What We Learned About Simulation in the COVID-19 Era.

To the Editor:

The delivery of simulation training and assessment has seriously been affected by the COVID-19 pandemic.[1,2] Thus, we held an international virtual Webinar on the “Zoom” platform entitled “Simulation in the COVID-19 Era” to share experiences from 3 institutions in 3 different countries: Iran, Turkey, and the United States. The 2-hour Webinar was held in cooperation with the Educational Development Center (EDC) and Medical Education Department of Tehran University of Medical Sciences on January 18, 2021. The workshop was scheduled from 12:30 pm to 2:30 pm GMT, which was an appropriate time for all participants from these 3 countries. During the Webinar, the experiences of 3 institutions from the 3 mentioned countries were presented by prominent professors in the field of simulation, and the questions of the participants were answered. This letter is a brief report of the Webinar, sharing our experiences using simulation in both developed and developing countries.

In Iran, the use of simulation for various educational activities began many years ago, and the Objective Structured Clinical Examination (OSCE) is a key part of this. At Tehran University, medical students have to pass a high-stake OSCE to graduate, and World Health Organization (WHO) protocols had to be implemented to prevent COVID-19 transmissions. It is worth noting that despite the early experience in using virtual reality technology in Iranian medical education, there were still major obstacles—mainly logistics-related—to its widespread use. Until the beginning of the pandemic, simulation technology was only used in research, and because of a lack of necessary infrastructure, it had not risen to become an established tool for teaching and assessment.

Because of the pandemic, Hacettepe University in Turkey also had to move their communication and clinical skills training for medical students to online platforms. They established a successful virtual simulation program by sending 1500 free packages with tools and raw materials to students' homes to facilitate skills practice. The mailings were followed by remote e-classes for teaching basic clinical skills such as suturing on mannequins. Connecting virtually from home, students had to demonstrate their acquired skills via video and received feedback from educators. To teach communication skills, interviews were conducted with simulated patients (SPs) virtually. Instructors observed the encounters and followed up with feedback.

Initially, at Maimonides Medical Center in the United States, all OSCEs for Pediatric and Internal Medicine residents were canceled. A few months later, they went virtual to reduce infection risks for all those involved in the program. This was supported by the Association for Standardized Patient Educators (ASPE) Standards of Best Practice, which advocates for SPs' physical and psychological safety.[3] To help OSCE programs move to a virtual format quickly, a list of SPs who were willing and able to work remotely was compiled. Zoom breakout rooms were used to simulate the OSCE station environment. Based on learner evaluations, the virtual training experience was as useful as the in-person OSCEs.

Our virtual meeting clearly proved that, no matter where a medical training program is located, creative solutions can be found everywhere to deal with the dramatic and traumatic changes brought on by a pandemic. This crisis gave us an opportunity to think out of the box, expand on previous innovations, and come up with new educational models that will surely outlast COVID-19 during the time. The online conference format allowed a more instantaneous, worldwide exchange of ideas that can only improve medical education everywhere. Thus, in this COVID era, we have gained some new connections and new tools that help move our field forward.