SimMon: A Use Case

by: Sheila Waslawski, MD

During the COVID-19 pandemic, medical education has been forced to pivot in many directions. While didactics and small-group education have readily available alternative platforms, simulation has required more creativity to adapt to the pandemic’s restrictions.

During the midst of our institution’s in-person education restrictions, we redesigned our pediatric resident and nursing simulation (i.e., mock code) format. We implemented high-frequency, brief, in-situ simulations to decrease the number of participants per simulation. This entailed smaller, more frequent simulations with each mock code having four participants—two pediatric nurses and interns. The simulations were conducted in-situ on the general pediatric floor, creating the mock environment by placing simulation supplies (crash cart, airway supplies, IV start kit, etc.) in the same locations as supplies are typically stored on the general ward. Each simulation consisted of a five-minute pre-brief, two five-minute clinical scenarios, and a ten-minute debrief. This 30-minute timeframe allowed interns and nurses to easily step away from their clinical duties to participate. The brevity also allowed us to concentrate our clinical scenarios on the first five minutes of an acute decompensation, a period of time which we had previously identified our general floor nurses & residents were uncomfortable managing.

Fundamental to the redesigned curriculum was the high frequency of the simulations. We know that resuscitation skills are acquired through practice and repetition, so we required interns to complete this simulation at least three times over the course of their four-week inpatient block. We achieved this repetition by utilizing uncomplicated technology including a low-fidelity infant mannequin¹ and the SimMon² app. The SimMon app allowed the facilitator to control and display vital signs using one iPad as a remote control and a second iPad connected via Bluetooth as the display monitor. The SimMon app is designed to easily facilitate a monitor & remote-control system as the app will prompt you to select whether you would like to utilize the app as a “standalone monitor” or as a “remote control.” Vital signs including heart rate with a rhythm strip, pulse oximetry with a waveform, blood pressure, respiratory rate, and temperature were able to be clearly displayed on the iPad in a format similar to that of a real patient monitor, as shown in photo 2, right. Although we utilized iPads with iOS, per the SimMon website, most newer Android devices also support the app. SimMon’s interface allowed the facilitator to quickly change vital signs by either entering a new numerical value for the vital signs or toggling the current vital sign value up or down to increase or decrease the value respectively. Another way to change vital signs quickly was to utilize the app’s preset feature. By creating presets, we were able to enter the vital signs for the entire scenario beforehand, then while facilitating the simulation we would simply select the next state of the scenario which automatically changed the vital signs to the values we had previously entered. Our simulation team was able to set up, facilitate, and break down the simulation within one hour. We found SimMon to be very user-friendly with every facilitator confident in its use within several minutes of training. We never once ran into technical issues as SimMon solely relied on a stable Wi-Fi connection and appropriately charged devices (iPads).

Although this simulation curriculum was created out of pandemic restrictions, we have received positive feedback encouraging its continued use even after in-person restrictions are lifted. The more intimate nature of the mock codes lessened the performance anxiety of participants, and the in-situ nature forced participants to better understand their available resources. The COVID-19 pandemic does not look to be going away anytime soon and neither does our new simulation curriculum.

1. Newborn Airway Management Skills Trainer (S320) https://www.gaumard.com/s320

2. https://simmon-app.com/ (cost $22.99)