Table 1 Overview of key elements of the SimUniversity telesimulation competition

Student orientation

Students were encouraged to choose a location well known to them for the simulation. Manikin, medical equipment, and the environment were thus familiar to the participants.

Simulator type

In order to be as inclusive as possible, we did not require any specific type nor manufacturer for the manikin to be used.

Simulation environment

The simulations were conducted online in a synchronous manner. Students were all gathered together at their location of choice, usually a simulation center or some other learning location. The facilitators and the technician were all in separate locations. Everyone was connected through Zoom, the online meeting platform.

Simulation scenario

All 8 teams were offered scenario 1.

Scenario 1: An adult patient was brought to the emergency room with a cardiac arrest and each team was required to perform advanced life support (ALS).

Four finalist teams were offered scenario 2.

Scenario 2: A young adult patient was brought to the emergency room with altered mental status (AMS). Each team had to evaluate the different differential diagnoses using a structured ABCDE approach.

Instructional design or exposure

In order to most closely resemble the classical face-to-face simulation competition, we used the traditional sequence of briefing, team-based simulated of the case, and virtual debriefing.

Duration:

The case was planned to run over approximately 10 min and the debriefing over 15–20 min.

Debriefing

Debriefing was focused on non-technical skills, clinical reasoning, and teamwork. As the simulator (manikin) was switched off, all clinical examination findings were communicated to the students, via an overhead intercom (colloquially also referred to as “Voice of God”).

Given that all clinical actions had a level of abstraction built into the simulation, discussion of the clinical findings was not the main focus of the debriefing. We chose PEARLS [6] as the debriefing structure, combined with the advocacy/inquiry technique [7] during the analysis phase.