The Covid 19 Pandemic learning strategy: From traditional simulation to online simulation


Chadli Dziri
Ibrahim Amara
Mouna Ben Rhouma
Wejden Mnasri
Mamoun Ben Cheikh


Introduction: In Tunisia, during the COVID-19 pandemic, face-to-face teaching was replaced by online teaching.

Aim: This study aimed to compare three teaching periods: face-to-face teaching in October 2020, screen-based simulation in November 2020 and screen-based simulation in April 2021.

Methods:  It was a comparison of the three periods of face-to-face teaching "October 2020" versus online teaching "November 2020" versus "April 2021" online teaching using Chi-square and Fisher Exact test when appropriate for categorical variables and Analysis of Variance (ANOVA) for quantitative variables. During the April 2021 period, we introduced knowledge assessment through pre- and post-tests. The interactivity was facilitated by the questions and answers with the "Google forms" and the simulation session performed by the facilitator guided by the remote learners.

The main criterion was "Overall satisfaction".

Results: Face-to-face teaching was superior to online teaching using screen-based simulation in terms of overall satisfaction, educational goal achievement, behavior change and recommendation.

The online teaching in April 2021 was superior to the online teaching in November 2020 in terms of satisfaction and recommendation rates. This was probably due to the interactivity of the Google forms questionnaire and the simulation by the facilitator guided by remote learners.

Conclusion: Face-to-face teaching was superior to online teaching in terms of overall satisfaction, educational goals achievement, behavior change and recommendation.



  2. Chasset F, Barral M, Steichen O, Legrand A. Immediate consequences and solutions used to maintain medical education during the COVID-19 pandemic for residents and medical students: a restricted review. Postgrad Med J. Apr 2021;postgradmedj-2021-139755.
  3. Statement-on-Use-of-Virtual-Simulation-during-the-Pandemic
  4. virtual-medical-simulation/
  5. Simon R, Raemer DB, Rudolph JW. 2010. Debriefing Assessment for Simulation in Healthcare (DASH)© Rater's Handbook. Center for Medical Simulation, Boston, Massachusetts. content/uploads/2017/01/DASH.handbook.2010.Final.Rev.2.pdf. 2010. English, French, German, Japanese, Spanish, Portuguese
  7. Leighton K, Kardong-Edgren S, Schneidereith T, Foisy-Doll C, Wuestney KA. Meeting Undergraduate Nursing Students' Clinical Needs. Nurse Educ. 2021;46(6):349-54.
  8. Warren JN, Luctkar-Flude M, Godfrey C, Lukewich J. A systematic review of the effectiveness of simulation-based education on satisfaction and learning outcomes in nurse practitioner programs. Nurse Educ Today. nov 2016;46:99-108.
  9. Haoran G, Bazakidi E, Zary N. Serious Games in Health Professions Education: Review of Trends and Learning Efficacy. Yearb Med Inform. August 2019;28(1):240-8.
  10. Drummond D; Delval p; Abdenouri S; Truchot J; Ceccaldi, Pierre F; Plaisance P; Hadchouel A; TesnièreA . Serious game versus online course for pretraining medical st... : European Journal of Anaesthesiology | EJA [Internet]. [cited 25 Jan 2022]. Available from:
  11. &article=00008&type=Fulltext
  12. Seymour-Walsh AE, Bell A, Weber A, Smith T. Adapting to a new reality: COVID-19 coronavirus and online education in the health professions [Internet]. [cited 25 Jan 2022]. Available from:
  13. Brusamento S, Kyaw BM, Whiting P, Li L, Tudor Car L. Digital Health Professions Education in the Field of Pediatrics: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res. 25 Sep 2019;21(9):e14231.
  14. Coyne E, Rands H, Frommolt V, Kain V, Plugge M, Mitchell M. Investigation of blended learning video resources to teach health students clinical skills: An integrative review. Nurse Education Today. Apr 2018;63:101-7.
  15. Taroco ALC, Valente TC de O, Carbogim CS. Distance learning for updating health professionals in palliative care: a systematic review. BMJ Support Palliat Care. June 2017;7(2):205-11.
  16. Ellman MS, Schulman-Green D, Blatt L, Asher S, Viveiros D, Clark J, et al. Using Online Learning and Interactive Simulation To Teach Spiritual and Cultural Aspects of Palliative Care to Interprofessional Students. Journal of Palliative Medicine. nov 2012;15(11):1240-7.
  17. Kononowicz AA, Woodham LA, Edelbring S, Stathakarou N, Davies D, Saxena N, et al. Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res. Jul 2, 2019;21(7):e14676.
  18. 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
  19. PositionStatement-on-Use-of-Virtual-Simulation-during-the-Pandemic
  21. Taveira-Gomes T, Ferreira P, Taveira-Gomes I, Severo M, Ferreira MA. What Are We Looking for in Computer-Based Learning Interventions in Medical Education? A Systematic Review. J Med Internet Res. August 1, 2016;18(8):e204.
  22. Verhey JT, Haglin JM, Verhey EM, Hartigan DE. Virtual, augmented, and mixed reality applications in orthopedic surgery. Int J Med Robot [Internet]. Apr 2020 [cited 25 Jan 2022];16(2). Available from:
  23. Kombination von simulationsbasiertem Lernen und Online-Learning in der Augenheilkunde [Internet]. [cited 25 Jan 2022]. Available from: