Anaesthesiology is a constantly adapting and changing specialty. Many trainees will have been regaled with stories of past anaesthesiologists holding a facemask for hours without so much as a restroom break or a pulse oximeter. A slight exaggeration perhaps, but a testament still to how far the specialty and workforce have progressed. Two unique attributes have persisted over the years - anaesthesiologists are still at the forefront of patient care and safety, and they continue to show great resilience. Today our specialty faces one of its biggest challenges to date. Ever since the SARS-CoV-2 outbreak spread to Europe and the rest of the world, we have rapidly had to learn how to adapt and live with Covid-19. Whilst hospitals have adapted to an ever-changing situation, so too has our education and training. High fidelity simulation training is a key component of the College of Anaesthesiologists of Ireland (CAI) training curriculum, as well as being essential for the practice of high risk, low frequency clinical crisis we may face as anaesthesiologists. Unpublished results of a recent survey of 64 CAI trainees have shown that 85% of respondents felt that they lost out on important training opportunities because of the pandemic, with 28% strongly agreeing. These lost opportunities included attending mandatory courses (43%), and recommended courses (28%). To partly counteract that shortage, there were hospital-based simulation initiatives with 44% of respondents participating in simulation, 21% designing and implementing simulation, and 25% involved in protocols and guidelines design. 58% of simulation training was in donning and doffing PPE, 50% was in airway management, and 23% was in cardiac arrest management. (Data courtesy of Dr. Sarah Corbett and Prof. Crina Burlacu) Despite the initial cessation of onsite training, examinations and educational activities during the first lockdown, the College has remained fully committed to its core activities, i.e. the organisation, supervision and counselling of doctors in training in Ireland. The priority, as a College, is to support trainees’ progression throughout their training, whilst keeping people safe. The College has also remained fully committed to the framework for restrictive measures introduced by the Government and continues to be informed by ongoing public health advice. And so, over the summer began the arduous task of adapting the College of Anaesthesiologists Simulation Training (CAST) programme to the realities of the Covid-19 pandemic. This time last year, social distancing probably meant taking a break from Facebook and Twitter for a few days, whilst wearing a facemask at all times only happened if you were rostered on the orthopaedic list and faced with a demanding surgeon. Now these are the norm. Physical distancing, hand hygiene, and other health and safety guidelines have required adaptations to the simulation environment. For those of you who have taking part in simulation training before, you know that simulation is about working in teams, hands on practice and small group discussions, often confined for 8 hours in a relatively small simulation suite. You will appreciate therefore the issues that we faced. Following many meetings and tremendous buy-in from all stakeholders, we have adapted in several ways. 1) The number of delegates and faculty on simulation courses have been reduced in line with public health advice on congregations. 2) Hand gel for personal use is widely available as well as surface cleaning of the clinical and simulation equipment is perfomed at the beginning of each course as well as between the scenarios. 3) A pre-course covid screening questionnaire is now required for all faculty and delegates. (The SimMan is the only ‘person’ who doesn’t need to fill out the Covid questionnaire nor apologise for coughing in someone’s face!) 4) The lecture theatre is now used for both observing simulations and for post-simulation debriefing. It allows for adequate social distancing, adequate people flow, as well as being more spacious and air-filled. 5) To facilitate viewing from remote areas, significant planning and investment has gone into the upgrade of IT and audio-visual system. 6) The wearing of facemasks is now mandated at all times, as well as other PPE where appropriate in the simulation laboratory. This now accurately reflects the world and workplaces we live in. 7) Where possible, we are limiting close contact interactions as much as possible within the simulation laboratory. Every effort is made to balance this against the need for a simulation scenario to properly unfold. To fill any potential knowledge/experience gaps, video resources have been deployed, and have been well received. 8) One of the most coveted features of simulation courses at the College – the delicious lunch, highly acclaimed in participants’ feedback - is now individually packed. (I guess that means no sneaky seconds for the foreseeable!) Each of the tables are lined with Perspex shielding for maximum protection during that limited mask-free period. (Even the customary team bonding pints after the Sim day are gone for now!) These changes have ensured that we can continue to provide simulation courses in an interactive and hands-on manner, whilst maintaining the safety of all those involved. Huge credit for this goes to the simulation team led by Prof. Crina Burlacu, for the endless meetings and planning, re-planning, and re-replanning (is that a word?!) in conjunction with the course leads, the broader faculty and the college as a whole. To date, I am happy to report that feedback has been overwhelming positive, and delegates have both enjoyed, and learned from their sim experiences. We look forward to meeting you all at a Government compliant, socially distanced and mask filled sim (but hopefully still fun filled also!) in the very near future.

Stay Safe,

Dr. Peter Mc Cauley