Development and Implementation of Screen-Based Simulation Technology to Meet Medical Education Demands During the COVID-19 Pandemic.

Background: Simulation-based learning has been a valuable integrated part of simulation curricula. Simulation modalities include high-fidelity simulation (HFS), clinical skills (SK), standardized patients (SP), hybrid and combined simulation. HFS and SK are usually taught face-to-face and require specialized equipment. In response to the COVID-19 pandemic and lockdowns, efforts to develop distributed screen-based high-fidelity simulation accelerated to provide enhanced remote learning. The authors set out to develop cost-effective, high fidelity, user-friendly software to assist medical students in developing cardiac auscultation skills and clinical reasoning. Physical manikins are expensive, where costs range from $23,000-$250,000 each. The following applications: Heart Auscultation Trainer (HAT), Lung Auscultation Trainer (LAT), and a distributed screen-based high-fidelity simulator (DSB-HFS) comprise a comprehensive medical education software package developed and implemented at the University of South Dakota Sanford School of Medicine (USD SSOM). The HAT application was specifically evaluated in this project.

Methods: HAT and LAT were developed for Macintosh, Windows, and Linux operating systems. Both applications feature an on-screen human torso on which users can auscultate heart and lung sounds. Users can select from 52 heart and 15 lung conditions, built-in lessons, a testing mode, and sonograms. DSB-HFS is a network of applications distributed over the internet. Learners can view a patient avatar, perform basic physical exam, review vital signs, and order treatments. An instructor can change avatar parameters in accordance to administered treatments. Information exchange between the instructor and learners occur via a cloud-based connection. Effectiveness, simplicity, and cross-platform usability of HAT was assessed via survey. DSB-HFS has been developed, tested, and piloted. As of December 2022, DSB-HFS was under next phase of development.

Results: The 11-question survey was distributed to medical students with an 81.4% response rate. More than half of respondents used HAT at least once per week. Most respondents agreed that: installation was relatively easy, the Graphic User Interface was easy to use, built-in lessons were somewhat useful, and he/she would recommend HAT to other students. Narrative feedback was collected to improve future iterations of HAT. No data were collected regarding LAT or the DSB-HFS simulator.

Conclusion: The suite of applications was found to be effectively implemented and was a cost-saving addition to a remote software package available to medical students at the USD SSOM. HAT was perceived by first-time users to be an easy to use and effective learning tool. User-generated feedback will be implemented to improve applications. Limitations to this project include a lack of quantitative data.