Position Paper Supporting Virtual Simulation during COVID-19 Pandemic

Date posted

March 30, 2020


The International Nursing Association of Clinical Simulation and Learning (INACSL, www.inacsl.org) and the
Society for Simulation in Healthcare (SSH, www.ssih.org) support the use of virtual simulation as a replacement
for clinical hours for students currently enrolled in health sciences professions (i.e. nursing students, medical
students) during the current public health crisis caused by COVID-19.

The Problem

The COVID-19 pandemic is currently affecting over 80 countries and has spread throughout every state in the
United States.1 Countries including China, Italy, United States, Spain, Germany, Iran, and France are some of the
highest affected facing challenges of treating thousands of patients that exceed health system capacity.2 With
global shortages in personal protective equipment, many healthcare professionals are becoming ill with the
virus themselves leading to current shortages of healthcare professionals on the front lines.3, 4
With the pandemic expected to surge in waves and last for months, it is critical that the pipeline of educating
healthcare professionals remains intact. Universities across the world have transitioned to continuing education
through online or virtual means. In the context of health professions education, many regulatory bodies (such as
state boards of nursing) require completion of a set number of hours within the clinical setting. For example, in
California 5, thousands of nursing students who planned to graduate in a couple of months are being blocked due
to this clinical hour requirement. While policymakers in Texas6 and New York7 have readily promoted policy
change to assist with the educational challenges related to COVID-19 in the interest of helping needed
healthcare workers graduate, other regulatory agencies have remained firm.

The Resolution

The professional organizations of INACSL and SSH encompass the world’s leading experts in simulation-based
education for healthcare providers. We can attest that virtual simulation has been used for over a decade
successfully. Further, research has repeatedly demonstrated that use of virtual simulation - simulated
healthcare experiences on one’s computer - is an effective teaching method that results in improved student
learning outcomes.8, 9 Based on the current and anticipated shortage of healthcare workers, we propose that
regulatory bodies and policymakers demonstrate flexibility by allowing the replacement of clinical hours
usually completed in a healthcare setting with that of virtually simulated experiences during the pandemic. By
supporting this innovative yet effective way of teaching as a solution to address the clinical hour shortage of
health professions students, education efforts will continue seamlessly, and we will support timely career
progression of healthcare providers needed immediately to battle COVID-19.

Dr. Cynthia Foronda
President, INACSL
Bob Armstrong
President, SSH

1. Centers for Disease Control and Prevention. (2020, March 25). Coronavirus disease 2019. Retrieved from
2. World Health Organization. (2020, March 25). Novel coronavirus (COVID-19) situation. Retrieved from
3. West, M.G. (2020, March 24). New York City hospitals face new strain: Not enough workers. The Wall Street
Journal. Retrieved from https://www.wsj.com/articles/new-york-city-hospitals-face-new-strain-no….
4. Aloisi, S., Pollina, E., & Barbaglia, P. (2020, March 23). Italy’s medics at end of our strength as they fall too ill.
Reuters. Retrieved from https://www.reuters.com/article/us-health-coronavirus-italy-doctors/ita…
5. Goldberg, E. (2020, March 20). Coronavirus may keep California’s nursing students from graduating. Retrieved
from https://www.nytimes.com/2020/03/20/health/coronavirus-nurses-healthcare…
6. Office of the Texas Governor. Governor Abbott takes action to expand the nursing workforce. Press Release.
Retrieved from https://gov.texas.gov/news/post/governor-abbott-takes-action-to-expand-…
7. Chavez, N. & Carver, M. (2020, March 25). NYU wants its senior medical students to graduate early and join
the battle against coronavirus. CNN Health. Retrieved from https://www.cnn.com/2020/03/25/health/nyumedical-students-graduation-co….
8. Kononowicz, A. A., Woodham, L. A., Edelbring, S., Stathakarou, N., Davies, D., Saxena, N., Tudor Car, L.,
Carlstedt-Duke, J., Car, J., & Zary, N. (2019). Virtual Patient Simulations in Health Professions Education:
Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. Journal of Medical Internet
Research, 21(7), e14676. https://doi.org/10.2196/14676
9. Foronda, C.L., Fernandez-Burgos, M., Nadeau, C., Kelley, C.N., & Henry, M.N. (2020, February). Virtual
Simulation in Nursing Education: A Systematic Review Spanning 1996-2018. Simulation in Healthcare, 15(1), 46-
54. doi: 10.1097/SIH.0000000000000411