Development of a Cooperative Online Clinical Simulation Tool: Problems and Solutions for Implementation. The SimGame project

Introduction: Clinical simulation is a tool that effectively improves crisis management. Due to COVID- 19 restrictions, there is a challenge to keep training in closed environments. The answer is the ability to train from distance, and that is how SimGame was born. Material and methods: A group of software developers and anesthesiologists developed an online simulation tool (www.medicalsimgame.com). Simgame allows for real time communication where up to 5 participants can take part in simulated scenarios where airway management and drugs among other duties have to be fulfilled. Plenty of scenarios including advance life support and difficult airway management can be emulated. In every scenario, each participant must perform a sequence of actions, including mini-games which replace skills that cannot be trained online. A leader must be selected to improve communication and decision making in every scenario. A debriefing analysis is performed at the end of a simulation. A survey was conducted for the first 15 participants to evaluate and report feedback together with evaluations by the group of anesthesiologists. Surveyed participants were asked to assess issues arisen, learning process and overall satisfaction. Results: Our survey among participants found that audio settings was the major issue during simulation, with 18% of participants having at least minor issues. Median overall satisfaction was 8.2 on a scale of 1 to 10. The main problem encountered by developers was the implementation of the audiovisual system. The main problem encountered by anesthesiologists was finding the appropriate minigames to emulate the actions and adjusting difficulty. Conclusions: Designing a real-time online simulation tool is a challenge for both programmers and anesthesiologists. The adjustment of the audio and difficulty of minigames were found to be the biggest challenges. The result makes it possible to have an online tool that allows the training of teamwork and communication skills.