Next Article in Journal
Patients Taking Direct Oral Anticoagulants (DOAC) Undergoing Oral Surgery: A Review of the Literature and a Proposal of a Peri-Operative Management Protocol
Next Article in Special Issue
Nursing Students’ Perception on the Effectiveness of Emergency Competence Learning through Simulation
Previous Article in Journal
Associated Effects and Efficiency Evaluation between Wastewater Pollution and Water Disease Based on the Dynamic Two-Stage DEA Model
Previous Article in Special Issue
Using High-Fidelity Simulation to Introduce Communication Skills about End-of-Life to Novice Nursing Students
Open AccessArticle

Simulated Video Consultations as a Learning Tool in Undergraduate Nursing: Students’ Perceptions

Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain
University Centre of Health Sciences San Rafael, San Juan de Dios Foundation, Nebrija University, 28036 Madrid, Spain
Author to whom correspondence should be addressed.
Healthcare 2020, 8(3), 280;
Received: 30 June 2020 / Revised: 10 August 2020 / Accepted: 18 August 2020 / Published: 20 August 2020
(This article belongs to the Special Issue Clinical Simulation in Health Sciences)


Simulated video consultations, a teaching tool based on high-fidelity simulations, were implemented in response to the necessary adaptation of high-fidelity clinical simulation sessions to the online or virtual modality during the university closure due to the COVID-19 confinement. The purpose of our study was to explore the undergraduate nursing students’ satisfaction and perceptions about simulated video consultations using the high-fidelity simulation methodology. A mixed-method was utilized with 93 undergraduate nursing students using a validated satisfaction questionnaire (quantitative data), which included an observations section (qualitative data). Of the total sample, 97.8% of the students expressed a high overall satisfaction with simulated video consultations, highlighting their practical utility and positive learning outcomes. From the students’ comments, two main themes and their related categories emerged: advantages (satisfaction and enjoyment, learning, and calmness during simulated scenarios), and disadvantages (technical issues and technical skills development). Simulated video consultations may be considered as one more high-fidelity simulation teaching option. Nursing students should be trained in this modality of healthcare to face the challenge brought on by its increased use in healthcare services, beyond the specific adaptation of clinical simulation sessions due to the closure of universities during this pandemic.
Keywords: COVID-19; high fidelity simulation training; learning; nursing education; video conferencing; virtual simulation COVID-19; high fidelity simulation training; learning; nursing education; video conferencing; virtual simulation

1. Introduction

The pandemic experienced worldwide due to the novel coronavirus disease 2019 (COVID-19) has created great concerns for health services [1,2] and caused the implementation of public health measures to reduce the spread of the virus [3,4,5], which included limiting human contacts [2]. Consequently, many governments had to regulate social distancing with measures starting in March 2020 that increasingly restricted teaching practices [6]. In Spain, the government declared the state of alarm on 15 March 2020, using Royal Decree 463/2020 [7] for the management of the healthcare crisis situation owing to the COVID-19 pandemic, by calling for home confinement of the entire population, and including the closure of schools and universities.
To this end, telemedicine systems proliferated, significantly increasing the number of video consultations [8,9]. Among the different telemedicine options, video consultations are being implemented in many countries as a digital health strategy [10,11]. This modality of health care has provided multiple benefits such as avoiding agglomerations due to social distancing restrictions [12], patient satisfaction [13,14,15] and cost reduction [16,17].
Before this pandemic, video consultations were mainly used with patients who had problems accessing the healthcare services [18], for medical consultations in primary and hospital care [19,20], and for chronic disease conditions [21,22,23]. In addition, video consultations were also used for communication between healthcare professionals and clinicians [24]. During this pandemic, video consultations proliferated and their use expanded to other medical conditions and situations [11,13,24,25,26,27], with telemedicine now widely used. In fact, this pandemic has created the need to integrate these telemedicine systems into national health systems [10]. Consequently, training for healthcare professionals is needed [28,29], so they may adequately deal with the possible new challenges of this new modality of health care. In this sense, it should be noted that the interactions in video consultations between patients and healthcare professionals are quite different from an in-person consultation, so these professionals must be prepared to connect and adequately start a video consultation, properly manage possible disruptions during the conversation with the patient, connection failures and latency time during the conversation [24].
Furthermore, this pandemic has become a great challenge to education due to the suspension of face-to-face classroom sessions and closure of education centers [7]. Consequently, these centers have been forced to adapt to new technologies, signifying an opportunity for developing alternatives to achieve the learning objectives planned for each subject. It should be noted that educational institutions have a unique opportunity to bridge this current gap in clinical education with telemedicine, creating interesting proposals for the future [30,31]. More specifically, health sciences students have been particularly affected by this situation due to the suspension of their clinical practices in all healthcare centers and laboratory practices, and the development of high-fidelity clinical simulation sessions, with high-fidelity referring to simulation experiences that are extremely realistic and that provide a high level of interactivity and realism to the learners [32]. This teaching methodology has been demonstrated to be an effective tool for evaluating competencies and clinical performances in both students and healthcare professionals, being an essential part of their training and education [33,34].
In response to this situation, we considered it necessary to adapt our high-fidelity clinical simulation sessions to the new reality in education. Thus, a teaching tool based on high-fidelity simulation, i.e., simulated video consultations, was implemented during the COVID-19 confinement. In addition, these simulated consultations also seemed to be a perfect option for students to practice simulated video consultations for training and for adapting to this booming healthcare modality [35,36]. Thus, during this time, we implemented simulated video consultations utilizing scenarios according to the current reality of this pandemic.
Therefore, the purpose of our study was to explore undergraduate nursing students’ satisfaction and perceptions of simulated video consultations using high-fidelity simulation methodology.

