PG29 Achieving fidelity in digital simulation: the case of mental health training

Abstract

<h3>Background</h3> COVID-19 placed limitations on in-person training and heralded mass adoption of remote consultations. Ostensibly, digital simulation can emulate remote consultations. However, in simulating in-person interactions, course designers, technicians and actors are presented with several challenges and the patent risk of sacrificing psychological and physical fidelity. <h3>Summary of Work</h3> Maudsley Simulation employ actors trained in mental health role play to deliver high-fidelity simulation in a smots-equipped centre. An existing full-day course for psychiatric trainees was adapted and piloted online by staff working partially remotely over a half-day. In-house testing and three half-day pilots were conducted. Through consultation with faculty, technicians and actors, existing scenarios were adapted where possible. Actors were based remotely and relied on in-built laptop webcams and microphones. <h3>Summary of Results</h3> Two categories of adaptable scenarios emerged: suitability as remote consultation and potential as digital analogue i.e., context unchanged. Scenarios deemed unsuitable for adaptation were replaced with pre-recorded video scenarios continuous in narrative with the chosen live simulation. Scenario settings were a home (remote consultation) and inpatient mental health unit (digital analogue). The use of a plant was adapted through a simulated phone call. Short video clips were produced to contextualise and close scenarios. Participant and actor feedback were collected to refine technical and operational procedures. <h3>Discussion</h3> Actors assumed full responsibility for mise-en-scène (incl. lighting, décor, props, costume). This increased their burden in the context of the already heightened remote working-related operational challenges. Additionally, the conventional use of plants (typically played by faculty) was limited. Actors’ use of their own equipment created variation in audio-visual quality, in some cases limited quality and, in all cases, limited scope for movement. Movement limitations challenged actors to explore new ways of transgressing personal boundaries and eliciting feelings of threat, for example. Other fidelity-related factors included: webcam-related gaze perception issues associated with empathy and non-verbal communication constraints.¹ Network and platform stability and individual technical issues were barriers to achieving higher fidelity levels. These were improved by troubleshooting and revising operational procedures. Providing actors with external webcams and microphones is worth consideration. <h3>Conclusion</h3> Qualitative feedback suggests digital simulation affords active participants and observers with a highly immersive experience. Additionally, it is capable of high-fidelity for remote mental health consultations which have become increasingly common. Achieving fidelity levels comparative with in-person simulation presents inherent challenges. However, digital simulation represents a viable adjunct or alternative for mental health training. <h3>Reference</h3> Grondin F, Lomanowska AM, Jackson PL. Empathy in computer-mediated interactions: a conceptual framework for research and clinical practice. Clinical Psychology: Science and Practice. 2019 Dec;26(4):e12298.