Effect of Implementing Simulation Education on Health Care Worker Comfort With Nasopharyngeal Swabbing for COVID-19

Otolaryngol Head Neck Surg. 2020 Aug;163(2):271-274. doi: 10.1177/0194599820933168. Epub 2020 Jun 2.


Objective: To determine if rapid implementation of simulation training for the nasopharyngeal swab procedure can increase provider confidence regarding procedure competency.

Methods: A simulation training exercise was designed as a departmental initiative to improve competency performing nasopharyngeal swabs during the COVID-19 pandemic. Sixty-one health care workers attended teaching sessions led by the Department of Otorhinolaryngology on proper nasopharyngeal swab technique. After a brief lecture, participants practiced their swab technique using a high-fidelity airway simulation model. Pre- and postintervention self-evaluations were measured via standardized clinical competency questionnaires on a 5-point Likert scale ranging from "No knowledge, unable to perform" up to "Highly knowledgeable and confident, independent."

Results: Forty-six participants in this study submitted pre- and postintervention self-assessments. Postintervention scores improved on average 1.41 points (95% CI, 1.10-1.73) out of 5 from a mean score of 3.13 to 4.54 (P < .0001). This reflects a large effect size with a Glass's delta value of 1.3.

Discussion: Lecture coupled with simulation-based teaching can significantly improve health care workers' confidence in performing nasopharyngeal swabs. Proper training for frontline workers performing swabs for COVID-19 is essential to improving testing accuracy and can be achieved in a simple and timely manner.

Implications for practice: To meet the testing needs of the growing pandemic, many health care workers who are unfamiliar with nasopharyngeal swabs have been asked to perform this test. Simulation-based teaching sessions may improve health care workers' confidence and help prevent false-negative results. This intervention is easily reproducible in any setting where frequent nasopharyngeal swab testing occurs.

Level of evidence/study design: Prospective cohort study.

Keywords: COVID-19; PS/QI; coronavirus; education; nasopharyngeal; otolaryngology; simulation; swab; testing.