2. Materials and Methods

2.1. Study Design

We conducted a descriptive cross-sectional study using a mixed-method (both quantitative and qualitative data were assessed) to analyze undergraduate nursing students’ perceptions of simulated nursing video consultations.

2.2. Setting and Sample

The study was carried out at a public university in Almeria (Spain) where this simulation modality was implemented, and it included all 3rd-year undergraduate students enrolled in the nursing degree (113 students). The nursing study program at this university is structured into four academic years, and the high-fidelity clinical simulation methodology is implemented in the third and fourth years. Of these, 93 nursing students chose to participate in the study (82.3% response rate).

2.3. Simulation Design Process

The implementation of this simulation methodology followed the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM [37,38,39,40]. In this way, all the stages included in the high-fidelity clinical simulation were accomplished: pre-briefing (establishment of a psychologically-safe learning environment), briefing (previous information related to the simulated scenario), simulated scenario (performance of simulation experience), and debriefing (analysis and discussion of clinical performance during the simulated scenario). These utilized a structured and supported approach, the Gather, Analyze and Summarize (GAS) debriefing tool and the plus-delta technique that allows the observers to differentiate good behaviors (+) from subpar behaviors (Δ) [41]. All of these stages were developed using a virtual platform of online video conferences provided by the university, namely Blackboard Collaborate LauncherTM.
A total of six simulated scenarios were designed related to basic healthcare at patients’ homes (all patients were simulated). These simulated scenarios addressed the following clinical cases: a child with febrile syndrome, a bed-ridden patient with a pressure ulcer, a post-surgical patient (laparoscopic cholecystectomy), a child diagnosed with attention deficit hyperactivity disorder (ADHD), a patient diagnosed with arterial hypertension, and a woman with an anxiety disorder (potential case of gender-based violence). All standardized patients (actors and actresses who performed the role of patient according to the Association of Standardized Patient Educators Standards of Best Practice [42]) were confined during the COVID-19 pandemic, so all the specific issues they raised about its adequate management and about protection measures were attended to, aside from the reason behind each consultation. Although the standardized patients changed during the different simulated scenarios, all of them were facilitators in clinical simulation. They were chosen for their experience in this methodology and were trained to play their roles in each simulated scenario, ensuring a high-fidelity level for the simulation experience [42].
Lastly, all nursing students completed three simulation sessions which lasted four hours each (one session of pre-briefing and two sessions where six simulated scenarios were performed, totaling 12 h) and were divided into eight groups (12–16 students). Consequently, each group was divided into six operational work teams (two–three students), who performed a complete simulated scenario together, portraying the role of nursing professionals. While a work team was performing a simulated scenario, the rest of the work teams observed in the debriefing room, learning from the mistakes of their classmates.

2.4. Data Collection

The study was carried out between 2 April and 21 May 2020. On the one hand, the quantitative data were collected by employing the Satisfaction Scale Questionnaire with High-Fidelity Clinical Simulation [43]. Using this questionnaire, we determined the nursing students’ satisfaction with the simulated video consultations. A total of 33 items were included in this questionnaire, which had to be answered using a 5-point Likert response scale (from 1 = strongly disagree to 5 = totally agree). The internal consistency obtained by its creators was satisfactory (Cronbach’s value = 0.920) [43]. On the other hand, the qualitative data were collected from the nursing students’ comments and opinions expressed in an observations section included at the end of the previously-mentioned satisfaction questionnaire. In this section, all the students could express their views on any matter related to the recent completed simulation experience.

2.5. Data Analysis

Both quantitative and qualitative data were analyzed. Firstly, the descriptive statistics of the sociodemographic data and each item included in the satisfaction questionnaire were calculated (mean, standard deviation and percentages). This descriptive analysis was performed using IBM SPSS Statistics Version 24.0 software for Windows (IBM Corp., Armonk, NY, USA). Secondly, all qualitative data collected from the students’ comments and opinions were analyzed independently by two researchers. The ATLAS.ti 8 software (Scientific Software Development GmbH, Berlin, Germany) was used for storing, managing, classifying and organizing all the information contained in the qualitative data. Lastly, a thematic analysis was performed for identifying reiterated words, sentences, or ideas in order to be grouped, first into themes and then into categories [44]. In addition, and to ensure anonymity, the participants were numerically labeled in chronological order according to the date of the interview, preceded by the letter “S” (student).

2.6. Ethical Considerations

This study was carried out following the ethical principles for medical research of the international Declaration of Helsinki [45] and the data protection policy included in current Spanish legislation [46]. In addition, this study was approved by the Research and Ethics Board of the Department of Nursing, Physiotherapy, and Medicine at the university (nº EFM 75/2020). All nursing students were informed about the study and those who accepted to participate voluntarily signed a written consent.

