New education method or tool
Open Access

Adapting to the need of the hour: Communication skills simulation session using an online platform during COVID-19

Meghana Sudhir[1][a], Sharon Mascarenhas[1], Jolly Isaac[2], Jalal Alfroukh[1], Safeeja Abdul Rahuman[1]

Institution: 1. Institute for Excellence in Health Professions Education,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, 2. College of Nursing and Midwifery, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai
Corresponding Author: Mrs Meghana Sudhir ([email protected])
Categories: Educational Strategies, Teaching and Learning, Technology, Clinical Skills, Simulation and Virtual Reality
Published Date: 01/05/2020

Abstract

Background: As Covid-19 continues to spread around the world and disrupt lives, universities around the globe are impacted extensively. Training sessions conducted at simulation centers needed an alternative approach to adapt to the gravity of the situation hence, the simulation centre team piloted a communication skills training session using Microsoft Teams.

Objectives: The objectives of the pilot session were to develop a plan for training on communication skills remotely, identify an online platform, pilot an online communication skills session using the identified platform and evaluate the effectiveness of the process.

Approach: Communication skills training session for 2 groups of students involving facilitators and simulated patients were conducted simultaneously using sub channels on Microsoft Teams.

Outcomes: The sessions followed a predefined structure and were completed as planned. It was discovered that remote simulation-based communication skills training facilitated through online platform is both feasible and effective. The findings suggest that remote simulation sessions can provide an effective educational environment.

Keywords: Simulation; Simulated Patients; Communication Skills; Microsoft Teams; COVID-19; Remote Simulation; Online

Background

The ability to communicate effectively is a core competency required of a healthcare professional. There is increasing evidence that patient centred communication results in better clinical outcomes, greater patient satisfaction and increase in perceived quality of care (LaNoue and Roter, 2018). Various teaching learning methodologies are used to teach this vital skill to students in healthcare professions. One such methodology in simulation is using simulated/ standardized patients, which allows students to develop and enhance their communication skills in a safe non-threatening environment where they can rectify mistakes based on feedback from simulated patients, instructors, and peers (Qureshi and Zehra, 2020).  

Simulated practice, both face-to-face and computer-based, is well established within healthcare education, allowing rehearsal and refinement of clinical skills (Rourke, 2020).  Remotely facilitated simulation-based training (RF-SBT) is less positively appraised than face-to-face, locally facilitated simulation-based training (LF-SBT), despite being considered as an acceptable alternative (Christensen et al., 2018). When emergencies arise, alternatives are looked upon with urgency.

As Covid-19 continues to spread around the world and disrupt lives, universities around the globe are impacted extensively. Since the beginning of March 2020, many universities around the world, including all universities in the UAE, have closed campuses and moved courses online – a move that has never been seen on this large scale ever before. The Simulation Center team under The Institute for Excellence in Health Professions Education at Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates felt the need for developing a structure for communication skills training using an online platform. As Microsoft Teams was readily available and accessible, it was selected as the platform of choice.

Approach

The objectives of the pilot project during the early weeks of COVID-19, were to develop a plan for communication skills training remotely, to identify an online platform, to pilot an online communication skills session using the identified platform and to evaluate the effectiveness of the process.

The participants for the program involved simulation centre team and simulated patients. Various roles were tested including roles of facilitators, simulated patients, students involved in communication skills training, students involved in observation of the scenario as well as debriefing.

The participants were divided into Group A and Group B. Each group had one facilitator, one simulated patient and three simulated students.

Structure of the Program 

On Microsoft Teams, 5 Channels were created. Figure:(1)

  1. General Channel: A common platform for all participants as well as for sharing common documents. 
  1. Facilitator Channel: Access for facilitators only where facilitators could meet, discuss and share files related to the session for facilitators 
  1. Simulated Patient [SP] Training Channel: Access only for SPs and SP trainer where the scenarios were shared and SPs were trained prior to the simulation session. 
  1. Group A Channel: Access only for facilitator, students and SP of group A 
  1. Group B Channel: Access only for facilitator, students and SP of group B 

 Figure:(1): The structural representation of whole process and the communication channels

 

All resources which were used onsite for communication skills training were shared through online platform. These included synopsis of the session with objectives, schedule and time allotment, candidate instruction, SP script, peer evaluation checklist and debriefing guidance sheet for facilitator. These were uploaded into their respective channels. SPs were trained over SP training channel prior to the simulation session. 

Ground rules were set for all participants which included wearing a professional outfit, blurring the background while using Microsoft Teams, minimizing disturbances, adequate lighting, adjusting camera to provide an optimal view, uninterrupted high speed internet facility, mute the microphone when required etc.  

