It seems like every hour provides new challenges in responding to the global pandemic of COVID-19. Healthcare educators, including those practicing various forms of simulation, are being confronted with difficult decisions about their work. Should we continue training? Should we close down our operations? What about converting to on-line simulations? Is using PPE for training wasteful? What is our role?
FHSS’s position is that each situation needs to be carefully assessed according to a thoughtful risk / benefit analysis. If the benefit truly outweighs the risk, then what risk mitigation strategies can be applied to improve safety?
We believe in the guiding principle of: first, do no harm. Does the educational or operational benefit of the simulation activity outweigh the risk to personal health or public safety? In most cases, education and training unrelated to the pandemic response would fail this test. If the participants in simulation are students, it seems very unlikely that physical presence simulation can be justified during a pandemic. If the participants are hospital workers, it is important to consider that this population is at especially high risk for infection and carriage of the virus. Also, the loss of a healthcare worker to the illness is devastating to the battle against the pandemic. This weighs heavily on the risk side of the equation.
In considering the benefits, alternatives such as live stream video, teleconferencing, tabletop exercises, or other creative forms of practice should be contemplated first. Only if these methods are insufficient should physical presence simulation be assented to.
If an educational program is deemed highly beneficial and the physical presence of learners or of educators and educational staff is deemed worth the risk, a number of mitigation questions should arise. Can the exercise be conducted with strict infection controls in place? Can physical distance be maintained for participants and educators? If the simulation requires people to work closely together, can infection control practices be maintained throughout? Is there a way to minimize the drain on resources so that it does not impact the patient care operations?
We were heartened to see safety focused questions raised on social media. For example, a twitter poll by Victoria Brazil asked simulationists to weigh in on the use of real vs. simulated PPE, sparking conversations about the balance between using limited PPE resources with need for practice. The topic was discussed on Simulcast: http://simulationpodcast.com/catalogue (Episode 97 COVID 19 Sim). Several Twitter posts described scaling back use of PPE or using creative mock PPE. Others used full PPE and shared lessons learned to guide others’ efforts. Either way, we were pleased to see the thoughtful decisions being made and discussed openly.
Finally, there are inherent biases present in making these kinds of decisions. Simulation educators are dedicated healthcare workers and are committed to actively helping. Healthcare workers pride themselves as willing to take risks in the care of others. Their colleagues on the front lines are truly battling this risk and, in some cases, losing that fight. It is natural to want to stand beside those heroes. There is the desire to feel relevant, be a contributor, and be appreciated by an organization and colleagues. Simulation education does not exist in a vacuum – it exists to serve the interests of patients and colleagues. Consequently, decisions about training mustn’t be made in a vacuum and should actively engage independent individuals and experts, especially those we hope to support.
We would love to hear your thoughts.
Foundation for Healthcare Simulation Safety 