3. Results

In our study, 93 undergraduate nursing students aged between 20 and 44 years old (mean = 22.14; SD = 6.568) participated, and most of them were women (n = 76; 81.7%). Table 1 shows the descriptive data and frequencies obtained in the analysis of each item contained in the satisfaction questionnaire utilized. It should be noted that the five response options were grouped into three scales, as their results were quite similar, facilitating analysis (‘strongly disagree’/‘in disagreement’, ‘indifferent’, and ‘in agreement’/‘completely agree’). In this way, nursing students mainly scored most highly items within the ‘in agreement’/‘completely agree’ range (scores higher than 90%). In this sense, students provided higher scores in the items ‘practical utility’ (100%), ‘I have learned from the mistakes I made during the simulation’ (98.9%), the three items related to the debriefing phase (98.9%), and ‘overall satisfaction with the sessions’ (97.8%). By contrast, they provided low scores for the items ‘I became upset during some of the cases’ (19.4%), ‘I have improved my technical skills’ (49.9%), and ‘simulation has made me more aware/worried about clinical practice’ (63.43%). Regarding the internal consistency of the questionnaire, we obtained a Cronbach’s value quite similar to that obtained by its creators (Cronbach’s value = 0.922), indicating a satisfactory reliability.
Regarding the students’ observations collected in the questionnaire, all the nursing students contributed with short comments. Two analysis themes were identified: advantages and disadvantages of this simulation modality and their corresponding categories. Table 2 shows all categories identified after thematic analysis, including examples of significant quotes provided by the participants.

3.1. Theme 1. Advantages of Simulated Video Consultations

Nursing students described multiple advantages after experiencing simulated video consultations. Specifically, the following four categories were identified (ordered according to frequency of mention):
Category 1.1.
Satisfaction and enjoyment: The participants expressed high satisfaction and enjoyed the implementation of this simulation modality. It was positively valued as an alternative to face-to-face high-fidelity clinical simulation sessions by nursing students. In addition, they considered this simulation modality not only as a good adaptation to the situation caused by the COVID-19 pandemic., but also a good method for practicing a modality of health care that may be needed in their future professional career.
Category 1.2.
Learning: The nursing students ascribed value to the learning acquired through simulated video consultations, considering that this modality may be used during their future clinical practice. They also considered that this modality contributed to increasing and/or reinforcing their learning of non-technical skills (communication, active listening, appearance, empathy, and teamwork), promoting health education, as all the technical skills required during the simulated scenarios had to be explained to the standardized patient to mitigate the inability to perform them in a face-to-face clinical simulation session. However, they also described traditional educational aspects which may be acquired in a typical clinical simulation session, such as practicing in a realistic environment and learning from errors.
Category 1.3.
Calmness during simulated scenarios performance: Participants indicated that performing simulated scenarios at home using a computer may have contributed to generating less nervousness.

3.2. Theme 2. Disadvantages of Simulated Video Consultations

Participants focused their comments about the disadvantages of this simulation modality on two key points, which were identified as the following two categories (ordered by frequency of mention):
Category 2.1.
Technical issues: Nursing students indicated the Internet connection as a disadvantage, as video consultations require technological resources that must function properly to provide adequate health care.
Category 2.2.
Technical skills development: They highlighted the inability to perform clinical techniques required in simulated scenarios owing to its virtual format.

