Reentry During COVID-19: Reimagining Simulation Experiences

Part 1 of a 3-Part Series

By: Crystel L. Farina

Shortly after ringing in the 2020 New Year, many of us celebrated simulation at the International Meeting for Simulation in Healthcare in San Diego, California. As we left the meeting, we heard a brief news story about a virus and new protocols for screening people at the San Diego airport. Who knew that just a few months later, simulationists would emerge as essential to health care education?

As COVID-19 developed into a worldwide pandemic, health care educators across academia and practice settings scrambled to develop innovative ways to ensure continuity of education for all health professions (Carolan et al., 2020; Lowe et al., 2020; Massie et al., 2020; Mouli et al., 2020). Throughout the United States, academic institutions were losing access to clinical learning experiences as acute and chronic care settings faced the overwhelming need to focus on patients. These institutions were unable to dedicate the time and personal protective equipment needed to provide educational opportunities and keep learners safe (Swift et al., 2020). Practice settings were also searching for educational opportunities to teach new care techniques and protocols as well as the donning and doffing of PPE (Lowe et al., 2020; Massie et al., 2020; Mouli et al., 2020; Tabatabai, 2020).

As nursing programs considered how to educate students and keep them safe, it was necessary to reimagine how to provide simulation-based experiences and best utilize simulation space and advanced technologies. Simulationists throughout the US and globally found innovative means to develop virtual simulation-based experiences (American Association of Colleges of Nursing, 2020; Hodges et al., 2020; Jackson et al., 2020) and share virtual resources (International Nursing Association for Clinical Simulation and Learning [INACSL], 2020; National League for Nursing [NLN], 2020). Publishers, virtual reality vendors, and state and international alliances provided limited free trials of simulation scenarios and worked together to keep learners moving forward. It was amazing to observe how imagination and technology led to international collaboration in the health care simulation community,

While face-to-face simulation remains an important teaching strategy made easier by enhanced technology, simulationists in programs lacking resources were able to provide simulation-based experiences with a monitor, pictures, and a web-based meeting platform, and they shared their creations with others (University of Illinois, n.d.). Virtual experiences with rapid-cycle deliberate practice were developed as interactive experiences available through virtual meeting platforms for neonatal resuscitation, ventilator management, and cardiopulmonary resuscitation in the prone position (D. Timms, personal communication, April 14, 2020; T. Schneidereith, personal communication, June 30, 2020)

During the unprecedented COVID-19 pandemic, simulationists demonstrated new possibilities for simulation-based experiences. Going forward, educators will need to reimagine the future of simulation and simulation spaces. Is it a necessity to have million dollar simulation centers or could the operation of simulation move to Cave Automatic Virtual Environments (CAVE) or Wide Area Virtual Environments (WAVE) with enhanced technology (Lioce et al., 2020)? What if there were capabilities to stream events in simulation spaces to anyone connected from home, at any place in the globe? Could remote operations of simulators and space provide a hybrid to the virtual simulation? How about a virtual presence in the room (Dang et al, 2018)? Is access to technology a new basic need for health care education programs and learners?

Simulationists have demonstrated that they are collaborative, innovative, and imaginative. Simulation leaders have presented learning environments that were once considered unachievable, too complex, or too lengthy to develop, and there are no limits to their innovation. COVID-19 forced the realization that interactive learning happens without animators and avatars to create a virtual, collaborative, interactive simulation with learners involved in simulation scenarios. Most importantly, simulationists shared their knowledge about how to make it work. The simulation community has demonstrated that teams are willing to collaborate and work together for the good of all learning.


American Association of Colleges of Nursing (2020, March 30). Considerations for COVID-19 preparedness and response in U.S. schools of nursing.

Carolan, C., Davies, C., Crookes, P., McGhee, S., & Roxburgh, M. (2020).COVID-19: Disruptive impacts and transformative opportunities in undergraduate nurse education [Guest Editorial]. Nurse Education in Practice, 46, 1-2.

