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
IntroductionMental health Simulation has an important role to play in improving clinical outcomes for patients. Transitioning to digital simulation presents facilitators, actors and technicians with several challenges to maintain high fidelity simulations.MethodsDuring the Coronavirus pandemic, Maudsley Simulation took a full-day simulation course and made adaptations for online delivery over a half day, testing in-house during a piloting phase. At the Simulation Centre, the sole focus for our simulated patients is acting, as technicians stage manage and dress scenes for them. The actors are experienced in playing these roles and have attended a Quality Assurance Course.Trial sessions were passively observed by other faculty members. Following each session, observations and reflections were logged and organised thematically.ResultsInitially, platform instability was challenging for the team and actors, and was felt to undermine the fidelity of scenarios. We started by trialling teleconference type scenarios that were static in nature and set in the community but developed this over subsequent trials. Actors are well versed in acting to camera and adapted quickly to this aspect of online simulation. Transitions to scenarios proved challenging and distracting in the early stages but were improved upon with audio-visual clips.Discussion and ConclusionSeveral issues required resolution to allow high-fidelity online simulation to be delivered. Switching platforms, adjusting pre-briefs for actors to include technical aspects of stage management, transitions and IT support greatly improved this and supported the achievement and maintenance of high fidelity scenarios for participants and observers.Actors’ spaces were tested to ensure the lighting, sound quality and camera angles were good. Actors were guided to dress their environment at home with input from technicians.We overcame initial difficulties for a scenario set on a psychiatric ward, by inviting the actor into our simulation centre. This allowed the technician to dress the environment and have more control over the audio-visual set up. The male actor used a hand-held cam to create a much more immersive experience, which was deemed to be an improvement by our team. A closer view of facial expressions resulted in a more empathetic approach to the patient, as his fears and worries were much more apparent and this was reflected on in the debriefs.Online simulation provides quality outcomes for participants, which will enable greater access for clinicians in remote or overseas locations to attend high quality simulation training. We plan to deliver full-day formats in future.
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.