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Simulation in Healthcare in the Midst of the Pandemic

Scerbo, Mark W. PhD, FSSH, FHFES

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Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: December 2020 - Volume 15 - Issue 6 - p 373-374
doi: 10.1097/SIH.0000000000000533
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Like many of you, I was busy with my usual commitments attending an exciting International Meeting on Simulation in Healthcare in January, 2020. I was aware of reports of a novel coronavirus detected in Wuhan, China, but that was China. I returned home and started digging through the work that accumulated while I was away. Within 2 weeks, mild concerns about China became mild concerns about the United States when a public health emergency was formally declared. On March 11, 2020, however, the World Health Organization declared COVID-19 a pandemic.1 Then, the world changed as mild concerns turned into urgent concerns and global emergencies.

The pandemic spread rapidly from country to country with rising infection rates and loss of life. The need to respond to overwhelming numbers of infected patients and keep frontline providers safe became paramount in all hospitals and healthcare facilities. At the same time, nonessential workers in regions experiencing high infection rates were told to stay home.

While at home contemplating my nonessential status, I turned my attention to how this journal should respond. First, under David Gaba's leadership,2 the journal had published a series of articles on highly communicable disease in April, 2016. The articles were submitted in response to the Ebola virus disease outbreak that began in West Africa in 2014 and discussed how simulation could be used to inform about the spread of disease, how to prepare for an outbreak, what was learned from exercising protocols, and implications for safety. Case scenarios were also provided for those wishing to conduct exercises at their institutions. This was critical information for people facing the current pandemic, and we posted a link to this material on the Society for Simulation in Healthcare Web site. However, the need to quickly share information specific to the COVID-19 was paramount.

Healthcare journals and other outlets for scholarly work soon began receiving submissions from the authors who managed to find time outside of patient care to disseminate observations, methods, techniques, and solutions for maintaining safe and effective patient care under the most taxing conditions. We began receiving submissions related to COVID-19 in March, and there has been a continual stream of manuscripts on this topic since then. We have worked to expedite the peer review and publication process to make this content available as soon as possible. Moreover, our publisher, Wolters Kluwer, also agreed to make all COVID-19 content freely accessible to the public for the first 2 months.

However, we felt that more could be done to quickly disseminate this important information. Thus, in July 2020, we announced a new format: COVID-19 Brief Reports. The primary objectives were (1) to solicit and disseminate simulation-based ideas and solutions that might benefit the healthcare simulation community and (2) to expedite the publication of these reports. We wanted to provide an alternative format for providers and simulationists to share their direct experiences as they fought the effects of the pandemic. We asked authors to state the specific problem they addressed, how they addressed it, and what they learned in 1000 words or less.

To date, the response had been enthusiastic. We received 5 submissions within the first month after announcing the new format. We sought articles that offered innovative solutions that could be easily adopted and applied broadly. I am pleased to announce that the first 2 of these COVID-19 Brief Reports appear in this issue.

The COVID-19 Brief Reports are not intended as a substitute for traditional submissions. We continue to seek manuscripts that offer more detailed descriptions of novel applications and research related to the pandemic that go beyond how centers have responded. We are interested in topics that capture how the pandemic affects the delivery of care, what may be needed in the future, and the unique role of simulation in these efforts. We are particularly interested in empirical research and solutions supported by objective data. Sample topics include the following:

  • patient and provider safety
  • noncompliance with new safety measures
  • how teams and communication are affected by personal protective equipment
  • simulations to assess large-scale institutional readiness or multisite efforts
  • psychological effects of personal protective equipment, social distancing, and quarantine on patients and providers
  • virtual solutions for training and assessment

The pandemic has altered all of our lives in countless ways, personally, and professionally. Sadly, here and abroad, we have seen record levels of infections, mortality, disrupted economies, and unemployment. Even for those who are not affected directly by the virus, it still pulls at the fabric of our humanity. The need to restrict social gatherings undermines the experiences we most cherish sharing with others: worshiping with our congregation, going to concerts and sporting events, and attending convocations.

As if this were not bad enough, we must now wear masks to minimize the potential spread of the virus. Properly placed, the mask covers the nose, mouth, chin, and most of the cheeks, thereby blocking all components of nonverbal communication except for the eyes and eyebrows. Furthermore, the mask disrupts speech by distorting or attenuating the higher frequencies, which carry most of the information needed to distinguish consonant sounds. The deleterious effects of masks on spoken and nonverbal communication are compounded further by the need to maintain increased social distance, which lowers the volume of speech and renders facial expressions more difficult to discern. Thus, the virus not only constrains opportunities for us to interact socially, but it undermines the ability to communicate even when we can interact.

Concerns over impoverished communication due to masks are captured in a timely and thoughtful Reflections on Simulation piece in this issue. Kathleen Huth and Peter Weinstock3 explore the effects of mask wearing on nonverbal communication, how we relate to one another, psychological safety, and what that means for patient care.

I echo the sentiment expressed in this article. We may have limited ability to mitigate the spread of COVID-19 and may need to interact with one another from behind masks, but we do not have to surrender our humanity. Simulation affords us the means to adapt and circumvent risk, to experiment with alternative treatment methods away from patients, and to foster better communication through debriefing and self-reflection.

As I monitor the national and international statistics on the spread of COVID-19, I sometimes wonder what the mortality rates would be had healthcare not embraced simulation 15 to 20 years ago. The infrastructure and personnel to rapidly train healthcare providers to treat COVID-19 patients and to remain safe were already established when this pandemic emerged. That so many simulation centers have seen unprecedented demand during this pandemic underscores the reality that healthcare simulation is now essential, and the deftness with which simulationists have adopted distance simulation approaches in response to social distancing guidelines speaks strongly of the resilience of our community of practice.


I would like to thank Aaron Calhoun for his helpful comments on an earlier draft of this article.


1. WHODirector-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. ( Retrieved October 12, 2020.
2. Gaba DM. Introduction to special issue on highly communicable disease management. Simul Healthc 2016;11:71.
3. Huth K, Weinstock PH. Masks: the new face of healthcare and simulation. Simul Healthc 2020;15: (in press).
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