Structure of schedule 

Table (1): Schedule of the Communication Skills Simulation Session on Microsoft Teams

 Timing

 Group A

 Group B

 10 minutes 

 Welcome & Pre-Briefing -Facilitator 1 

 Welcome & Pre-Briefing -Facilitator 2 

 10 minutes 

 Scenario 

 Student A with SP1 

 Other students and facilitator observing 

 Scenario 

 Student B with SP2 

 Other students and facilitator observing 

 20 minutes 

 Debriefing 

 Debriefing 

 20 minutes 

 Evaluation of the pilot program 

Outcome

The simulation session was completed as per schedule. The process was evaluated immediately after the session through online discussion with all participants and was followed by an online survey through Microsoft Forms. All participants agreed that the objectives were met. Majority of the participants [90%] believed that the online platform had a user-friendly interface and was easy for facilitators, SPs and students to become skilful with in a personalized and intuitive manner. All participants believed that the tool allowed users to communicate through different channels (audio, visual, textual) and allowed for non-sequential, flexible/adaptive engagement with resources. Another feature which the participants found helpful was, the tool does not require equipment beyond what is typically available to instructors, SPs and students (computer with built-in speakers and microphone, camera, internet connection, etc.). Majority of the participants agreed that facilitation of prebriefing, scenario and debriefing over online platform was effective even though they were doing it for the first time. 

Despite the formulation of best practice guidelines for in-person simulation, there has been uncertainty regarding debriefing practices for virtual experiences (Verkuyl et al., 2020). During the online session, it was concluded that the debriefing was as effective as in-person simulation. Additionally, we noticed that it was more intense and with less distraction.

Microsoft Teams allows access to the organization employees and students to communicate over the platform. There was concern over the access to Simulated Patients as they were not having an organizational email address. But this was tackled by creating Microsoft outlook account by the SPs. With an outlook account, facilitator could provide access to SPs on respective channels. 

There were some concerns raised which include restriction with recording of session in small groups over the various sub channels created on Microsoft Teams. We were not able to record the session for future reflection. On the general channel of Microsoft teams this facility is available. Another limitation noticed was we could have only 5 participants at a time on the screen over video. This could create disengagement if the group size is larger than 5. 

Remote training using an online curriculum and simulation-based training facilitated through remote video conferencing is both feasible and effective (Shao et al., 2018). Our findings suggest that remote simulation sessions can provide an effective educational environment.

Next Steps

Even though this pilot project was an attempt to tackle the current difficulties in training communication skills simulation sessions, during COVID-19 outbreak, the outcome gave a promising direction for communication during difficult times. Moreover, we have future plans to replace campus based simulated patient training for communication skills on an online platform. This will be cost effective as well as convenient for all involved.

Take Home Messages

  • Not all simulations sessions can be replaced virtually or online. But sessions involving communication skills training for small groups can be facilitated on an online platform.
  • A well-structured pre-briefing, scenario, SP training and debriefing process is required for successful implementation of an online communication skills simulation session.
  • As for any simulation session, everyone involved need to prepare themselves before hand and immerse in simulation session in order to full fill the learning objectives.  

Notes On Contributors

Meghana Sudhir

Meghana Sudhir is a Simulation Educator at Mohammed Bin Rashid University of Medicine and Health Sciences for the past six years. She is a Certified Healthcare Simulation Educator-Advanced [CHSE-A] from Society of Simulation in Healthcare. She holds MBA in Healthcare Services Administration and Master of Science in Nursing.

Sharon Mascarenhas 

Sharon Mascarenhas is a Simulation Educator at Mohammed Bin Rashid University of Medicine and Health Sciences for the past five years. She is Certified Healthcare Simulation Educator [CHSE] from Society of Simulation in Healthcare. She holds Master of Science in Nursing.

Jolly Isaac 

Jolly Isaac is a Lecturer of Nursing at Mohammed Bin Rashid University of Medicine and Health Sciences and works closely with the simulation center team. She holds Master of Science in Nursing and Doctorate in Education.

Jalal Alfroukh 

Jalal Alfroukh is Senior Simulation Technologist at Mohammed Bin Rashid University of Medicine and Health Sciences. He is a Certified Healthcare Simulation Operation Specialist [CHSOS] from Society of Simulation in Healthcare. 

Safeeja Abdul Rahuman 

Safeeja Abdul Rahuman is an Executive at Mohammed Bin Rashid University of Medicine and Health Sciences. She is responsible for the administrative activities of Simulation Center. She holds MBA in Project Management.

