Triage by Zoom: Multi-Patient Emergency Medicine Simulation Event Conducted Entirely Virtually

I nervously waited for the ER doctor, actually doctors as I knew there would be more than one, and several medical students. I had many unanswered questions, but knew they’d be addressed in time. I just had to be patient and wait. One tries to prepare for a day like this, but Edward Murphy (and his law) whispers in the recesses of one’s mind, ‘what can go wrong, will’.

The facilitators from the Michigan College of Emergency Physicians were the first to arrive via Zoom, followed by over thirty medical students. Yet another conference casualty of COVID was the MCEP Winter Symposium, a two-day CME event designed to provide the latest information about emergency medicine to Michigan ER doctors. On the second day, at the end of the program, medical students interested in pursuing emergency medicine are invited to join, and historically, are able to participate in a hands-on simulation event called EMSIMS. This year, like for so many, meeting in person was still not possible.

Last November, I received an email from one of our clinical board members, Dr. Andrew Bazakis. Dr. Bazakis is the co-director of the EM simulation curriculum at Central Michigan University, and as I would find out, co-hosts the EMSIMS simulation portion of the MCEP Winter Symposium. He shared with me the challenge he was faced with: finding a valuable alternative to hands-on manikin simulation, and asked if there’s anything PCS could do. “Andy, I’ve been training my whole life for this exact moment”, he laughs, we start preparations. 

The remote simulation logistics would be as follows: medical students from all over Michigan would join a Zoom meeting at 4pm EST. There would be 15 minutes for a brief introduction and instructions. Then, the medical students would be assigned into breakout rooms led by a faculty debriefer. Over the course of 90 minutes, the students would individually interview 3 PCS artificially intelligent digital patients and then reassemble as a group in their small groups to debrief each patient. In summary, 30 minutes per patient, with the first 15 used for interviewing and the final 15 for debriefing; a moderator keeping time and pushing reminder notifications.

Dr. Bazakis and I prepared 3 patients for the event: chest pain, headache, and pediatric acute respiratory distress. Student orientation documentation was prepared and proofread. Trust but verify: the unofficial slogan of the simulation dry run, but as we all know in simulation, there’s a small subset of variables that we can’t prepare for or anticipate. Would the student’s computers have the bandwidth and processing power to run Zoom and conduct an on screen interview? Would 15 minutes be sufficient time to conduct an interview with a digital patient on a platform they had never used before? Could the learners navigate between programs, working first individually then rejoining for group debrief?

I anxiously awaited the conclusion of the EMSIMS introduction. No one had questions – so far so good, appears orientation was sufficient. The moderator put us into breakout rooms. The faculty facilitator introduced themselves, tells us the name of the first patient and gave everyone the green light to begin interviewing. I watched my tiled Zoom meeting window as the students turned off their cameras and mute their microphones. One by one the student titles went dark, with only their names in white font remaining. Still connected, but a passively running application. I simultaneously watched my PCS Faculty Administrator screen and see more and more sessions are active. The students were successfully interviewing. 

The moderator sends a chat message to the group with a 5 minute warning, then “Time’s Up”. The students return to our zoom breakout room, and one by one turn on their cameras and unmute their microphones. Dr. Bazakis welcomes us all back and kicks off the debrief, “What did we learn about our patient? Student A, let’s start with you…”. For the 15 minute debrief, each student shared the subjective and objective information they obtained from the patient, followed by a discussion about what labs they had ordered, why they ordered them, and the results of their labs confirming their diagnosis. The moderator notifies us of time, the process starts again with the next patient. The students minimize Zoom, navigate to PCS, and select the next patient. 

Edward Murphy is quiet now in my mind, the MCEP EMSIMS remote simulation was a resounding success without a technical hiccup. Concerns about capacity, technology, student onboarding were assuaged, replaced with feelings of pride and appreciation. I’m grateful to Dr. Bazakis and the MCEP for this experience, and I’m proud we were able to provide a solution, to be the solution. It’s stressful yet thrilling to push limits, and find out what’s possible in this post-covid world. I’m reminded about what the great Ted Lasso said, “Takin’ on a challenge is a lot like ridin’ a horse. If you’re comfortable while you’re doin’ it, you’re probably doin’ it wrong”. 

Michelle M. Castleberry

Co-founder, Chief of Content

Head of Clinical Advisory Board

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