Medical Simulation Center Readiness: Navigating Essential Changes From COVID-19

“Exactly how are we able to teach in the simulation center given the consequences of the recent COVID-19 pandemic invasion?” asks Dr. Jayne Smitten PhD, MEd, CHSE-A, FSSH, and SSH President-Elect Candidate 2021, Professor and Director of the Experiential Simulation Center (ESC) and her colleague Dr. Michelle Higgins-Mahe DNP, RN, Assistant Professor of Nursing and
Vice Chair Faculty Senate at Hawaii Pacific University’s College of Health and Society. In today’s submitted article, Dr. Smitten and Dr. Higgins-Mahe acknowledge that “pedagogical challenges and logistical restrictions from the Coronavirus have prevailed”, and that “addressing the fundamentals, including sanitation, distancing, screening, and workplace scheduling, are essential for the safety and security of faculty, students, staff, and visitors participating in our medical simulation center.” They write…

The surge of COVID-19 related infections in Hawaii resulted in dramatic government restrictions, which also prompted reimagining of our SIM Center communication approaches, teaching strategies, and collaborations among students and faculty as identified areas of required adjustment. Integration of the public health protocols with moral and pedagogical changes in healthcare simulation education appeared to require creative and deep thinking.


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Exactly how are we able to teach in the SIM Center given the consequences of the recent pandemic invasion? Pedagogical challenges and logistical restrictions prevailed. Addressing the fundamentals, including sanitation, distancing, screening, and workplace scheduling, were essential for the safety and security of faculty, students, staff, and visitors participating in our SIM Center. The surge of COVID-19 related infections in Hawaii resulted in dramatic government restrictions. This also prompted re-imagining of our SIM Center communication approaches, teaching strategies, and collaborations among students and faculty as identified areas of required adjustment. Integration of the public health protocols with moral and pedagogical changes in healthcare simulation education appeared to require creative and deep thinking.

Setting the Stage

Sanitization and screening procedures for the Experiential Simulation Center (ESC), following CDC, OHS and state guidelines, were developed and executed to welcome students and faculty back to the onsite simulation healthcare facilities. Faculty were designated as the ‘stewards of their teaching and learning environments’ and provided with the policies and procedures in place to further enforce the standards of practice for their safe and secure SIM Center environment. ‘Checklists with ease’, using dropdown menus on an iPad, provided the simple yet useful solution for daily accountability of the mandated sanitization practices and standards practiced in all areas.

Mandated mask wearing and screening via a daily, accessible COVID Screening questionnaire, in addition to thermal scanning stations strategically placed throughout the campus, further emphasized the adherence to safety and security for all stakeholders entering and utilizing the ESC.


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Physical Setting Modifications with Distancing

Thorough deliberations from the HPU Facilities Team (environmental, safety and security) resulted in performing assessments and facilitating the modifications for the classrooms, clinical low, medium, and high-fidelity training areas, and each simulation/debriefing area. Special electrostatic fogging procedures were performed throughout the HPU campus to further enhance the environment for protection from the COVID virus. Ventilation was also addressed and enhanced with greater air flow adjustments where possible. Even open-air classroom environments were considered and adopted in certain areas of the campus to allow for more engagement in outdoor teaching and learning opportunities. [This faculty member was going to have more FAB moments (Fresh Air Breaks!) throughout the day!]

And in Hawaii…why not!

Classroom settings were drastically changed, including the removal of all fabric chairs. Every piece of furniture and/ or shelving unit, equipment, and containers were reviewed for necessity with the environmental impact and space requirements in mind. Distancing for onsite seating and arrangements of desks were strategically positioned, within even the smaller areas. Signage was used to augment the desired placements and instructional directions were incorporated for flow of traffic.

Teleworking, staggering workforce times, and emphasis on other scheduling modifications were considered. Thought to the workforce scheduling during shutdowns, adhering to group number restrictions and now with the transition of return to work practices- all required necessary input and deliberations. Faculty were all apprised to visit the university facilities at their leisure and on an appointment basis through the Dean’s Administrative Assistant. The intent was to further emphasize the importance as well as promote the helpful mentorship by faculty for their students and the entire CHS environment and ohana (family) upon return to face-to-face campus settings.

Pedagogical Readaptation with Simulation to the Rescue

As we are all aware there is no playbook to address a global pandemic affecting all of faculty in our efforts to pivot and educate our students in the world of simulation. I, like so many others, are reporting feelings not only of fear at times, but also great loss — a loss of our daily routines, of our connections to one another, and of the comfort we too often take for granted regarding the health of our family, friends, and colleagues. As stated by our former First Lady Michelle Obama: “You know, I’ve gone through those emotional highs and lows that I think everybody feels, where you just don’t feel yourself (Obama, 2020)”. American Psychological Association (APA) (2020), in its third pulse check of the nations stress due to covid-19 and its effects, civil unrest, economic and education consequences, and an increasingly hostile political environment stated that Americans are experiencing considerable stress related to the coronavirus and are also reporting higher levels of general stress than in recent years. Yet, even as our lives have been turned upside down, there is one noticeable constant through it all: our commitment to educating our students, and to caring for one another.

