CHESTGuidelines & Topic CollectionsCOVID-19 Resource CenterHow Simulation Can Effectively Prepare Staff During COVID-19

How Simulation Can Effectively Prepare Staff for Optimal Patient Care and Minimal Viral Spread During COVID-19

Sanjana Mathur, MD
Published August 26, 2020

Sanjana Mathur, MD, is a physician and instructor in clinical skills and simulation. Dr. Mathur currently holds an adjunct faculty appointment in the Department of Education at The University of Central Florida College of Medicine in Orlando. She is also a member of CHEST’s Social Media Work Group. Sanjana’s areas of professional interest include medical education, simulation, and global health. Sanjana can be followed on Twitter (@teaandreverie) or contacted via email (

The COVID-19 pandemic created a need for new learning techniques for emergency departments and ICU staff members, who were suddenly working with uncertainty and a requirement to be as efficient as possible while trying to stay safe. Many institutions found credence in simulation to educate hospital teams and prepare them for what was to come. While some used in-situ simulations with mannequins to practice procedures such as intubation, others focused on rehearsing using virtual communication or ensuring they were using proper personal protective equipment (PPE) techniques.

Despite the looming uncertainty, a few things became apparent when managing patients with suspected COVID-19, including the importance of establishing clear communication and coordination among staff. At one institution, practicing this communication assisted in building a team of attendings, nurses, respiratory therapists, pharmacists, and technicians.1 This team was then able to practice efficiently and properly perform techniques such as donning and doffing PPE, as well as wearing PPE while performing intubations and other procedures through aerosol glass.

Conducting these simulation sessions underscored at an institutional level the importance of preparing equipment and medications and of having an airway plan in place before donning to minimize time in PPE. The use of hazmat suits, masks, face shields, and gloves can cause staff to become overheated, and physical discomfort will increase stress and could inhibit performance.

One center used a nontoxic fluorescent solution during a simulation scenario to recreate aerosolization from the simulator mannequin utilizing a nebulizer. Ultraviolet light was used to visualize the spread of the solution after both proper and improper PPE donning and doffing techniques. This simulation demonstrated that more contamination, especially to the face and forearms, occurred after improper doffing of PPE.2

In Dubai, a simulation center team prepared a communication skills training session using Microsoft Teams. They deduced that remote simulation-based communication skills training via an online platform is both possible and effective.3

As with any simulation session, debriefing is paramount. For many participants in these simulations, debriefings highlighted misconceptions regarding implementation, difficulty in communication between staff due to physical barriers, and other quality or safety concerns. Debriefings produced excellent discussion among team members and allowed for interprofessional feedback, clarification of questions, and recommendations for areas of improvement.

Simulation exercises provide a reliable way to optimize patient care and minimize viral exposure, while accommodating the needs of learners and clinicians. The COVID-19 pandemic may have accelerated the use of this important training and educational strategy.

Using Simulation at Your Institution

Have you tried using simulation to prepare your colleagues? How did it work? If your institution does not have a simulation center, it is still possible to run through possible scenarios to prepare. Instructors can set time aside to practice procedures and prepare staff on the floor or in the emergency department.

If your focus is on enhancing team communication, using an online platform such as Zoom or Microsoft Teams has been shown to be very effective.

A number of online resources are also available for use:


  • Keiran J, Warner M. Improving emergency department airway preparedness in the era of COVID-19: an interprofessional, in situ simulation. Accessed August 4, 2020.
  • Hughes PE, Hughes KE, Ahmed, RA. Does my personal protective equipment really work? A simulation‐based approach. August 4, 2020.
  • Sudhir M, Mascarenhas S, Isaac J, et al. Adapting to the need of the hour: Communication skills simulation session using an online platform during COVID-19.
    MedEdPublish. 2020;9(1):85.

For more information on COVID-19, visit CHEST's COVID-19 Resource Center.