4. Discussion

When this simulation methodology was carried out, there was a shortage of research studies that had implemented high-fidelity simulation in video consultations, perhaps because it was not considered necessary until the present. However, the COVID-19 pandemic has changed the reality of healthcare services and video consultations are currently considered as the future of healthcare, although they have also become the immediate present [28,47]. Therefore, we consider that the training and educating of both nursing students and nursing professionals in this modality of healthcare as being essential to adapt them to new healthcare demands, beyond the specific adaptation of clinical simulation sessions for students due to the closure of universities during this pandemic.
Our results indicate a high satisfaction with simulated video consultations (97.8%) supported by the students’ comments, which highlighted their great satisfaction with and enjoyment of the practice and its adaptation of the format for performing clinical simulation sessions during the suspension of in-classroom activities. Another advantage expressed was related to the opportunity to learn from errors and practice in a realistic environment during the simulated scenarios. All of these results are congruent with other studies that obtained a high-level of satisfaction and positive learning outcomes from learners using clinical simulation methodology in face-to face sessions [43,48,49,50]. Particularly, nursing students recognized the important and relevant role of the debriefing phase in their learning, with this result being consistent with other studies [51,52].
Furthermore, the nursing students ascribed value to the learning acquired through simulated video consultations, considering that this modality could be used in their future clinical practice. In addition, our quantitative data showed that all students highlighted the practical utility of this simulation experience (100%). In this sense, it should be noted that this pandemic has challenged health systems worldwide, increasing the use of telemedicine services and in particular the wide use of video consultations [53]. In this way, training in this modality of health care is necessary to adequately manage a video consultation and provide high-quality health care [28]. Our students also considered that this modality contributed to increasing and/or reinforcing their learning of non-technical skills (communication, active listening, appearance, empathy, and teamwork). Clinical simulation also helps with developing these skills, although more research is recommended in this field to assess the development of non-technical skills through virtual simulation modalities [54]. However, since this modality requires healthcare professionals to be more responsive and cautious in order to achieve results similar to face-to-face consultations, the learning of non-technical skills may be increased [55,56].
In previous studies related to face-to-face clinical simulation sessions, learners often expressed high levels of anxiety [57,58]. However, our students describe being calm during the simulated scenarios (68.8%). Thus, our quantitative results were opposite from previous studies, although our qualitative results reinforced our finding, indicating that conducting simulated scenarios at home helped students to be in a safer environment. In this sense, to create a safe environment during simulated scenarios in our study, current recommendations and standards defined by the literature were followed [37,59,60].
However, our students perceived both technical issues and technical skills development as disadvantages of this methodology. Although the use of clinical simulation methodology has been demonstrated to help and improve clinical skills development [33,34], our results showed that simulated video consultations were not adequate for this. However, these disadvantages were quite similar to those indicated by healthcare professionals in real video consultations, who also complained about the inability to perform physical exams and clinical techniques or procedures. In this sense, it should be noted that new platforms and devices are currently being developed to adapt some clinical procedures [26,56]. In addition, this modality of healthcare requires some technological resources, so technological difficulties are the most worrying problem among healthcare professionals who hold video consultations in clinical practice [17,28,56,61]. In particular, these technical problems were aggravated for our students owing to the overloading of the internet connection during the confinement.
The main limitations of our study are related to technical problems during simulated video consultations, and these problems were aggravated by the internet connection overload during the COVID-19 confinement, as both tele-working and online classrooms were widespread. However, technical problems usually occur also in real-life video consultations, and their effectiveness is related to adequate network access and the correct functioning of technology [21,22,56]. Lastly, the high student satisfaction with simulated video consultations obtained in our study should be confirmed by other studies, so more research is needed in this field. In this sense, future studies should also analyze the instructors’ satisfaction with this methodology, assess the acquisition of nursing competencies, and, lastly, be expanded to other settings and education centers.

5. Conclusions

Clinical simulation based on simulated video consultations was a satisfactory experience for the nursing students who participated in these simulation sessions. They highlighted that it is necessary to train in this modality of healthcare and to learn non-technical skills (such as active listening, communication, empathy and teamwork) to adequately manage a video consultation. In this way, we propose simulated video consultations as one more high-fidelity simulation option and recommend training and educating nursing students in this modality of healthcare to face the challenges brought on by its increased use in healthcare services.

Author Contributions

Conceptualization, D.J.-R.; methodology, D.J.-R. and O.A.; formal analysis, D.J.-R. and O.A.; investigation, D.J.-R.; data curation, D.J.-R. and O.A.; writing—original draft preparation, D.J.-R. and O.A.; writing—review and editing, D.J.-R. and O.A.; supervision, D.J.-R.; project administration, D.J.-R. All authors have read and agreed to the published version of the manuscript.


This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.


