Digital simulation: Maudsley Simulation launch online mental health training



Over the past few months, many of us have become fluent in video conferencing as it has now established a firm place in our daily lives. Although we learnt this language the hard way, we have relied on it heavily to connect with friends and family. In our personal lives, it became a safe social space against the backdrop of a global pandemic. Clinicians in the NHS and beyond have begun undertaking regular remote consultations with patients, in addition to team meetings with colleagues. Educational departments within healthcare organisations are no different. They too have had to drastically change how they engage with technology. This mass digital migration has been at a scale and come at a pace which many would have struggled to envisage in the recent past.  


The evolving need for fully online simulation 

Prior to the pandemic, fully online simulation in mental health seemed like a distant dream. In some respects, it was a proposition that begged the question: just because we can do it, should we? It certainly did have appeal, however, in terms of opening educational opportunities to people that were geographically remote, or who may not have otherwise been able to attend due to time constraints. Social distancing, the associated restrictions and an uncertain future have certainly turned this digital simulation proposition on its head and rendered its need much more pressing. Furthermore, the rise of remote consultations in mental health have created new learning needs for clinicians due to our new ways of practicing in this disturbed reality. These new skills and learning needs call for dedicated training. All of this has come against a background of concerns about surges in mental healthcare demand in the short-to-medium term related to COVID-19. 


At Maudsley Simulation, we have recognised these needs. As such, our faculty and technicians have been working hard to ensure our simulation-based education courses can continue into a future potentially held up by COVID-19 restrictions. We have been working on testing new video conferencing platforms, adapting and migrating existing courses, developing new ones and building our confidence in using new platforms through several pilot courses. We want to ensure our educational ethos can thrive online and we can continue to share our high-quality mental health simulation courses regardless of any future bumps in the road. 


Meeting challenges with ingenuity and creativity 

While we have extensive experience in delivering ‘in-person’ simulation-based education, this new form of digital delivery has brought its own challenges and tested the limits of our technical ingenuity and creativity. All of our courses are designed to encompass high-fidelity simulation scenarios and ensure these scenarios best support the overall learning objectives of the course. We are used to delivering our courses at a specially equipped centre. For these past few months, we have not had the luxury of full use of this centre. We employ actors with mental health training to play our simulated patients. They have not been in a position to travel from their homes. The task of delivering simulation remotely has undoubtedly posed extra challenges for our technicians in terms of enhancing realism through the use of props and mise-en-scène. We have extensively tweaked and tested video conferencing platforms to recreate a convincing stage for our scenarios.  


In terms of fidelity, digital simulation does appear to offer advantages and disadvantages. On the one hand, it allows for observers to be fully immersed (via their screens and headphones) in a simulated clinical interaction. On the other hand, for the active participant, it can only attempt to emulate the feelings that come from being in a room with a patient. That said, remote consultations are fast becoming increasingly commonplace. As such, digital simulation paradoxically offers the highest possible fidelity, with a training modality analogous to the real-life experience. 


As a group, working remotely ourselves has thrown up technical constraints, challenges and conundrums that have kept us busy. Despite all these challenges, we have persevered. Also, we have been very fortunate to have had the benefit of several willing volunteers (including actors, trainee doctors, psychologists and undergraduates) to help us with our piloting phase. In many ways, it may have been unlikely that we would have committed so much time to developing digital simulation had it not been for the pandemic. Despite the significant challenges it has brought in terms of how we work, we did not want to simply find the best way to play a bad hand so to speak. Instead, we approached the challenge with a positive and creative mindset and had extensive discussions about new learning opportunities. We are very excited about this new way of delivering simulation entirely online. In our recent testing sessions, we have had participants from different corners of the world sharing their experiences in debriefs with a truly international dimension and characterised by a renewed thirst for engagement. This is very much breaking new ground for us! 


The future is bright for digital simulation 

We want our simulation courses to be available to as many clinicians as possible. Although the pandemic has created significant challenges for us in terms of our usual way of working, we believe digital simulation offers many benefits and is a hugely promising prospect for the future of mental health workforce development both nationally and internationally. We even already have plans to deliver an array of simulation courses entirely online in the coming weeks and months. A global pandemic has curved our space-time. In this new world, our simulation team want to continue to teach and learn where it matters, in the thick of it. 


Watch this (virtual) space and keep an eye on our website for upcoming course advertisements. 


Article written by Dr Owen O’Sullivan and Dr Grégoire Billon