Acceptability, technological feasibility and educational value of remotely facilitated simulation based training: A scoping review

Figures & data

Figure 1. PRISMA Flowchart

Table 1. Key features identified in studies using ‘telesimulation’ techniques

Author	Educational activity	Participants and assessment methods	Findings
			Level 1 Technical feasibility and student/facilitator perception	Level 2 Teamwork, student changes in attitude, effectiveness of teaching learning outcomes
Ahmed et al. 2016 [20]	Simulated emergency training sessions for medicine residents that included teledebriefing or on-site debriefing	44 debriefing sessions using DASH 246 assessments	Teledebriefing was perceived as effective but the effectiveness was rated as lower than on-site debriefing (p < 0.001)
Bolle 2009 [23]	Linked videoconferencing pairing 3 rural hospital emergency teams with 3 university hospital trauma teams	9 participants Semi-structured group interviews		Videoconferencing was found useful during emergencies and for developing virtual emergency teams
Christensen et al. 2015 [5]	Simulation scenarios delivered locally and remotely by videoconference to recently graduated doctors and nurses	305 Participants 16 questions (5-point Likert scale) measuring LF vs. RF experience Pre-post-test scores on knowledge	LF training demonstrated higher scores for participant learning experience compared to RF training (p = 0.01).	LF had a higher impact on teamwork and effectiveness of learning outcomes (p ≤ 0.04). Differences in pre- and post-test knowledge were similar for RF vs. LF (p = 0.65)
Collins et al. 2019 [17]	Traditional LF versus RF cardiopulmonary resuscitation training using videoconferencing for health students at two geographically separate sites	10 Participants 9 survey questions (5-point Likert scale)	RF environment was rated high for visual connectivity, facilitator audio connectivity and recommended for locations with low resource and facilitator availability	RF SBT met interprofessional learning outcomes, was an adequate replacement for traditional facilitation and a remote facilitator could provide a valuable simulation training experience using distance education
Hayden, Navedo and Gordon 2012 [18]	Web-conference software was used to deliver either standard in-person instructions or instructions delivered by a remote instructor to preclinical students caring for patients in a stimulation laboratory	44 surveys from 23 education events Seven questions (5-point Likert scale)	Communication was identified as a barrier to understanding the case delivered by the remote instructor (p < 0.0001). Willingness to participate in future RF sessions was lower compared to LF SBT (p = 0.0003)	No differences were observed between LF and RF SBT for the acquiring of new skills (p = 0.39) or knowledge (p = 0.41).
Ikeyama, Shimizu & Ohta 2012 [6]	Video recordings of stimulation scenarios (ventricular fibrillation or desaturation in an intubated patient) performed by healthcare providers at a training centre were transferred to a remote facilitator through the system for debriefing and interactive communication.	16 participants and 3 facilitators 2 pilot RF SBT sessions 5 online survey questions (5-point Likert scale)	Facilitators reported concerns they could not assess participants emotions and expression but gave a 5/5 rating of the ‘Operability’ of RF system.	Learning quality of RF was rated more effective than LF (94% vs. 87%) and 88% of the participants opted for RF training again.
McCoy et al. 2017 [21]	A live TV internet connection was used for communication and debriefing of medical students who remotely observed a live, fully immersive simulation case and its debriefing done by an on-site simulation group.	32 respondents LF and RF compared using a written evaluation tool	Evaluation scores of RF vs. LF were not different; RF 96.8% (95% Confidence Interval [CI] 94.8% – 98.9%) vs. LF 96.6% (95% CI 94.5% – 98.6%).	Learners reported that RF was an effective learning tool, beneficial to their education and enhanced patient care in clinical settings.
Ohta et al. 2017 [22]	Bidirectional live video communication between medical students allocated either to remote or on-site facilitation for paediatric resuscitation training.	136 participants in two groups Comparison made using a facilitator rated behavioral assessment tool (BAT) 7-survey questions (7-point Likert scale)	RF training was rated as a more effective facilitation format than LF (p = 0.004) and as more realistic (p = 0.049)	The observed improvement in BAT scores were similar between the two groups (p = 0.94).
Shao et al. 2018 [19]	Web conference software with recording capabilities was used to deliver remote, structured simulation training for clinicians from intensive care units in 7 countries.	18 participants 16 Sessions Performance assessed using a validated tool Satisfaction assessed with a survey (5-point Likert scale)	94% felt they were well prepared to manage common acute presentations following the training, 75% felt the training was realistic and 81% recommended training should be undertaken by all critical care team members.	Critical task completion rate significantly improved pre-post training (p = 0.002). Improvements post-RF training were also noted in code status, disability and review of home medication and allergies (p ≤ 0.01).

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