  1. Sohrab, C.; Alsafi, Z.; O′Neill, N.; Khan, M.; Kerwan, A.; Al-Jabir, A.; Iosifidis, C.; Agha, R. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int. J. Surg. 2020, 76, 71–76. [Google Scholar] [CrossRef] [PubMed]
  2. Vellingiri, B.; Jayaramayya, K.; Iyer, M.; Narayanasamy, A.; Govindasamy, V.; Giridharan, B.; Ganesan, S.; Venugopal, A.; Venkatesan, D.; Ganesan, H.; et al. COVID-19: A promising cure for the global panic. Sci. Total Environ. 2020, 725, 138277. [Google Scholar] [CrossRef] [PubMed]
  3. Wang, C.; Horby, P.W.; Hayden, F.G.; Gao, G.F. A novel coronavirus outbreak of global health concern. Lancet 2020. [Google Scholar] [CrossRef]
  4. Lotfi, M.; Hamblin, M.R.; Rezaei, N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin. Chim. Acta 2020, 508, 254–266. [Google Scholar] [CrossRef]
  5. Nagesh, S.; Chakraborty, S. Saving the frontline health workforce amidst the COVID-19 crisis: Challenges and recommendations. J. Glob. Health 2020, 10, 010345. [Google Scholar] [CrossRef]
  6. Pather, N.; Blyth, P.; Chapman, J.A.; Dayal, M.R.; Flack, N.A.; Fogg, Q.A.; Green, R.A.; Hulme, A.K.; Johnson, I.P.; Meyer, A.J.; et al. Forced Disruption of Anatomy Education in Australia and New Zealand: An Acute Response to the Covid-19 Pandemic. Anat. Sci. Educ. 2020, 13, 284–300. [Google Scholar] [CrossRef]
  7. Spanish Government. Real Decreto 463/2020, de 14 de Marzo, por el que se Declara el Estado de Alarma Para la Gestión de la Situación de Crisis Sanitaria Ocasionada por el COVID-19. 2020. (In Spanish). Available online: (accessed on 20 June 2020).
  8. Contreras, C.M.; Metzger, G.A.; Beane, J.D.; Dedhia, P.H.; Ejaz, A.; Pawlik, T.M. Telemedicine: Patient-Provider Clinical Engagement During the COVID-19 Pandemic and Beyond. J. Gastrointest. Surg. 2020, 1–6. [Google Scholar] [CrossRef]
  9. Hong, Y.R.; Lawrence, J.; Williams, D., Jr.; Mainous, A., III. Population-Level Interest and Telehealth Capacity of US Hospitals in Response to COVID-19: Cross-Sectional Analysis of Google Search and National Hospital Survey Data. JMIR Public Health Surveill. 2020, 6, e18961. [Google Scholar] [CrossRef]
  10. Ohannessian, R.; Duong, T.A.; Odone, A. Global Telemedicine Implementation and Integration within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Health Surveill. 2020, 6, e18810. [Google Scholar] [CrossRef]
  11. Greenhalgh, T.; Wherton, J.; Shaw, S.; Morrison, C. Video consultations for Covid-19. BMJ 2020, 368, m998. [Google Scholar] [CrossRef]
  12. Rockwell, K.L.; Gilroy, A.S. Incorporating telemedicine as part of COVID-19 outbreak response systems. Am. J. Manag. Care 2020, 26, 147–148. [Google Scholar] [CrossRef] [PubMed]
  13. Szmuda, T.; Ali, S.; Słoniewski, P.; NSurg Wl Group. Telemedicine in neurosurgery during the novel coronavirus (COVID-19) pandemic. Neurol. Neurochir. Pol. 2020, 54, 207–208. [Google Scholar] [CrossRef]
  14. Jones, M.S.; Goley, A.L.; Alexander, B.E.; Keller, S.B.; Caldwell, M.M.; Buse, J.B. Inpatient Transition to Virtual Care During COVID-19 Pandemic. Diabetes Technol. Ther. 2020, 22, 444–448. [Google Scholar] [CrossRef]
  15. Shokri, T.; Lighthall, J.G. Telemedicine in the Era of the COVID-19 Pandemic: Implications in Facial Plastic Surgery. Facial Plast. Surg. Aesthet. Med. 2020, 22, 155–156. [Google Scholar] [CrossRef] [PubMed]
  16. de la Torre-Diez, I.; López-Coronado, M.; Vaca, C.; Sáez Aguado, J.; de Castro, C. Cost-Utility and Cost-Effectiveness Studies of Telemedicine, Electronic, and Mobile Health Systems in the Literature: A Systematic Review. Telemed. J. E-Health 2015, 21, 81–85. [Google Scholar] [CrossRef] [PubMed]
  17. Ignatowicz, A.; Atherton, H.; Bernstein, C.J.; Bryce, C.; Court, R.; Sturt, J.; Griffiths, F. Internet videoconferencing for patient-clinician consultations in long-term conditions: A review of reviews and applications in line with guidelines and recommendations. Digit. Health 2019, 5, 2055207619845831. [Google Scholar] [CrossRef]
  18. Smith, W.R.; Atala, A.J.; Terlecki, R.P.; Kelly, E.E.; Matthews, C.A. Implementation guide for rapid integration of an outpatient telemedicine program during the COVID-19 pandemic. J. Am. Coll. Surg. 2020. [Google Scholar] [CrossRef]
  19. Lee, J.J.; English, J.C. Teledermatology: A Review and Update. Am. J. Clin. Dermatol. 2018, 19, 253–260. [Google Scholar] [CrossRef]
  20. Peters, L.; Greenfield, G.; Majeed, A.; Hayhoe, B. The impact of private online video consulting in primary care. J. R. Soc. Med. 2018, 111, 162–166. [Google Scholar] [CrossRef]
  21. Mallow, J.A.; Petitte, T.; Narsavage, G.; Barnes, E.; Theeke, E.; Mallow, B.K.; Theeke, L. The use of video conferencing for persons with chronic conditions: A systematic review. Ehealth Telecommun. Syst. Netw. 2016, 5, 39–56. [Google Scholar] [CrossRef]
  22. Nordtug, B.; Rygg, L.Ø.; Brataas, H.V. The use of videoconferencing in nursing for people in their homes. Nurs. Rep. 2018, 8, 6761. [Google Scholar] [CrossRef]
