Onlinization of a simulation course that includes minor emergency procedures

Abstract

Aim

We attempted to convert a simulation course held on‐site for primary care physicians to learn about the initial treatment of minor emergencies, including some common surgical procedures, to an online format.

Methods

We reviewed the subjects covered in the course and evaluated whether it was “decision‐making” or “technical skills” that had been primarily taught as simulation‐based training for each subject, and then supplemented the contents accordingly.

Results

As a result, satisfaction levels with the online course were comparable to those with the on‐site course as measured by a postcourse questionnaire (97.6% [83/85 participants] rating it as “excellent” or “good” on a 5‐point Likert scale postcourse questionnaire).

Conclusion

We showed that it is reasonable to offer simulation in place of in‐person training even for some procedures that were once assumed to be difficult to teach online. Of note, the online course is not just a replacement for the on‐site course; it can offer other benefits, including opportunities for those who have difficulty attending courses due to distance or work‐related reasons. After the COVID‐19 pandemic period, both onsite and online courses can be held, allowing participants to choose the style of course that best suits their situation.

We attempted to present a simulation course online to learn about the initial treatment of minor emergencies, which was held on‐site until the COVID‐19 pandemic. We reviewed the subjects covered in the course and evaluated whether these were “decision‐making” or “technical skills” that had primarily been taught as simulation‐based training for each subject, and then supplemented the contents accordingly. As a result, satisfaction levels with the online course (good feedback from 97.6% of the 85 participants) were comparable to those with the on‐site course as measured by a postcourse questionnaire, which confirmed success in the onlinization of the simulation course.

The Triage and Action Minor Emergency course ¹ is a simulation course for primary care physicians to comprehensively learn about the initial treatment of minor emergencies, including some common surgical procedures. ² , ³ , ⁴ , ⁵ The course aims to improve clinical knowledge and skills for managing minor emergencies. The course has been held 33 times, and 940 physicians have completed it as of March 2020, reporting a participant satisfaction rating of 98%. ² However, this course was discontinued due to the coronavirus disease (COVID‐19) pandemic. Since then, we have been exploring options to resume this course. Here, we report that we have been able to reopen the course online.

Originally, the course consisted of three parts: lectures, demonstrations, and simulation‐based training. Specifically, this is a 1‐day, 6‐h course that includes lectures and demonstrations on eight emergency conditions—ocular surface foreign bodies, central retinal artery occlusion, epistaxis, foreign bodies in the ear, minor burns, animal bites, sprains, and fractures—with simulation‐based training on five of them. The simulation‐based training uses real case scenarios, and participants decide how to treat the minor emergency in each simulated patient. Two Triage and Action Minor Emergency course multidisciplinary instructors supervise five participants. The instructors describe patients with various diseases and injury scenarios and assess the participants' “decision‐making” and “technical skills.” ² , ⁵ In addition, a panel of experts, including specialists in ophthalmology, otolaryngology, dermatology, and orthopedics, participated in demonstrations and a question‐and‐answer session.

The first two parts, the lectures and demonstrations, can easily be delivered online. However, the challenge was determining whether simulation‐based training could be delivered online. We reviewed the subjects covered in the course and evaluated whether “decision‐making” or “technical skills” had primarily been taught in the simulation‐based training for each subject. We found that the subjects covered in the course, including ocular surface foreign bodies, central retinal artery occlusion, minor burns, animal bites, sprains, and fractures, were largely based on decision‐making. In contrast, epistaxis and foreign bodies in the ear were largely based on technical skills. For the minor emergencies mainly requiring decision‐making skills, we supplemented the procedures with lectures and demonstrations, emphasizing the crucial turning points of decision‐making. In addition to role‐playing, oral questions were used to evaluate the participants' comprehension of the turning points of decision‐making. ⁶ For the two subjects mainly requiring technical skills, namely epistaxis and foreign bodies in the ear, the simulation kit used in the on‐site courses were distributed to all participants. As a result, we were able to create a remote learning environment similar to that on‐site. However, we could still not replicate the hands‐on instructions and nonverbal communication offered on‐site. To overcome these barriers, we created a manual that provides step‐by‐step guidelines on teaching medical procedures in any environment, ⁶ shared it among the instructors, and worked on removing the online barriers.

