This photo demonstrates how Covid-19 has turning classrooms upside down and dark

As most students across the country have transitioned from in-person school to virtual on-line instruction, for some this approach isn’t all that’s needed. For the hundreds of thousands of healthcare students, including future nurses, pharmacists, physical and respiratory therapists, and physicians, who must earn hundreds of required hours of in-person clinical experiences to graduate and sit for licensing exams, the coronavirus has meant that these hands-on learning opportunities cannot happen.  At a time when we are seeing hospitals overrun, large numbers of healthcare workers becoming ill or succumbing to coronavirus we simply cannot afford to have any slowdown in being able to inject new workers into the system. Fortunately, healthcare simulation is quickly being deployed to help fill this educational gap, thus helping to ensure that a new healthcare workforce will join the healthcare profession at a time when our medical system is under extreme stress. By allowing these students to graduate on schedule, simulation-based    learning is playing a critical role in this urgent time.

Healthcare simulation is a technique used to replace or amplify real experiences with guided practices that evoke or replicate substantial aspects of the real world in an interactive manner. Healthcare simulation uses a variety of tools ranging from life-like or immersive simulated healthcare settings replete with almost anything you can find in a real clinical setting to virtual healthcare environments offered in a virtual format.

In the immersive version, humans alone or in combination with advanced technology manikins that can depict normal and abnormal human physiology create interactive settings where emergent and non-emergent scenarios can be created to provide safe practice arenas for learners without risk to patients or the potential for psychological trauma to students if an error were made on a human. In virtual simulation, computer-based programs similarly allow for practice in a safe environment, but do so using a computer-based platform. Virtual simulation does not allow some of the hands-on practice experiences or the in-person interactivity afforded in immersive simulation such as placing a breathing tube in a patient, palpating a pulse or practicing CPR compressions with real time feedback.  But the usual disadvantage of virtual simulation not allowing hands-on practice has now become a huge advantage in a time of coronavirus because virtual simulation can fill the void in healthcare education when medical campuses have closed.  

Harvey is an example of a high technology manikin. Harvey was one of the earliest human patient simulators available; models continue to be all over the globe as part of healthcare curricula.
Thank you
Univ of Miami Gordon Center for Simulation and Innovation in Medical Education
Photo Credit: David Sutta

Simulation facilities are nearly ubiquitous in schools of nursing and medicine; most healthcare programs now incorporate some simulation to augment in-person clinical experiences and didactic content. In the last twenty years, simulation has garnered support for its use as part of quality healthcare programs due to its unique educational benefits backed by research demonstrating its effectiveness. Some pre-licensure programs, such as nursing, with the backing of accrediting bodies and state licensing boards have even begun using simulation to replace in-person clinical hours following a recent multi-site landmark study providing evidence that high quality simulation could reliably replace up to 50% of clinical hours while producing similar educational outcomes.

Acadicus is an example of a virtual simulation product. Here it is used with learners remote conferencing in to participate in a virtual simulated case
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Arch Virtual – 

Simulation in many ways has been a game changer in terms of quality of healthcare education and readiness for practice of students, but we have never had to implement it like we are now in the absence of clinical experiences . While many healthcare schools are well versed at augmenting their curricula with immersive simulation alone or in combination with virtual simulation, the vast majority are not adept at completely replacing clinical hours with only virtual simulation.  Also, the fact that immersive simulation isn’t possible due to social distancing measures means this shift in educational programing has to be done at Mach speed to prevent hundreds of thousands of healthcare students to fall behind and fail to graduate on time. In a setting where healthcare systems are being tested beyond their limits, we simply can’t afford not to ensure we can keep the pipeline of healthcare workers moving forward. Even before coronavirus, the US faced an impending nursing shortage, and we simply do not have enough healthcare workers or resources in rural settings. Coronavirus amplifies these dire circumstances. We need more healthcare workers, and we need them now. Some states are even pushing for the early graduation of healthcare students so that they can serve communities that are being hardest hit by coronavirus.

As a healthcare simulation expert, I am heartened by how the simulation community has come together to help, including educators, businesses, and organizations. Two of the major simulation organizations, Society for Simulation in Healthcare and the International Nursing Association for Clinical Simulation and Learning joined forces, putting out a joint position statement on the use of virtual simulation during the pandemic.  The listserv of both organizations have become think tanks for new uses of simulation during these challenging times. WhatsApp groups, social media pages and cloud-drives are rife with resources that have been shared from all corners of the globe, and  many companies have generously shared their products free of charge. Even in this time of social distancing and forced isolation, healthcare simulation educators and the simulation community as a whole have never been more connected and singly focused on a goal than now.

While the battle against an invisible enemy wages on across the world, simulationists are quietly readying the next generation of healthcare professionals using the best tools we know how. As scientists and current healthcare professionals test new medications and develop new treatments, we are conducting our own important work. We are testing the depth and breadth of healthcare simulation, learning how far we can push it, creating new ways to use it, and discovering how impactful it can be in a new setting. Our outcomes – the next generation of healthcare soldiers – ready for battle.  

Jill Steiner Sanko is an assistant professor of Nursing and Health Studies at the University of Miami and a Public Voices Fellow.