  23. Jess, M.; Timm, H.; Dieperink, K.B. Video consultations in palliative care: A systematic integrative review. Palliat. Med. 2019, 33, 942–958. [Google Scholar] [CrossRef] [PubMed]
  24. Shaw, S.E.; Seuren, L.M.; Wherton, J.; Cameron, D.; A’Court, C.; Vijayaraghavan, S.; Morris, J.; Bhattacharya, S.; Greenhalgh, T. Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction. J. Med. Internet Res. 2020, 22, e18378. [Google Scholar] [CrossRef] [PubMed]
  25. Hagge, D.; Knopf, A.; Hofauer, B. Telemedicine in the Fight against SARS-COV-2-opportunities and Possible Applications in Otorhinolaryngology: Narrative Review. HNO 2020, 1–7. [Google Scholar] [CrossRef]
  26. Santos-Peyret, A.; Durón, R.M.; Sebastián-Díaz, M.A.; Crail-Meléndez, D.; Goméz-Ventura, S.; Briceño-González, E.; Rito, Y.; Martínez-Juárez, I.E. Herramientas de salud digital para superar la brecha de atención en epilepsia antes, durante y después de la pandemia de COVID-19 (E-health tools to overcome the gap in epilepsy care before, during and after COVID-19 pandemics). Rev. Neurol. 2020, 70, 323–328. [Google Scholar] [CrossRef] [PubMed]
  27. De Marchi, F.; Cantello, R.; Ambrosini, S.; Mazzini, L.; CANPALS Study Group. Telemedicine and technological devices for amyotrophic lateral sclerosis in the era of COVID-19. Neurol. Sci. 2020, 21, 1–3. [Google Scholar] [CrossRef]
  28. Portnoy, J.; Waller, M.; Elliott, T. Telemedicine in the Era of COVID-19. J. Allergy Clin. Immunol. Pract. 2020, 8, 1489–1491. [Google Scholar] [CrossRef]
  29. Jiménez-Rodríguez, D.; Santillán García, A.; Montoro Robles, J.; Rodríguez Salvador, M.; Muñoz Ronda, F.J.; Arrogante, O. Increase in Video Consultations During the COVID-19 Pandemic: Healthcare Professionals’ Perceptions about Their Implementation and Adequate Management. Int. J. Environ. Res. Publ. Health 2020, 17, 5112. [Google Scholar] [CrossRef]
  30. Wosik, J.; Fudim, M.; Cameron, B.; Gellad, Z.F.; Cho, A.; Phinney, D.; Curtis, S.; Roman, M.; Poon, E.G.; Ferranti, J.; et al. Telehealth transformation: COVID-19 and the rise of virtual care. J. Am. Med. Inform. Assoc. 2020, 27, 957–962. [Google Scholar] [CrossRef]
  31. Iancu, A.M.; Kemp, M.T.; Alam, H.B. Unmuting Medical Students’ Education: Utilizing Telemedicine During the COVID-19 Pandemic and Beyond. J. Med. Internet Res. 2020, 22, e19667. [Google Scholar] [CrossRef]
  32. Lioce, L.; Lopreiato, J.; Downing, D.; Chang, T.P.; Robertson, J.M.; Anderson, M.; Diaz, D.A.; Spain, A.E. (Eds.) The Terminology and Concepts Working Group. In Healthcare Simulation Dictionary–Second Edition; Agency for Healthcare Research and Quality: Rockville, MD, USA, 2020. [Google Scholar]
  33. Ricketts, B. The role of simulation for learning within pre-registration nursing education—A literature review. Nurse Educ. Today 2011, 31, 650–654. [Google Scholar] [CrossRef] [PubMed]
  34. Shin, S.; Park, J.H.; Kim, J.H. Effectiveness of patient simulation in nursing education: Meta-analysis. Nurse Educ. Today 2015, 35, 176–182. [Google Scholar] [CrossRef] [PubMed]
  35. Phadke, N.A.; Del Carmen, M.G.; Goldstein, S.A.; Vagle, J.; Hidrue, M.K.; Boti, E.S.; Wasfy, J.H. Trends in Ambulatory Electronic Consultations During the COVID-19 Pandemic. J. Gen. Intern. Med. 2020, 1–3. [Google Scholar] [CrossRef] [PubMed]
  36. Webster, P. Virtual Health Care in the Era of COVID-19. Lancet 2020, 395, 1180–1181. [Google Scholar] [CrossRef]
  37. INACSL Standards Committee. INACSL standards of best practice: SimulationSM simulation design. Clin. Simul. Nurs. 2016, 12, 5–12. [Google Scholar] [CrossRef]
  38. INACSL Standards Committee. INACSL standards of best practice: SimulationSM facilitation. Clin. Simul. Nurs. 2016, 12, 16–20. [Google Scholar] [CrossRef]
  39. INACSL Standards Committee. INACSL standards of best practice: SimulationSM simulation glossary. Clin. Simul. Nurs. 2016, 12, 39–47. [Google Scholar] [CrossRef]
  40. INACSL Standards Committee. INACSL standards of best practice: SimulationSM Debriefing. Clin. Simul. Nurs. 2016, 12, 21–25. [Google Scholar] [CrossRef]
  41. Phrampus, P.E.; O′Donnell, J.M. Debriefing Using a Structured and Supported Approach. In The Comprehensive Textbook of Healthcare Simulation; Levine, A.I., De Maria, S., Schwartz, A.D., Sim, A.J., Eds.; Springer: New York, NY, USA, 2013. [Google Scholar]
  42. Lewis, K.L.; Bohnert, C.A.; Gammon, W.L.; Hölzer, H.; Lyman, L.; Smith, C.; Thompson, T.M.; Wallace, A.; Gliva-McConvey, G. The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Adv. Simul. 2017, 2. [Google Scholar] [CrossRef]
  43. Alconero-Camarero, A.R.; Gualdrón-Romero, A.; Sarabia-Cobo, C.M.; Martínez-Arce, A. Clinical simulation as a learning tool in undergraduate nursing: Validation of a questionnaire. Nurse Educ. Today 2016, 39, 128–134. [Google Scholar] [CrossRef]
  44. Mayan, M. Essentials of Qualitative Inquiry; Left Coast Press, Inc.: Walnut Creek, CA, USA, 2009. [Google Scholar]
