation

What? Our organization has been running some courses remotely since autumn 2020. Sessions for medical students and foundation doctors have taken place, allowing those who are isolating or shielding to participate, and facilitating the training of those who are outside our organization. We are now writing many courses with remote learning in mind and creating our course materials in digital format. This means that we are not starting from scratch if changes in circumstance prevent face-to-face training in the future. The remote format involves candidates controlling an ‘avatar’ in-centre, supported by a confederate (in nursing or junior doctor role), with access to a digital notes bundle. The screen on Microsoft Teams has a relatively fixed room view taking up the majority of the screen, with a change in feed to a different camera if appropriate to the flow of the scenario – to focus on the defibrillator, for example, with observations in a corner, and results popping up when requested. There is no option for candidates to alter this view. During a dry-run of a scenario involving a simulated patient (played by a faculty member) with hallucinations due to delirium, the candidate struggled in their appreciation of how abnormal the patient’s behaviours were, as they were unable to see all the small movements that were evident to those of us in the room, and low volume speech and muttering might have been difficult to hear, despite the faculty member wearing a microphone, though may have been easier through headphones. We sought feedback on the format and the feasibility for the scenario from the candidate, and the phrase ‘I didn’t see/hear that’ was used a lot.

So what? This has led me to wonder how much detail our candidates are dialling in from home, particularly those who are using a tablet, phone or laptop with a small screen, and have been missing, and how that might have affected their behaviour and clinical reasoning. Submitted feedback makes little reference to missing things in the course of the scenarios, but some candidates seem to have had more issues than others. This may have been due to technical or connectivity problems but could be viewed as a limitation of the set-up in its current format. Reviewing the feedback, while some expressed frustration about technical issues, there are many more comments about how they had enjoyed the experience and hoped it will continue. The jury seems to be out, but there is much to work on as we move forward.