Acknowledgements

A special mention to Prof Nabil Zary, Director, Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences whose unending support, enthusiasm and expertise helped us move this project from an idea to reality in a seamless manner.

The Successful completion of this project would not have been possible without the valuable contribution of our simulated patients: Sanober Sheikh, Rency Mathews, Moses Oyelere and Sanju John Mathew.

Figure1 and Table 1, Source: 1st Author Meghana Sudhir.

Bibliography/References

Christensen, M. D., Oestergaard, D., Dieckmann, P. and Watterson, L. (2018) ‘Learnersʼ Perceptions During Simulation-Based Training,’ Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 13(5), pp. 306–315.

LaNoue, M. D. and Roter, D. L. (2018) ‘Exploring patient-centeredness: The relationship between self-reported empathy and patient-centered communication in medical trainees’, Patient Education & Counseling, 101(6), pp. 1143-1146.   https://doi.org/10.1016/j.pec.2018.01.016

Qureshi, A. A. and Zehra, T. (2020) ‘Simulated patient’s feedback to improve communication skills of clerkship students,’ BMC Medical Education, 20(1). https://doi.org/10.1186/s12909-019-1914-2

Rourke, S. (2020) ‘How does virtual reality simulation compare to simulated practice in the acquisition of clinical psychomotor skills for pre-registration student nurses? A systematic review,’ International Journal of Nursing Studies, 102, p. 103466. https://doi.org/10.1016/j.ijnurstu.2019.103466

Shao, M., Kashyap, R., Niven, A., Barwise, A., et al. (2018) ‘Feasibility of an International Remote Simulation Training Program in Critical Care Delivery: A Pilot Study,’ Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2(3), pp. 229–233. https://doi.org/10.1016/j.mayocpiqo.2018.06.008

Verkuyl, M., Lapum, J. L., St-Amant, O., Hughes, M., et al. (2020) ‘Exploring Debriefing Combinations After a Virtual Simulation,’ Clinical Simulation in Nursing, 40, pp. 36–42. https://doi.org/10.1016/j.ecns.2019.12.002

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

This is not a research paper. This paper simply describes a tool that we have devised to facilitate communication skills simulation remotely as a result of the 'stay-at-home' enforced to curb the Covid-19 outbreak. No 'real' students took part in this project. All participants were from the simulation centre team taking various roles as 'simulated' students and facilitators. All participants in this project have given written permission to be part of this project and were involved in the design and delivery of the simulation session.

External Funding

This article has not had any External Funding

Reviews

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Alexandra Webb - (25/05/2020)
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This was an interesting article to read at a time when educators are challenged to rapidly implement technological solutions to facilitate the development of clinical skills whilst ensuring the safety of students, staff and patients. Thank you for sharing your experiences. From a practical point of view it would have been helpful to learn more about the specific features of Microsoft Teams used to deliver the training and how these were selected to ‘replace’ previous classroom-based methods. Also how students, staff and simulated patients were trained to utilise these tools. It is not clear from the manuscript the number of students involved in this pilot project, their year of medical training or previous exposure to communication skills training. Given the concomitant increase in telemedicine during, and possibly beyond, the COVID-19 crisis, it would seem pertinent to incorporate this into the online communication skills training. The manuscript would benefit from the addition of a more in-depth exploration of the pedagogical limitations, and shortcomings relevant to medical student development of clinical skills, of this online training compared to previously delivered face-to-face training. The authors conclude that there are future plans to continue delivery of communication skills training using this format but provide minimal justification for this.
James Gray - (18/05/2020)
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An area of interest as we all seek to develop our online option during Covid with potential benefits for future considerations of developing ways of teaching beyond the conventional. I was a little confused between the statement of 6 "students" but table 1 suggesting only 2 did the simulation, either way these are very small numbers (accepting it is a pilot) and the fact that these were staff would make me feel that this is more an indication that the technology can function adequately to teach in this area rather than representing a true pilot evaluation as staff experience is very different to student experience.
Mohamed Hassan Taha - (04/05/2020)
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Interesting article, and timely study and also relevant in the current COVID crisis times.
I really enjoyed reading this article. Currently, there are future directions toward replacing campus-based simulated patient training for communication skills on an online platform. This study could be considered as a very useful experience to be taken into consideration. The platform that they used, MS teams, provides a useful feature of recording the sessions, providing feedback and as a formative assessment. Still, some skills could not be assessed online.
I recommend this article as a useful contribution to the field that should be read by those with an interest in the area.
Alexander Woywodt - (04/05/2020) Panel Member Icon
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This paper caught my eye because we had just discussed this in our team: Can one teach communication skills remotely? The topic is of great relevance to medical education in a post-COVID world. On reading this paper I am not sure this came alive for me. It would have been nice to have a better idea of which scenarios were actually taught, and perhaps some free text feedback from students and simulated patients. It would also be helpful if the authors could discuss limitations and problems with this approach. Perhaps I am old fashioned but a lot of communication relies on both parties being in a room together - picking up subtle cues in body language etc. Also I note that there is a lot on social media on remote meeting exhaustion and the fact that zoom or MS team meetings are perceived as more arduous than face to face. Did the participants voice similar concerns? Other than that a good idea.
P Ravi Shankar - (04/05/2020) Panel Member Icon
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This is an interesting article discussing a pilot communication skills learning session using the online Microsoft Teams platform and standardized patients. The process has been described well. I am assuming that the students involved in the pilot project were real students. How were the students selected? What were the objectives of the pilot project? What do the authors plan to do next? Which scenarios were used during the pilot study? Are the authors confident of handling more complex scenarios online? I also assume that the standardized patients were experienced in teaching communication skills to students and were also familiar with online platforms so the major emphasis of training before the pilot project was in using the online platform to communicate with students.
Shazia Iqbal - (03/05/2020)
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This is an interesting article to provide an insight to continue the communication skills training remotely in the current situation. Although authors have mentioned that sessions involving communication skills training for small groups can be enabled on an online platform, realistically it is important to find which type of communication scenarios can be conducted. Not all communication scenarios can be conducted online.
Communication skills are more about gaining competencies to deal with compound situations while encountering patient’s emotions, understanding responses & non-verbal gestures. The complexity of some challenging scenarios seems a real contest to train medical graduates/ health professionals through online training sessions. For example: inform consent scenarios for surgical procedures, breaking bad news sounds very difficult online.
Additionally, attitude, and professional development through online training tools need to be evaluated during a long time scale before we predict the authenticity of online communication skills training for health professionals. Moreoever, we need to distinguish the contextual challenges (understand the potential barriers; psychological, social, cultural) and be proactive while embarking for the online platform.
Possible Conflict of Interest:

