Remote facilitation during simulation-based healthcare education: scoping review

Abstract

Introduction: During the COVID-19 pandemic, much healthcare education has been transitioned to remote platforms rather than in-person. However, remote facilitation is still considered a specific strategy applied in particular situations. The interaction between learners and instructors is essential to achieve effective healthcare simulation, but it is unclear whether this interaction can be performed adequately during remote facilitation. The purpose of this scoping review was to investigate the types of remote facilitation described in previous studies, their influence on learner outcome, and related factors.

Methods: The protocol followed the PRISMA-ScR and the framework by JBI. Inclusion criteria were: synchronous remote facilitation, health care personnel and related students, and educational simulation measured any learning outcome in the publication under a peer-reviewed journal before Apr 2021, written in English. We searched PubMed, Embase, CINAHL, Web of Science, and ERIC from Apr 19 to May 13, 2021. We conducted a pilot test with 50 randomly selected abstracts to assess their eligibility based on the inclusion criteria. Five reviewers worked as two teams, and in each team, two reviewers reviewed all abstracts and full-text independently for inclusion. A third reviewer reviewed where there was a conflict. We resolved disagreement by consensus of all reviewers. A data-charting form was developed and is updated in an iterative process. For critical appraisal, JBI critical appraisal tool was applied. The extracted data were synthesized, summarized, and reported in a descriptive format. We summarized the characteristics of simulation and facilitation initially. Then, we synthesized the essential qualitative data through discussions based on the research question and theme related to the learners’ outcome.

Results: We identified 2,809 articles published in multiple databases or registers. After full-text screening and final assessment, 31 articles were included in the scoping review. Of them, 13 articles have been published since 2020. In eight studies, education was conducted in multiple geographic regions. The form of the simulation was VR and screen-based simulation (n=9), simulated human patient/guardians/coworkers(n=9), task trainer(n=8), and mannequin(n=6). The videoconference(n=26) was mainly used. In 14 studies, the student and the facilitator performed remote demonstrations simultaneously. Most facilitators were either previously trained or experts. There were 8 cases of facilitation during the simulation, 9 cases of facilitation after simulation, and 14 cases of both. There were still very few RCTs comparing the effect of local and remote facilitation, so the effects could not be quantitatively compared. Before 2018, some studies reported that bad connections and technical issues were a barrier to communication. Most authors said more efficient in cost, time, and human resources management than in-person facilitation. When the learners could see a facilitator’s facial expression and were asked or explored, they felt the presence of a facilitator more.

Conclusion: We expect a better understanding of the advantages and disadvantages of remote facilitation technologies. In future simulation-based healthcare education, remote facilitation will increase. The remote facilitation factors that affect learner outcomes will lead to improvement during the healthcare education instructional design process.