  45. World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA 2013, 310, 2191–2194. [Google Scholar] [CrossRef] [PubMed]
  46. Spanish Government. Ley Orgánica 3/2018, de 5 de diciembre, de Protección de Datos Personales y Garantía de los Derechos Digitales. BOE Núm. 294, de 06/12/2018. (In Spanish). Available online: (accessed on 25 June 2020).
  47. Spence, D. Bad medicine: The future is video consulting. Br. J. Gen. Pract. 2018, 68, 437. [Google Scholar] [CrossRef] [PubMed]
  48. Franklin, A.E.; Burns, P.; Lee, C.S. Psychometric testing on the NLN Student Satisfaction and Self-Confidence in Learning, Design Scale Simulation, and Educational Practices Questionnaire using a sample of pre-licensure novice nurses. Nurse Educ. Today 2014, 34, 1298–1304. [Google Scholar] [CrossRef]
  49. Au, M.L.; Lo, M.S.; Cheong, W.; Wang, S.C.; Van, I.K. Nursing students’ perception of high-fidelity simulation activity instead of clinical placement: A qualitative study. Nurse Educ. Today 2016, 39, 16–21. [Google Scholar] [CrossRef] [PubMed]
  50. Zapko, K.A.; Ferranto, M.L.G.; Blasiman, R.; Shelestak, D. Evaluating best educational practices, student satisfaction, and self-confidence in simulation: A descriptive study. Nurse Educ. Today 2018, 60, 28–34. [Google Scholar] [CrossRef]
  51. Dufrene, C.; Young, A. Successful debriefing-best methods to achieve positive learning outcomes: A literature review. Nurse Educ. Today 2014, 34, 372–376. [Google Scholar] [CrossRef]
  52. Levett-Jones, T.; Lapkin, S. A systematic review of the effectiveness of simulation debriefing in health professional education. Nurse Educ. Today 2014, 34, e58–e63. [Google Scholar] [CrossRef]
  53. Hollander, J.E.; Carr, B.G. Virtually perfect? Telemedicine for covid-19. N. Engl. J. Med. 2020, 382, 1679–1681. [Google Scholar] [CrossRef]
  54. Bracq, M.S.; Michinov, E.; Jannin, P. Virtual Reality Simulation in Nontechnical Skills Training for Healthcare Professionals: A Systematic Review. Simul. Healthc. 2019, 14, 188–194. [Google Scholar] [CrossRef]
  55. Calton, B.A.; Rabow, M.W.; Branagan, L.; Dionne-Odom, J.N.; Oliver, D.P.; Bakitas, M.A.; Fratkin, M.D.; Lustbader, D.; Jones, C.A.; Ritchie, C.S. Top Ten Tips Palliative Care Clinicians Should Know about Telepalliative Care. J. Palliat. Med. 2019, 22, 981–985. [Google Scholar] [CrossRef]
  56. Greenhalgh, T. Video Consultations: A Guide for Practice. Available online: (accessed on 29 May 2020).
  57. Cantrell, M.L.; Meyer, S.L.; Mosack, V. Effects of Simulation on Nursing Student Stress: An Integrative Review. J. Nurs. Educ. 2017, 56, 139–144. [Google Scholar] [CrossRef] [PubMed]
  58. Nielsen, B.; Harder, N. Causes of Student Anxiety during Simulation: What the Literature Says. Clin. Simul. Nurs. 2013, 9, e507–e512. [Google Scholar] [CrossRef]
  59. Rudolph, J.W.; Raemer, D.; Simon, R. Establishing a safe container for learning in simulation: The role of the presimulation briefing. Simul. Healthc. 2014, 9, 339–349. [Google Scholar] [CrossRef] [PubMed]
  60. Turner, S.; Harder, N. Psychological Safe Environment: A Concept Analysis. Clin. Simul. Nurs. 2018, 18, 47–55. [Google Scholar] [CrossRef]
  61. Flodgren, G.; Rachas, A.; Farmer, A.J.; Inzitari, M.; Shepperd, S. Interactive telemedicine: Effects on professional practice and health care outcomes. Cochrane Database Syst. Rev. 2015, 9, CD002098. [Google Scholar] [CrossRef]
Table 1. Descriptive data and frequencies obtained in each item included in the satisfaction questionnaire (n = 93).
Table 1. Descriptive data and frequencies obtained in each item included in the satisfaction questionnaire (n = 93).
ItemMean (SD)Strongly Disagree/In DisagreementIndifferentIn Agreement/Totally Agree
1. Facilities and equipment were real4.01 (0.993)6.5%16.1%77.4%
2. Objectives were clear cases4.58 (0.538)0%2.2%97.8%
3. Cases recreated real situations4.80 (0.456)0%2.2%97.8%
4. Timing for each simulation case was adequate4.09 (0.868)6.5%14%79.5%
5. The degree of cases difficulty was appropriate to my knowledge.4.24 (0.728)3.3%4.3%92.4%
6. I felt comfortable and respected during the sessions4.65 (0.654)2.2%3.2%94.6%
7. Clinical simulation is useful to assess a patient’s clinical simulation4.41 (0.679)1.1%7.5%91.4%
8. Simulation practices help you learn to avoid mistakes4.56 (0.580)1.1%1.1%97.8%
9. Simulation has helped me to set priorities for action4.37 (0.672)1.1%7.5%91.4%
10. Simulation has improved my ability to provide care to my patients4.25 (0.670)1.1%9.7%89.2%
11. Simulation has made me think about my next clinical practice4.63 (0.547)0%3.2%96.8%
12. Simulation improves communication and teamwork4.55 (0.617)1.1%3.2%95.7%
13. Simulation has made me more aware/worried about clinical practice3.54 (1.113)20.5%16.1%63.4%
14. Simulation is beneficial to relate theory to practice4.52 (0.583)0%4.3%95.7%
15. Simulation allows us to plan the patient care effectively4.34 (0.651)1.1%6.5%92.4%
