Feasibility of an International Remote Simulation Training Program in Critical Care Delivery: A Pilot Study

Abstract

ObjectiveTo determine the feasibility and effectiveness of a video-enabled remote simulation training program to teach a systematic, standardized approach to the evaluation and management of the critically ill patients as part of an international quality improvement intervention.Patients and MethodsIn this pilot “train-the-trainer” prospective cohort study, we provided a remote simulation-based educational program for practicing clinicians from intensive care units involved in an international quality improvement project (www.icertain.org). Between February 21, 2014, and August 6, 2015, participants completed a self-guided online curriculum and participated in structured simulation training using web conference software with recording capabilities. The performance was assessed using a matched pair analysis at baseline and using standardized scenarios and a validated assessment tool postintervention. Participants rated their satisfaction with the training experience and confidence in implementing these skills in clinical practice.ResultsEighteen local champions from 8 hospitals in 7 countries in Asia, Europe, and South and Central America completed the educational program. Learners exhibited significant improvements in cumulative critical task performance during simulated critical care scenarios with training (60.3%-81.8%; P=.002). Most clinicians (94%) reported that they felt well prepared to manage the common critical care scenarios after training. These local champions have subsequently delivered this educational program to more than 800 international clinicians over a 4-year period.ConclusionInsufficient training is a major barrier to the delivery of cost-effective critical care in many areas of the world. Video-enabled remote simulation training is a low-cost, feasible, and effective method to disseminate clinical skills to critical care practitioners in diverse international settings.

Implementation of a Global Quality Improvement Project in 20 Countries: A Case Study

“…2. Remote simulation training [5]: When the baseline data had been collected, the center participated in remote simulation training, which included baseline training without integration of the CERTAIN tool and an advanced training session with integration of the CERTAIN tool.…”

Use of Virtually Facilitated Simulation to Improve COVID-19 Preparedness in Rural and Remote Canada

“…At the beginning of the COVID-19 pandemic, urban, suburban, rural, and remote centers were requesting SBE for disaster preparedness (Dubé et al, 2020a), but RRC proved particularly challenging to reach because in addition to budgetary constraints, the pandemic resulted in new public health guidelines and restricted travel (Government of Alberta, 2020). In order to facilitate COVID-19 preparedness training for RRC, existing simulation techniques were applied through a novel approach using entirely virtually-facilitated simulation (VFS) including virtual debriefing for communities with limited access to continuing medical education (Alberta Health Services eSIM Provincial Simulation Program, 2019; Cheng et al, 2020;Cheng et al, 2017;Ikeyama, Shimizu, & Ohta, 2012;Shao et al, 2017;INACSL Standards Committee, 2016). The program's rural simulationists evolved into a virtual team, leveraging their established rapport and trust with RRC clinical nurse educators for the subsequent development and implementation of VFS.…”

Use of Telemedicine to Improve Neonatal Resuscitation

“…More sophisticated options include experts completely controlling a high-fidelity simulator and running a scenario/debrief much as you would if the learners and experts were at the same facility (Figure 1 and Figure 2). The feasibility of telesimulation has been described in a number of papers [26,30,31,32] including transoceanic telesimulation [33,34]. Multiple studies have also reported that the effectiveness of remote telesimulation is at least equal to in-person training [32,35,36,37], although one study reported communication issues between participants and the facilitator [36].…”