TeleSimulation is a novel teaching process by which telecommunication and healthcare simulation resources are used to provide education, training and assessment to learners at an off-site location. Usually, a telesimulation event is designed to represent a simulated telemedicine meeting, but could also refer to distance-based learning opportunities for “off campus” simulated training. While medical simulation modules can be completed from remote environments, the ability to teleconference simulation across geographical barriers promotes active learning of realistic scenarios and conditions without having to be physically present in the sim lab room. The telesimulation mode of education has become an especially important training method across healthcare simulation during the coronavirus pandemic to limit possible virus exposure.

TeleSimulation can be used to help learners develop interpersonal skills, improve communication and test problem-solving skills. The practice leverages internet technology to allow learners to interact with their instructors just as they would during an in situ clinical simulation. Today, telesimulation can be used to train learners on skills such as the fundamentals of laparoscopic surgery, intraosseous training, ultrasound, pediatric anesthesia, neonatal resuscitation and more.

Often, the process of completing a telesimulation module will nearly mirror the same simulation performed within a clinic, with a few minor limitations, such as less oversight from instructors. TeleSimulation can also be subject to dependence on internet connection stability, language barriers, technical problems and errors, and time difference challenges as well. However, more experienced simulationists can greatly benefit from the independent analytical approach to new simulations that telesimulation encourages.

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During a standard telesimulation learning module, the participant will immerse themselves in a simulated scenario experience and engage within the lesson’s parameters. If needed, simulation manikins can even be operated during a healthcare simulation by remote control to increase the fidelity of the experience. Once the lesson is complete, the learner will reflect on their performance and/or an educator will perform a simulation debriefing to identify errors and possible performance improvements. Debriefing can be facilitated by the instructor(s) in real time via an online platform or through video conferencing or can be done at a later time depending on needs and convenience.

Whether the learner chooses to repeat the module or move on, they will be able to use takeaways from each respective telesimulation module to improve their performance moving forward. Just as in the case of simulations performed in a clinical environment, telesimulation can lead to increased practice opportunities and in-term improved patient outcomes and increased patient safety.

A clear benefit of telesimulation is that the use of technology to expand learning opportunities off-site means that resource-limited environments can have access to simulation tools. This provides the potential for healthcare systems and institutions to overcome geographic obstacles that would otherwise prevent them from employing simulation education and training. TeleSimulation can also be used in instances where time constraints make travel to the clinic or the instructor impractical or impossible.

Further, telesimulation has become an innovative teaching tool for educators and learners practicing emergency medicine. The process presents the opportunity to offset the utilization of critical resources, as well as to maximize instructor availability through pre-recorded simulation scenarios.This allows both the learner and the educator to maximize their time by allowing them to engage with, complete and debrief on tele simulations scenarios largely at their own convenience.

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In September 2020, the world’s first International TeleSimulation in Healthcare Conference brought together leading healthcare simulation educators and experts from around the world to share advances and innovations in telesimulation methods, curriculum, and tools. This new conference was specifically designed to support those exploring or using telesimulation from a community of healthcare professionals who have already pioneered some of these uncharted waters.

While the realm of telesimulation services is still relatively new to the education space, as use of the technology is expanded, there will become a greater need for the identification of best practices, guidelines and related terms. Until then, as long as educators continue to integrate telesimulation practice into their curriculums, learners will continue to gain valuable insight from these experiences — helping develop them into skilled healthcare professionals.

TeleSimulation During the COVID-19 Pandemic

The coronavirus disease has created numerous obstacles in clinical education. While many healthcare facilities consider medical simulation to be an essential service, the rapid spread of the coronavirus has led to increased hospital and healthcare facility safety measures. For example, some simulation centers have vastly limited the number of educators and learners allowed within a facility at any given time. Others have closed the clinical space and required their staff and learners to pivot to an approach that solely involves telesimulation.

As traditional simulation‐based medical education has shifted toward this virtual platform, COVID-19 management strategies have been able to be taught remotely. For example, healthcare employees who have needed to be redeployed to help treat coronavirus patients have been able to use telesimulation to train on ventilator management. They have also used telesimulation to simulate and treat other signs and symptoms of coronavirus infection.

Along with focusing on COVID-19 treatment readiness, telesimulation has granted many academic healthcare programs the ability to continue program educating and training their learners. For instance, the John Hopkins University Department of Anesthesiology and Critical Care Medicine has adapted resident education using telesimulation. Specifically, they began to use high-fidelity immersive case-based simulation scenarios for telesimulation by using the virtual meeting platform Zoom to meet residents’ curricular needs.

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Within the article “The sim must go on: adapting resident education to the COVID-19 pandemic using telesimulation,” leaders of the John Hopkins University telesimulation explained, “Two cohorts of anesthesiology residents participated [in the telesimulation] 2 weeks apart. All learners were located at home. Four faculty members conducted the telesimulation from different locations within our simulation center in the roles of director, simulation operator, confederate anesthesiologist, and confederate surgeon. The anesthesiologist performed tasks as directed by learners.”

They added that the scenario was divided into four scenes to permit reflection on interventions / actions by the learners based on the clinical events as the simulation scenario progressed, to facilitate intermittent debriefing and learner engagement. Additionally, all residents were given a medical knowledge pretest before the telesimulation, a posttest and learner satisfaction survey at the conclusion. According to the telesimulation leaders, the scenario was authentic and immersive, represented an actual case, and provided the opportunity to practice lessons that could be applied in the clinical setting.

John Hopkins University is not the only institution utilizing telesimulation to perform training via Zoom. This methodology is being used by simulation facilitators and supervisors with standardized patients to present patient case scenarios remotely. When this is the case, telemedicine can enable actors to present patient cases from anywhere and at any time, rather than meeting a standardized patient in a clinical or academic environment. For example, GIGXR and MedCognition are implementing augmented reality holographic standardized patients for use across teleSimulation events.

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