As educators we have been able to adapt to hybrid classes, repurposing simulations to fit our online agendas and learning new technology such as Zoom, Teams, Blackboard Collaborate, so that we could continue to offer robust programs for our students. Many ask if this abrupt change in pedagogy and methods of delivering content comes at a price. Recent evidence has shown that e-learning produces neutral or positive academic outcomes in undergraduate nurse and health professional education (Carolan, Davies, Crookes, McGhee, & Roxburgh, 2020).
However, recognizing, and mitigating barriers when shifting teaching methods is a priority to ensure effective student learning. Some of the reported barriers are isolation; learning space; course structure; poor institutional design; time; cost; and labor (Carolan, Davies, Crookes, McGhee, & Roxburgh, 2020). Each facility needs to assess their strengths and needs and look for opportunities within their limits to enhance their programs.

Pedagogical considerations when shifting from face-to-face instruction should be presented in a unified and positive front to students. Never express that the shift from face-to- face to online, or the shift of clinical sites to skills labs or simulation, is at all some sort of deficit to the students learning. Educators need to lead by example. The integrity and credibility of a leader is important in a crisis; if the leader is not credible then the message communicated will not be perceived as credible (Fernandez & Shaw, 2020). Academic leaders that can communicate a thoughtful shared vision for the institution that is realistic and attainable can inspire other faculty, staff, and students. Helping students realize that the shift to simulation, Vsim, small class-face-to-face, will teach them how to be competent critical thinkers. Educators need to help students understand that learning skills can be done on the job; and that potential employers know that new grads from the Covid era may be deficit in some but not all skills training due to

the lack of clinical opportunities. What these new grads may lack in hands on skills training will make up for in critical thinking and problem solving (Monforte_Royo & Fuster, 2020).
Simulation is being used not only in nursing school but across the medical field. Kurz, Ospel, Kurz, & Goyal (2020), described how simulation was used to identify safety threats and helped nurses nad physians to practice relevant tasks and behaviors such as donning and doffing PPE during the Covid -19 crisis. Exposing students to these simulations while in school will give them confidence knowing that senior members of the medical team also partake in simulation excerises to enhence their learning on the job.

Distance learning, using the ‘flipped classroom’ and independent learning are all concepts that can be re-invented to meet our new pedagogic demands. The key challenge faced by higher educational institutions (HEIs) is readapting these modes of instruction to the virtual approach (Leigh, et al., 2020). Educators must revisit the process of delivery, the digital tools available, and their own identity as a lecturer, as well as becoming aware of the importance of self-care and the care for students, colleagues, family and the community in these stressful changing times.
Our university and college, as many academic institutions across the nation, continue to demonstrate commitment to simulation education and the work necessary towards safety, security and alleviating the anxiety of the faculty, students and staff. It is indeed a changed healthcare simulation educational world with logistical and pedagogical challenges — What is next?!

References

  • American Psychological Association (APA). (2020). Stress in the Time of COVID-19. APA.org/covid-19, 3, 1-3. Retrieved from https://www.apa.org/news/press/releases/stress/2020/stress-in-america-covid-july.pdf
  • CDC
  • Carolan, C., Davies, C. L., Crookes, P., McGhee, S., & Roxburgh, M. (2020). Disruptive impacts and transformative opportunities in undergraduate nurse education. Nurse Education in Practice, 46. doi:https://doi.org/10.1016/J.NEPR.2020.102807
  • Fernandez, A. A., & Shaw, G. P. (2020). Academic leadership in a time of crisis: The coronavirus and covid – 19. JOURNAL OF LEADERSHIP STUDIES, 14(1), 39-45. doi:10.1002/jls.21684
  • Kurz, M. W., Ospel, J. M., Kurz, K. D., & Goyal, M. (2020). Improving stroke care in times of the covid-19 pandemic through simulation: Practice your protocols. Stoke, 51, 2273- 2275. doi:DOI: 10.1161/STROKEAHA.120.030091
  • Leigh, J., Vasilica, C., Dron, R., Gawthorpe, D., Burns, E., Kennedy, S., . . . Croughan, C. (2020). Redefining undergraduate nurse teaching during the coronavirus pandemic: Use of digital technologies. British Journal of Nursing,, 29(10), 566-569. doi:https://doi.org/10.12968/bjon.2020.29.10.566
  • Monforte_Royo, C., & Fuster, P. (2020). Nurses who graduated during the COVID-19 pandemic. Will they be better nurses? Nurse Education Today, 94. doi:https://doi.org/10.1016/J.NEDT.2020.104536
  • Obama, M. (2020, 08 05). The Michelle Obama Podcast [Audio Podcast]. Spotify. Retrieved from
    https://open.spotify.com/show/71mvGXupfKcmO6jlmOJQTP?si=6fAogSmISQmawyIyI TkSlw
  • CDC: https://www.usa.gov/federal-agencies/centers-for-disease-control-and-prevention
  • OHS: https://ohsonline.com/home.aspx

Tomorrow is the last day to vote for members of the Society for Simulation in Healthcare for its board of directors. Jayne Smitten is running alongside Ron Levy and Haru Okuda for the position of President. Members can learn more and vote on the SSH website.


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