16. I have improved my technical skills3.04 (0.887)33.7%17.2%49.9%
17. I have reinforced my critical thinking and decision-making4.37 (0.527)0%2.2%97.8%
18. Simulation helped me assess patient’s condition4.39 (0.532)0%2.2%97.8%
19. This experience has helped me prioritize care4.32 (0.611)1.1%4.3%94.6%
20. Simulation promotes self-confidence4.42 (0.614)1.1%3.2%95.7%
21. I have improved communication with the team4.40 (0.630)1.1%4.3%94.6%
22. I have improved communication with the family3.94 (0.832)3.3%21.5%75.2%
23. I have improved communication with the patient4.44 (0.561)0%3.2%96.8%
24. This type of practice has increased my assertiveness4.28 (0.682)1.1%9.7%89,3%
25. I became nervous during some of the cases2.32 (1.199)68,8%11.8%19.4%
26. Interaction with simulation has improved my clinical competence4.25 (0.583)0%7.5%92.5%
27. The teacher gave constructive feedback after each session4.76 (0.498)1.1%0%98.9%
28. Debriefing has helped me reflect on the cases4.77 (0.492)1.1%0%98.9%
29. Debriefing at the end of the session has helped me correct mistakes4.74 (0.464)0%1.1%98.9%
30. I knew the cases’ theoretical side4.56 (0.616)1.1%3.2%95.7%
31. I have learned from the mistakes I made during the simulation4.69 (0.489)0%1.1%98.9%
32. Practical utility4.62 (0.509)0%0%100%
33. Overall satisfaction with the sessions4.62 (0.624)1.1%1.1%97.8%
Table 2. Themes and categories identified after thematic analysis, including examples of significant quotes provided by participants.
Table 2. Themes and categories identified after thematic analysis, including examples of significant quotes provided by participants.
ThemesCategoriesStudent Discourses (Student = S)
Theme 1. Advantages of simulated video consultationsCategory 1.1. Satisfaction and enjoyment“I liked it even more than I thought I would have, and I have learned and enjoyed it a lot” (S33).
“I had fun seeing how my peers acted, thinking about what I would have done and what should be corrected, so my experience has been satisfactory, and I’ve learned not only the theory to address, but also attitudes and how to manage a situation that I may not have experienced before: I have gained resources and knowledge” (S46)
“A complete novelty, of which I’m grateful to have been a part of, as they had never spoken to us about this possibility as an interview method and to be in contact with patients, so that I am grateful in light of the future” (S83)
“It has been a good alternative in light of the current situation we are facing” (S88)
Category 1.2. Learning“Realism, correcting mistakes, empathy, improvement of attitudes and skills, trust, not being embarrassed anymore, non-verbal language techniques. Promoting group participation” (S10)
“Learn how telehealth will be, as it is something that is being utilized in the health centers due to the current situation we are in, and I think it is important to know how to create a good environment for the patient in distance health services, because sometimes it is complicated” (S11)
“I have learned new communication skills, to pay attention to the verbal and non-verbal language, to listen to their worries and solve doubts, to explain myself using an easy and clear language, to create comfortable surroundings, and most of all to relax myself and deal directly with the patient. This has allowed me to have an idea about how to manage possible situations that I may experience with real future patients” (S49)
“It is an approach to a real situation with many realistic issues, it provides options for developing communication and psychological techniques, it lets us learn from our mistakes before making them in real life, and it makes you become truly involved with the patient, searching for all the means to help him or her” (S50).
Category 1.3. Calmness during simulated scenarios performance“You feel less nervous when you are performing the simulation from your house and within your comfort zone” (S52)
“I think we have felt less embarrassed and with more confidence when performing the simulation through the screen” (S65)
“When being in my own room, it didn’t feel like an exam, and this has resulted in me being more calm” (S71).
“Less nervousness” (S74)
Theme 2. Disadvantages of simulated video consultationsCategory 2.1. Technical issues“Maybe the main problem was the internet connection, but this is not dependent on the simulation” (S21)
“Maybe the quality of the connection, but there isn’t much to improve”. (S30)
“The connection problems (could be a positive issue if you know how to deal with it” (S57)
Category 2.2. Technical skills development“Due to the current situation of having to do the simulation online, practical skills have not been able to be demonstrated”. (S7)
“We have not been able to improve the technical skill in the same way” (S9)
“It’s difficult to learn practical skills with an online simulation, but many other things are learned”. (S60)
Back to TopTop