ASA Editorial Board for Simulation-Based Training

A new highly transmissible and deadly coronavirus appeared at the end of 2019. A few months later, the United States found itself in the midst of a worldwide pandemic. Physicians, health care workers, and systems quickly adjusted to care for patients with coronavirus disease (COVID-19) while learning “on-the-job” about how to manage patients with protean presentations and symptoms, including overwhelming ARDS. Education was disrupted everywhere to reduce transmission. This included the education of health care students and members of the health care workforce. The ASA Simulation Education Network rose to the challenge. This update shares some of the strategies that have emerged from the Simulation Education Network in response to COVID-19.

The Simulation Education Network is a consortium of 54 simulation programs ( endorsed by the ASA through a rigorous process developed and managed by the ASA Editorial Board for Simulation-Based Training. For anesthesiologists practicing in the U.S., these programs are known for providing the only course that allows ABA diplomates to complete the five-year Part 4 element (Quality Improvement) of the Maintenance of Certification in Anesthesiology (MOCA®) requirement in a one-day simulation session and performance improvement plan. Since 2010, over 13,000 ASA members have taken advantage of these highly-rated courses that include intense simulations to hone their crisis resource management (CRM) and medical management skills in a safe and individualized learning environment. Like any disruptive event, the pandemic brought tough challenges but also unique opportunities to collaborate and innovate within the Simulation Education Network. The pandemic created an acute need to modify or postpone MOCA simulation courses while pivoting simulation activities to focus on preparing clinicians for the unique challenges of caring for patients infected with COVID-19.


Some centers were closed as students were sent away for remote learning, and clinicians were pulled away from simulation teaching to manage the surge of patients. Early in the pandemic, many simulation centers canceled their MOCA courses due to safety concerns for participants and staff. To remain open, centers instituted pre-entry screening and required personal protective equipment (PPE) such as masks and face shields. Class sizes were reduced to allow for appropriate social distancing. Recognizing the growing demands on practicing anesthesiologists, the ABA waived MOCA requirements through the end of 2020 for all diplomates. This allowed programs and individuals to catch up with changing demands and restrictions. Despite limitations faced by simulation programs, 73 MOCA simulation courses were held in 2020, and some were even adapted to focus on managing patients with COVID-19 (J Clin Anesth 2020;66:109928).


Many centers were drafted into delivering new types of training. Large numbers of clinicians suddenly had an urgent need to learn how to properly don and doff PPE. Simulation instructors became particularly adept at developing “train-the-trainer” programs to quickly disperse educators who could provide simulation-based practice with feedback for this critical skill. The existing skills of anesthesiologists in emergency airway management, anesthesia care, and even pain and critical care changed essentially overnight (and often changed a week later) as clinicians learned to care for patients with known or suspected COVID-19. Anesthesiologists and other clinicians assumed new roles as the number of ill patients exploded in some parts of the country. Amid growing numbers of patients and high mortality rates, the Simulation Education Network programs provided formal interprofessional training to quickly develop staff who could effectively work together in an intensive care environment. The impact of these changes cannot be overemphasized. Network members have adapted program offerings to include simulation-based training that prepares providers for these new challenges where CRM skills are more important than ever.


In addition to educational programs, the faculty and staff at Simulation Education Network centers provided leadership in novel areas. New policies and procedures were quickly developed based on the best evidence available. Network centers used simulation to test and improve these in a realistic environment (J Clin Anesth 2020;66:109928). This was particularly critical in regions of the country where COVID-19 had not yet surged. Protective equipment intended to reduce the transmission and exposure of health care staff, such as various shields and barrier devices, were developed and tested in simulation centers. Some devices that proved ineffective in a simulated setting were avoided without risking increased infections of health care workers who might have used them. Highly innovative programs were supported to create and test new ventilators. Simulations of critically ill patients provided guidance on potential ventilator splitting, which was required when the surge in New York exhausted available critical care resources. Simulations were also used to assess the safety of modifications to CPAP devices that allowed them to function as ventilators.


Simulation experts are known for their collaboration. The COVID-19 pandemic enhanced communication among the different centers in the Simulation Education Network. ASA facilitated virtual town hall meetings where members shared innovative responses to the pandemic. Focus areas included evaluating and disseminating best practices in how to safely conduct in-person, high-fidelity simulation courses across the network. This has led to a modest increase in the number of offerings for MOCA credit. The Simulation Education Network is currently exploring new approaches for MOCA simulation courses that could provide additional options to safely participate in this unique, personalized CRM activity in the future. Planning has recently resumed for a 2021 joint simulation meeting between the ASA and American College of Surgeons that had to be cancelled last March. The planned focus is on enhancing communication in the perioperative setting using simulation.


The COVID-19 pandemic has presented health care providers and organizations with many challenges along with unexpected opportunities. Clinicians have adapted to new processes and even new roles. Moreover, rapid innovation of equipment and policies has leveraged simulation in novel ways that are essential for immediate deployment. Simulation Education Network member organizations have led simulation activities to help organizations and individuals meet these challenges and will continue to promote activities that improve patient care.