The online course was conducted twice in October and December 2022 using Zoom (Zoom Video Communications, Inc., San Jose, CA, USA), a common web conferencing tool. Participants attended the course from their homes or a spacious location where simulations could be carried out. The epistaxis and foreign body simulation kit, including the nose–ear model owned by the course (Figure 1), were sent to participants beforehand (shipping cost was approximately $30 per participant; the materials are reusable). The online course basically followed the structure of the on‐site course, with almost the same course schedule and instructor‐to‐participant ratio. Table 1 shows the schedule of this course. A panel of experts also participated online during the demonstrations and question‐and‐answer sessions.

FIGURE 1.

Nose–ear model for the Triage and Action Minor Emergency online course. The human head model is modified to allow insertion of gauze for hemostasis. The medial side is made of a transparent board to facilitate evaluation of gauze packing.

TABLE 1.

Schedule of the Triage and Action Minor Emergency online course

Schedule	Content
09:00–09:10 (10 min)	Introduction
09:10–09:30 (20 min)	Ophthalmology: Lecture and demonstration
09:30–10:00 (30 min)	Ophthalmology: Simulation‐based training
10:00–10:10 (10 min)	Break
10:10–10:40 (30 min)	Otolaryngology: Lecture and demonstration
10:40–11:30 (50 min)	Otolaryngology: Simulation‐based training a
11:30–11:40 (10 min)	Break
11:40–12:10 (30 min)	Q&A session by expert panel
12:10–13:10 (60 min)	Lunch
13:10–13:30 (20 min)	Dermatology: Lecture and demonstration
13:30–14:00 (30 min)	Dermatology: Simulation‐based training
14:00–14:10 (10 min)	Break
14:10–14:50 (40 min)	Orthopedics: Lecture and demonstration
14:50–15:20 (30 min)	Orthopedics: Simulation‐based training
15:20–15:30 (10 min)	Break
15:30–16:00 (30 min)	Q&A session by expert panel

Abbreviation: Q&A, question and answer.

^a Epistaxis and foreign body simulation kits were distributed to all participants.

A total of 87 doctors completed the course. We distributed a questionnaire after the event and received responses from 85 participants (response rate, 97.6%). The median number of years since graduation was 19 (interquartile range, 12–26; range, 6–42). The most common subspecialty was internal medicine (n = 48 [56.5%]), followed by surgery (n = 12 [14.1%]) (Table 2). We received highly positive feedback from the participants, with 97.6% (83/85 participants) rating it as “excellent” or “good” on a 5‐point Likert scale postcourse questionnaire. These results were comparable to the satisfaction levels of participants in the on‐site course. ² Some participants commented that the hands‐on experience of operating the equipment at hand deepened their understanding even if the guidance was through a screen, and the collaboration of specialists and primary care physicians as instructors created diversity in the instruction content and increased the knowledge acquired. Of note, the online course is not just a replacement for the on‐site course; it can offer other benefits, including opportunities for those who have difficulty attending courses due to distance or work‐related reasons. However, online courses are not necessarily less expensive because of the cost of shipping materials to each participant and instructor. In contrast, on‐site courses have lower shipping costs but incur venue and instructor travel costs. The potential costs of participant travel for on‐site courses cannot be ignored. Thus, it is difficult to determine the cost advantages of online versus on‐site courses. Finally, these results are only preliminary, and further studies are required to verify the effectiveness of the online course.

TABLE 2.

Characteristics of participants in the Triage and Action Minor Emergency online course (n = 85)

Postgraduate year, median (IQR, range)	19 (12–26, 6–42)
Specialty, n (%)
Internal medicine	48 (56.5)
Surgery	12 (14.1)
Neurology	4 (4.7)
Obstetrics and gynecology	4 (4.7)
Pediatrics	3 (3.5)
Orthopedics	3 (3.5)
Emergency medicine	2 (2.4)
Plastic surgery	2 (2.4)
Others	7 (8.2)

Abbreviation: IQR, interquartile range.

In conclusion, we were able to show that the online version of the Triage and Action Minor Emergency course was successfully conducted with a well‐designed online simulation. After the COVID‐19 pandemic period, both onsite and online courses could be held, allowing participants to choose the style of course that best suits their situation.

FUNDING INFORMATION

This work was supported by MHLW AA Program Grant Number JPMH 21AA2002.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interests for this article.

ETHICS STATEMENT

Approval of research protocol: N/A.

Informed consent: N/A.

Registry and registration no. of the study/trial: N/A.

Animal studies: N/A.

Matsubara T, Numata K, Inaba T, Maeno T. Onlinization of a simulation course that includes minor emergency procedures. Acute Med Surg. 2023;10:e883. 10.1002/ams2.883

DATA AVAILABILITY STATEMENT

Research data are not shared.