Dang, B., Palicte, J., Valdex, A., & O’Leary-Kelley, C. (2018). Assessing simulation, virtual reality, and television modalities in clinical training. Clinical Simulation in Nursing, 19, 30-37.

Gresh, A., LaFave, S., Thamilselvan, V., Batchelder, A., Mermer, J., Jacques, K., Greensfelder, A., Buckley, M., Cohen, Z., Coy, A., & Warren, N. (2020). Service learning in public health nursing education: How COVID-19 accelerated community-academic partnership. Public Health Nursing, 00, 1-10.

Guris, R., Elliott, E., Doshi, A., Singh, D., Widmeier, K., Deutsch, E., Nadkarni, V., Jackson, K., Subramanyam, R., Fiadjoe, J., & Gurnaney, H. (2020). Systems-focused simulation to prepare for CoVID-19 intraoperative emergencies. Pediatric Anesthesia, 00, 1-4.

Hodges, C., Moore, S., Lockee, B., Trust, T., & Bond, A. (2020). The difference between emergency remote teaching and online learning. EducauseReview.       remote-teaching-and-online-learning

International Nursing Association for Clinical Simulation and Learning. (2020). Resources: COVID-19 and virtual learning resource list.

Jackson, D., Bradbury-Jones, C., Baptiste, D., Gelling, L., Morin, K., Neville, S., & Smith, G. (2020). Life in the pandemic: Some reflections on nursing in the context of COVID-19 [Editorial]. Journal of Clinical Nursing, 1-3.

Lioce, L., Lopreiato, J., Downing, D., Chang, T., Robertson, J., Anderson, M, Diaz, D., Spain, A, & the Terminology and Concepts Working Group (2020), Healthcare simulation dictionary (2nd ed.). Agency for Healthcare Research and Quality.

Lowe, B., Dr Araugo, V., Haughton, H., Schweitzer, J., & Brazil, V. (2020). Preparing maternity for COVID-19: A translational simulation approach. Australia New Zealand Journal of Obstetrics and Gynaecology, 60, 628-632.

Massie, A., Boyarsky, B., Werbel, W., Bae, S., Cho, E., Avery, R., Ddurand, C., Desai, N., Brennan, D., Garonzik-Want, J., & Segev, D. (2020). Identifying scenarios of benefit or     harm from kidney transplantation during the COVID-19 pandemic: A stochastic simulation and machine learning study. American Society of Transplantation and American Society of Transplant Surgeons.

Morin, K. (2020). Nursing education after COVID-19: Same or different? [Editorial].  Journal of Clinical Nursing, 29, 3117-3119.

Mouli, T., Davuluri, A., Vijaya, S., Priyanka, A., & Mishra, S. (2020). Effectiveness of simulation based teaching of ventilator management among non-anaesthesiology residents to manage COVID-19 pandemic: A quasi experimental cross sectional pilot study. Indian Journal of Anaesthesia, 64, (2), S136-S140.

National League for Nursing. (2020). Virtual simulation options for undergraduate nursing students.

Swift, A., Banks, L, Baleswaran, A., Cooke, N., Little, C., McGrath, L., Meechan-Rogers, R., Neve, A., Reese, H., Tomlinson, A., & Williams, G. (2020). COVID-19 and           student nurses: A view from England [Editorial]. Journal of Clinical Nursing, 29, 3111-3114.

Tabatabai, S. (2020). Simulations and virtual learning supporting clinical education during the COVID-19 Pandemic. Advances in Medical Education and Practice, 11, 513-516.

University of Illinois College of Medicine Simulation and Integrative Learning (n.d.). Navigating uncharted waters: Simulation in the age of COVID-19 weekly webinars. https://chicago.medicine.uic-sail-simulation-webinars-weekly

2 thoughts

  1. Crystal- all so true. I think the smoke has cleared just enough, we are starting to think clearly again and assess “what happened” and “what comes next”. We have time to consider what to keep about what was changed, and what should go back to the way it was. May we live in interesting times!

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