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. 2021 Oct;19(5):279-286.
doi: 10.1016/j.surge.2020.08.013. Epub 2020 Sep 22.

The important role of in-situ simulation in preparing surgeons for the COVID-19 pandemic

Pierre Montauban  1 , Charannya Balakumar  2 , Jaideep Rait  3 , Prizzi Zarsadias  4 , Sara Iqbal  5 , Biju Aravind  6 , Ashish Shrestha  7 , Roland Fernandes  8 , Ankur Shah  9 ; Collaborators
Collaborators, Affiliations

The important role of in-situ simulation in preparing surgeons for the COVID-19 pandemic

Pierre Montauban et al. Surgeon. 2021 Oct.

Abstract

Background: Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19.

Methods: This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients.

Results: 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy.

Conclusion: In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.

Keywords: COVID-19; Simulation training; Viral outbreak; Visual analog scale.

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Conflict of interest statement

Declaration of competing interest The authors of this research manuscript have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Progression of the in-situ simulation session (a) Assessment of the patient - Appropriate PPE discussed by not used due to limited supply (b) Consenting patient – specific risks related to COVID-19 discussed (c) Anaesthetic review (d) Exploring team brief – specific aspects in view of risk of COVID-19 considered (e) Exploring preparation for surgery once the patient arrives in theatre (f) Debrief – In-depth recap of the scenario, highlighting key aspects in relation to the learning objectives.
Fig. 2
Fig. 2
Example of the VAS representing the level of confidence, ranging 0–100, for the premises in each question of the pre- and post-simulation surveys.
Fig. 3
Fig. 3
Median level of confidence (VAS Scores) for each question in the pre- and post-simulation surveys. Question 1: What guidance to follow (eg. SOP) and where to find it, Question 2: Clinically recognising high-risk COVID-19 patients, Question 3: What PPE to use and where to find it, Question 4: What specific investigations to request for high-risk patients, Question 5: Documentation, including consent form, Question 6: Specific aspects of the team brief prior to surgery, Question 7: Logistics of transferring patient from the ED/Ward to the Operating Theatre, Question 8: Appropriate PPE to wear in theatres based on risk assessment, Question 9: Role/location of the Surgeons during intubation and extubation.
See this image and copyright information in PMC

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