Table 1

Challenges and possible solutions for simulation and technology-enhanced learning during COVID-19 outbreak in China

Approaches		Challenges	Possible solutions
Online learning	MOOCs and other prerecorded online platforms; Teleconference software and mobile applications	Lack of learner engagement, interaction and real-time feedback	Online group discussion via social network services (phone applications and so on)
		Course-delivery quality, technical failure	Delivery platform how-to-use manual, testing before course presentation, improve recording environment
		Learner progress monitoring	Precourse and postcourse assignments
		Mostly knowledge-based learning, not enough on clinical skills	Add sessions on virtual lab/practical learning platform (eg, http://www.ilab-x.com/)
Simulation	Training and maintaining procedural Skills (eg, hand hygiene, PPE) Specific patient management skills (eg, airway management, CRRT and ECMO) Training to adapting unfamiliar working environment	Limited training resources; large number of HCWs that require training	Reuse of equipment and materials; strive for support from the leadership
		Limited qualified instructors	Design, develop of course materials and fast iterations; training and maintain homogeneous, qualified faculty team
		Limited time for course delivery	Devising a reasonable training scheme: reduce total training-time, allow self-paced learning, adequate grouping and scheduling
		Increased chance of infection	Self-protection, health check (body temperature and so on) before attending training, avoid a large group of learners attending
		Skill degradation over time	Allow for repeated training routines, deploy just-in-time training mechanism
	Systems probing	Access to a certain area Time allocation Staff support and attending	Seek support from hospital leadership and relevant departments (outpatient, fever clinic, department of infectious diseases, office of infectious control and so on)

CRRT, continuous renal replacement therapy; ECMO, extracorporeal membrane oxygenation; HCW, healthcare worker; MOOCs, Massive Open Online Courses; PPE, personal protective equipmen.