No conflict of interest.

Hui Meng Er - (02/05/2020) Panel Member Icon
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Online tools such as Microsoft Teams are widely used for communication skills training, replacing face to face simulation sessions during Covid-19. Similar approach and process in conducting the online sessions as those described in this paper are adopted in other institutions. It is reassuring that the feedback by the students and facilitators are positive from this study. However, it would be useful for the readers to know the challenges and limitations faced by the students, facilitators as well as simulated patients, for examples in aspects related to professionalism and non-verbal skills. The information would help to improve the implementation of online simulation sessions for communication skills, and overall design of curriculum to address the gaps in anticipation that online tools will be increasingly used in medical education even after the Covid-19 pandemic.
Puja Dulloo - (02/05/2020)
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I really enjoyed reading this article. It will motivate many researchers to use digital platform for teaching affective domain. This article has stimulated my neurons to think out-off box for teaching clinical sessions to medical students during the present pandemic state. Moreover, use of technology will allows faculties to provide one on one feedback to students were the student faculty ratio is huge and there always has been questioning for the feedback at both the ends.
Kindly explain why two groups were taken and how evaluation of program was done and what were the major contents of Microsoft form.
Overall a good effort as a pilot level project.
Possible Conflict of Interest:

NA

Tripti Srivastava - (01/05/2020) Panel Member Icon
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The manuscript paves the way for more such pilot based projects to digitalise teaching learning in such crisis situations. Teaching communication skills by Microsoft teams is a novel approach. A detailed description about number of students, their training to use microsoft teams, choice of SP, the method of their training, competencies addresses etc. would have been more useful. It can also be prudent to assess the retention of knowledge and skills imparted through such platforms. Overall a good attempt to target necessary professional competencies in health care through a digital mode.
Trudie Roberts - (01/05/2020) Panel Member Icon
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The authors are correct that in these unprecedented times new solutions to current training needs have to be looked for. I couldn't see how many students were in solved in the pilot and my question would be can you run this at scale.
However, I also wonder if the authors have missed an opportunity. After Covid 19 it is likely that tele-consultations will become much more common. Consequently, it would seem that training for this eventually should be started now and pilots like this are a natural vehicle to include in training
Dujeepa D. Samarasekera - (01/05/2020) Panel Member Icon
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Interesting study and also relevant in the current COVID crisis times. The challenge is that program evaluation only involves the participants and faculty perceptions. How are the students transferring their skills to actual practice settings should be included in any future evaluation of this method. I would also like to see if there are any impact on student learning or changes to their attitudinal development towards patients (or SPs) and their behaviours when using online vs face to face methods.