Implementation of simulation training in the Intensive Care Units (ICU) during the COVID-19 pandemic: A scoping review.

Introduction: In response to the important influx of critically ill patients as well as resources limitation, simulation would be a tool ensuring the continuum of medical training.

Aim: To assess the impact of simulation training on both education and performance related to protocol development during COVID-19 pandemic, in critical care.

Methods: This scoping review was written in accordance with the PRISMA Guideline. Data sources and studies were identified by searching "MEDLINE", "Cochrane library" databases and "Clinical trial.gov". Study inclusion adhered to the PICO criteria: Population, Intervention, Comparison, and Outcomes. The Kirkpatrick Model, is a tool for evaluating the level of impact of training results according to four levels Results: The search algorithm yielded sixteen articles of which eight were meeting criteria for inclusion and finally seven were available. The number of participants ranged from 12 to 108 with a median of 61 (IQR: 8-76). The length of intervention ranged from 12 min to three hours with a median of 38 min (IQR: 12-135). Studies reported that incorporating simulation yields a more pronounced impact compared to theoretical and clinical training alone in enhancing knowledge and confidence. Regarding the role of simulation in protocol development, results have shown that in the pre-test, all the participants failed donning and doffing Personal Protective Equipment (PPE), the mean cognitive load was high (7.43±0.9 points) and the performance was low (2.5±0.8) while in the post-test, 100% of participants were successful in donning the PPE, the mean of the cognitive load decreased (4.1±1.4 points), and the performance substantially increased (7.9±1.1). In addition, five studies showed behavioral changes after training and thus the simulation reached Kirkpatrick level three.

Conclusion: Results supported the impact of simulation, in critical care, as an effective method to enhance knowledge and confidence, and to improve protocol development during pandemics such as COVID-19.