Table 1 Key elements of simulation-based research [17]

Participant orientation

Participants were guided by the course director at each center. A constructive conversation was encouraged in which the team that would be in charge of the simulation and the participants were introduced. The methodology of the course, the tools that would be used for the simulation, the learning objectives, and the investigative intention of the activity were explained. The scheduled time for this activity was 30 min.

Simulator type

We used and transmitted the data (vital signs) generated by the Laerdal® ALS® and SimMom® patient monitor.

Simulation environment

The simulations were all in online-synchronized format. The participants and the simulation staff of each center were in their homes, connected through the meeting platform on their personal computers and mobile devices.

Simulation scenario

Learning objectives

The learning objectives were the initial diagnosis and management of the patient with COVID-19, the safe use of personal protective equipment (PPE), and the mastery of two non-technical skills (situational awareness and communication).

Team practice

The participants (students) formed teams and held positions in the care of the simulated case, these were leader, airway management, monitoring, medications, and information management.

Facilitators

All the teachers were medical specialists (internist, anesthesiologist, and intensivist) and had training in education and simulation with more than 10 years of experience. The leaders of each simulation team were the directors of the simulation centers, who were medical specialists and had training in education and simulation (ER-B and PAS-R: international courses, DAD-G: Fellowship and Doctorate)

Simulation staff

For each center an engineer was in charge of the operations area, a confederate played the role of nurse, and an actor the role of the patient participating; all of them had training in simulation (courses) and experience in the field of more than 3 years.

Instructional design or exposure

For this study, we used the sequence that we traditionally used in face-to-face simulation: Briefing, simulated case in teams, and debriefing.

Duration

We planned that the time for each simulation was not arbitrary, but should not exceed 30 min. The same applies for the time of the debriefing, the duration should be necessary to achieve a learning conversation, nonetheless, not exceeding one hour.

Assessment

The work with each team of students consisted of two clinical cases: in the first case, the students’ performance (T1) was evaluated before carrying out the first structured debriefing, where knowledge and performance gaps were closed. In the second case (T2), performance was evaluated, followed by a second structured debriefing session.

Debriefing

We used structured debriefing (with good judgment) [18], with both a debriefer and a co-debriefer. The learning conversation was conducted by the director of the simulation center in each country.