Table 1.

Summary of clinical scenarios, educational objectives, principles used and number of healthcare workers (HCWs) trained each week on various scenarios

Scenario	Educational objectives		Principles used for simulation design
Critical care silo
Application of PPE in the ICU	Donning/doffing. Concept of negative pressure isolation room.		IP or single professional training, low fidelity, mental rehearsal
Intubation of patient with COVID-19 from 100% non-rebreather mask	CRM. Standardised team (consultant/NCHD/nurse). Minimising AG for RSI. Correct attachment of mechanical ventilator. Ergonomics. Initial setting for mechanical ventilation.		‘PDSA’ cycle, ‘just-in-time’ training, IP training, in situ, high fidelity, RCDP
Intubation of patient with COVID-19 from CPAP hood	CRM. Standardised team (Consultant/NCHD/nurse). Safe CPAP hood removal. Minimising AG for RSI. Ergonomics.		‘PDSA’ cycle, IP training, in situ, high fidelity, RCDP
Extubation of patient with COVID-19 from ventilator	CRM. Standardised steps of safe extubation using a plastic sheet.		‘PDSA’ cycle, IP training, in situ, high fidelity, RCDP
Transfer of critically ill patients with COVID-19 from ICU to CT scan	CT scans for two separate sites: contrast and non-contrast. Communication with radiology to identify physical routes to each site. Communication with security and cleaning services. ‘Clean’ ICU team member’s role: brings emergency equipment and medication and remains in the clean console room during scanning. Communicates with transporting team if a clinical issue arises.		‘PDSA’ cycle, IP training, in situ, low fidelity
Transfer of critically ill patient with COVID-19 from ED to ICU	Safe patient assessment in ED. Minimum amount of HCWs in room/standardised team. Outside room: assisting ICU doctor or nurse with emergency equipment, PPE, medications. Plan a safe route to transfer patient to the ICU.		‘PDSA’ cycle, IP training, in situ, low fidelity
Proning of patient with COVID-19 in ICU	CRM. Allocation of roles. Multidisciplinary proning team. Proning steps. Safety checks at pre, intra and post-proning. Timing of proning to allow appropriate management of multiple prone patients. Management of unexpected events.		‘just-in-time’ training, IP training, in situ, low fidelity, RCDP
Tracheostomy for patient with COVID-19	CRM. Performing tracheostomy using special plastic sheets with sleeves to minimise AG.		IP training, in situ, low fidelity
General anaesthesia OR silo
Application of PPE in the OR	Donning/doffing. Concept of positive pressure OR.		IP or single professional training, low fidelity, mental rehearsal
Airway management of patients with COVID-19 undergoing general anaesthesia	WHO checklist. CRM. Minimising AG during intubation/extubation. Management of unexpected events: difficult airway, circuit disconnection, PPE damage. Handling tissues and blood samples, documentation.		‘PDSA’ cycle, ‘just-in-time’ training, IP training, in situ, high fidelity, RCDP
Airway management of pediatric patient with COVID-19 undergoing general anaesthesia	WHO checklist. CRM. Premedication. Minimising AG. Safe intravenous and gas induction. Intubation/extubation. Management of unexpected events: difficult airway, circuit disconnection, PPE damage. Managing parents at induction.		‘PDSA’ cycle for system testing and guideline development, in situ, high fidelity
General anaesthesia obstetrics silo
Emergency C-section in Gynae OR (neuraxial anaesthesia/GA)	CRM. Minimum amount of people in the room. Minimising AG for RSI. Management of new born and transfer to NICU. Donning/Doffing.		‘PDSA’ cycle, ‘just-in-time’ training, IP training, in situ, high fidelity, RCDP
Emergency C-section in labour ward OR (neuraxial anaesthesia/GA)	CRM. Minimum amount of people in the room. Minimising AG for RSI. Management of new born and transfer to NICU. Donning/Doffing.		‘PDSA’ cycle, ‘just-in-time’ training, IP training, in situ, high fidelity, RCDP
Number of HCWs trained on various simulated scenarios/week
	First week	Second week	Third week	Fourth week
Consultants (anaesthesia/ICU/surgical/obstetrics)	25	65	16	3
NCHDs (anaesthesia/surgical/obstetrics)	28	108	18	5
ICU nurses	28	95	35	30
OR nurses trained in ICU (anaesthesia/scrub/recovery)	30	70	89	40
Theatre nurses/Midwives trained in OR	0	44	22	14
Total*	111	382	180	77

*HCWs participated in multiple simulated scenarios and some of them multiple times. Allied healthcare workers are not included in the total number.

AG, aerosol generation; CRM, crisis resource management; CPAP, continuous positive airway pressure; C-section, Caesarean section; ED, emergency department; GA, general anaesthesia; ICU, intensive care unit; IP, interprofessionals; NCHD, non-consultant hospital doctor; NICU, neonatal intensive care unit; OR, operating room; PDSA, Plan-Do-Study-Act; PPE, personal protective equipment; RCDP, rapid cycle deliberate practice; RSI, rapid sequence induction.

Core educational objectives for all scenarios—apart from specific objectives— included PPE application, minimising aerosol generation (AG), team work principles.