ABSTRACT
Purpose: During COVID-19, Maudsley Simulation successfully pivoted to fully online delivery of simulation-based education (SBE) in mental health. In migrating digitally, the simulation faculty experienced a range of new phenomena and challenges. The authors' experiences may be transferable to other specialities and for other educator groups. By sharing the authors' experiences, this study aims to support others adapt to online SBE. Design/methodology/approach: This piece represents the authors' collective reflections on the challenges of adapting their facilitation skills to the online environment. It also offers various suggestions on how to improve the learner experience in view of these challenges. Findings: Beyond merely platform orientation and operating procedure familiarisation, the team gained insights into ensuring optimal learning, engagement and participant experience during online deliveries. Delivery of online SBE brings several potential barriers to psychological safety and these warrant careful consideration by experienced simulationists. Practical implications: Optimising participant engagement and psychological safety remain key considerations despite this novel medium. Facilitators must be willing to adapt accordingly to begin delivering high-quality online SBE. Originality/value: From their experience, facilitators must reframe their debriefing expectations and adjust how they engage participants and manage group dynamics given the inherently different nature of this new learning environment.
ABSTRACT
BackgroundTo ensure Maudsley Simulation can continue to deliver simulation-based education (SBE) despite COVID-19, digital simulation was piloted. This decision represented pragmatism and innovation. The process from initial design and in-house testing to piloting remote deliveries led to learning for faculty and technicians across several domains. This experience will be useful for other faculties planning to develop digital simulation capability.Summary of WorkAn existing full-day course for psychiatric trainees was adapted and piloted online over a half-day. Testing was across two video-conferencing (VC) platforms, Kaltura and Zoom. Actors and participants were remote and relied on in-built laptop webcams and microphones. Faculty and technicians were mostly based at the centre. In-house testing and three half-day pilots were conducted. Implementation data were gathered across multiple newly identified domains incl.: pre-course issues, session launch and structure, engagement, transitions, audio-visual (AV) issues, connectivity, role assignment, actor management, platform-specific issues, optimal default platform settings, platform needs requests and course evaluation.Summary of ResultsThe project encompassed assessing the scope of learning objectives and engagement, a technology-neutral requirements analysis, identification of suitable VC platforms, platform testing, drafting of implementation guidelines and process mapping. These elements were incorporated into piloting cycles. Each piloting cycle was linked to an implementation and troubleshooting log to capture issues, fixes and actions. Throughout, qualitative feedback and observations on technical aspects were sought from faculty, technicians, actors and participants. All feedback fed into the piloting cycle. As the phases progressed, the log expanded to categorise issues thematically. Analysis of qualitative feedback and observations informed the learning design of each pilot phase.DiscussionRemote delivery introduces additional variables and layers of technical complexity (e.g., AV quality, device suitability, connectivity). Locating technical issues within a group in real-time presented significant challenges for technicians and facilitators alike. To mitigate this, front-loading responsibility by specifying technical requirements in invite emails, the use of induction video content and pre-course orientation and testing was helpful. Operationally-speaking, clearly delineating the technician role toward assertive issue management and moderator chat supervision supported the team to limit disruptions.ConclusionFrom our testing, Zoom offered greater stability and functionality with platform stability and concurrency agreed upon as the foremost considerations. The process identified new faculty development needs regarding online facilitation. In the context of COVID-19, digital simulation represents a potentially valuable modality via which to deliver remote SBE. There are additional benefits in terms of scalability and accessibility.ClassificationEducational innovation.
ABSTRACT
BackgroundTransitioning to digital simulation presents facilitators with several challenges beyond platform orientation and operating procedure familiarisation.Summary of WorkAn existing full-day simulation course for psychiatric trainees was adapted for online delivery over a half-day. In-house testing and a piloting phase (three half-day pilots) were conducted. Testing was across two video-conferencing platforms, Kaltura and Zoom. Faculty experience levels ranged from novice to highly experienced (i.e., several years’ experience). Two facilitators ran each session. Sessions were passively observed by other faculty members. Following each session, observations and reflections were logged and organised thematically.Summary of ResultsIn comparisons with non-digital simulation, several themes consistently emerged: a distinctly higher cognitive load, the overall challenge of engaging a group through a more constrained medium, associated relative constraints in transitioning to break-out teaching sessions, technical issues as highly distracting and, finally, potential barriers to psychological safety (incl. challenges in rapport building, limitations in inter-participant engagement, platform-related barriers to fluency in debriefing).DiscussionFaculty described experiencing a higher cognitive load and a ‘live TV effect’ i.e., an experience of intense focus on the facilitator. Aside from relatively recent orientation to the platform, this was attributed to the diminished ease with which participants can communicate casually with each other, the consequent need for more active chairing and the requirement to monitor several modalities to ensure smooth running of proceedings (e.g., audio and visual input and output, moderator chat and ‘off-stage’ faculty stage management instructions and updates). This higher cognitive load was described as fatiguing over a half-day session however, faculty were confident this could decrease with more familiarity with the platform. There were similar reflections regarding participants and their likely issues in focusing for extended periods online.1 It was agreed this may potentially render a ceiling on session duration. This was factored into future scheduling of sessions.ConclusionPlatform instability (e.g., audio-visual lag, connection disruption) was described as a stressor for facilitators and felt to undermine fluency and potentially psychological safety. Ensuring clear delineation of technician and faculty roles in relation to platform orientation and assertive management of technical issues helped decrease faculty cognitive load and supported the achievement and maintenance of psychological safety. Breakout rooms and novel ice-breaker techniques are to be considered to encourage early inter-participant engagement. Owing to the additional demands of facilitating digital simulation, there may be a faculty development need for media-style training.ReferencesWiederhold BK. Connecting through technology during the coronavirus disease 2019 pandemic: avoiding ‘zoom fatigue’. Cyberpsychology, Behavior, and Social Networking 2020;23(7). DOI: 10.1089/cyber.2020.29188.bkw.