The Basic Principle

The basic principle of a webinar setup with your SIMStation system is simple: The video and audio data of the simulation, which you normally transmit to the debriefing room (and/or transmission room) using the SIMStation "Broadcast to:" function of the SIMStation Recording Software, will now be streamed 1-to-1 to the Internet. The following characteristics of this setup should be noted:

• Any installed SIMStation camera becomes a webcam.
• In the SIMStation Stage Designer you can arrange the image sources (the various split screens, the different rooms and views) and thus integrate them into your stream in a customized form.
• Thanks to the excellent sound quality of the headset microphones, the voices of several simulation participants can also be integrated as an audio source.
• The entire control of the stream can be run as usual via the SIMStation Software.

The Technical Implementation

The technical implementation of the Basic Webinar Setup – i.e., the transmission of the SIMStation Broadcast Stream to the Internet instead of to a TV set or a transmission screen in the simulation center – is quite simple and cost-effective.

Just do not connect the SIMStation Debriefing PC to your TV set/transmission screen as usual, but to a commercially available video grabber via the HDMI cable. If you now connect this video grabber to a PC via the USB interface, the video grabber will be initialized by the operating system as a new webcam source. The SIMStation Broadcast Stream can thus be routed to a streaming PC (via the interface of the video grabber) and streamed from there to the Internet. Functionally adequate video grabber models are already available from approx. € 100.

With this simple extension, the entire SIMStation infrastructure is already available as an online live stream and can be integrated via the device settings of the respective streaming platform (Zoom, Microsoft Teams, Facebook live, YouTube live, etc.). Simpler webinar formats can be implemented quickly and easily with this setup!

A question we are often asked by clients: "How can I actively involve the online audience in a live stream of a more complex simulation training?".

The general sense of such a much more elaborate constellation must be clarified elsewhere. But the attempt to answer this question reveals a particular advantage here: The complexity of the desired simulation settings (several room changes, channels and training participants, virtual and/or real presence, virtual debriefings, interactive participation, etc.) quickly shows the limits of the Basic Webinar Setup. And this illustrates the need for a more complex setup: the Advanced Webinar Setup.

Before we get into the features and implementation of the Advanced Webinar Setup, however, we must first divide the "simulation event" into the individual phases. And then we must determine where these are spatially/virtually located and decide which phases are suitable for online streaming. Which phases can be streamed 1-to-1, which can/must be bridged by recordings and/or moderation? And how can this be implemented technically? If it is possible at all ...

Please note: This planning service must take place in advance for every virtual event/simulation event!

Simulation Training

1. Onboarding
Where: debriefing room, foyer, meeting room
What: welcome of the participants and detailed discussion of the further procedure
Duration: max. 15'

2. Familiarization
Where: simulator
What: explanation of the workspace, technique and algorithms; development of a common mind-model
Duration: max. 45'

3. Break:
Where: hallway, common room
What: refreshment, Sim Team wiring, clinical vignette to the Sim Team, patient history to the audience
Duration: approx. 10'

4. Simulation:
Where: simulator
What: training, recording, annotating; transmission to the debriefing/transmission room
Duration: n.a.

5. Break:
Where: hallway, common room
What: Sim team de-cabling, refreshment; trainers: planning of the debriefing and learning goals
Duration: approx. 10'

6. Debriefing:
Where: debriefing room
What: debriefing, modification of the simulator
Duration: approx. 45'
 

7. Closing:
Where: debriefing room
What: administrative, farewell
Duration: approx. 5'

Web Stream

1. Onboarding:
Where: debriefing room, digital foyer/meeting room
Web stream: admission from the digital waiting room, clarification of the procedure and digital rules of conduct (mute, chat, etc.)
Duration: max. 15'

2. Familiarization:
Where: simulator
Web stream: transmission of the familiarization; Q&As in the chat or afterwards by the trainer
Duration: max. 45'

3. Break:
Where: hallway, common room
Web stream: via moderation: patient history to the online participants, followed by a refreshment
Duration: approx. 10'

4. Simulation:
Where: simulator
Web stream: training, recording, annotating; online live stream of the simulation; Q&As in the chat
Duration: n.a.

5. Break:
Where: hallway, common room
Web stream: moderation, interview with trainers, followed by a refreshment
*Duration: approx. 10'

6. Debriefing:
Where: debriefing room, digital foyer/meeting room
Web stream: moderated but separate discussion? Filling in of pre-prepared questionnaires? Discussion of results?
Duration: approx. 45'

7. Closing:
Where: debriefing room, digital foyer/meeting room
Web Stream: administrative, farewell
Duration: approx. 5'

The Problem and the Solution

This very simplified comparison illustrates not only methodological shortcomings (especially regarding debriefing!) but also technical difficulties that cannot be solved with the Basic Webinar Setup. Due to the specific requirements – e.g., additional video feeds for moderation and recordings – the SIMStation Broadcast Stream from the simulation room is simply not sufficient to run a live webinar as moderated, commented, and interactive content.

Implementing more complex webinars requires the more elaborate Advanced Webinar Setup. This setup bases on the main concept of the Basic Webinar Setup but adds a functional extension to the basic variant: video mixing. For this, a separate video mixer software must be installed between the video grabber and the streaming PC. Note: The video mixer software must be installed on the same PC on which the webinar software (Microsoft Teams, Zoom, etc.) is installed.

The aim of the Advanced Webinar Setup is to mix several video feeds (including the SIMStation Broadcast Stream of the simulation training) and create a coherent video stream that can subsequently be processed and streamed by the webinar software.

The Advantages

The big advantage of this setup is that you can use the entire SIMStation infrastructure as well as easily integrate other video feeds (for moderations, presentations, media feeds, etc.). With little financial and technical effort, this creates an enormously powerful "studio" with which complex live streams for webinars can be composed (=mixed).

Another advantage: As with the basic variant, the Advanced Webinar Setup does not interfere with the existing hardware and software architecture of the SIMStation system.

For video mixing, there are various software solutions on the market that have different advantages and disadvantages depending on the requirements. In our experience, in most cases the best results can be achieved with the free software OBS Studio – one of the most widely used streaming software in the gaming community worldwide. For more information on the OBS Studio software, please see the list of links at the end of this article.

The setups described above offer many productive and creative possibilities for streaming simulation training (and the associated teaching and learning goals) via online channels. However, they also bring some challenges and difficulties for professional simulation operations.

The Debriefing Problem

The principle of both setup variants is to intercept the transmission/debriefing stream, edit it and put it online in the form of a live webinar. This makes conventional live transmissions into a real room (a non-virtual room; mostly a debriefing room) as well as classical debriefing variants at the same time almost impossible or technically extremely demanding. A simultaneous implementation of a classical (taking place on site) and online debriefing would require a "splitting" of the signal transmission – for the stream and for the debriefing room. This conceivable solution is not yet practicable. The emphasis is on "not yet".

Another problem is the different quality of the simulation experience. The immersive character of simulation training and especially the closed atmosphere of a debriefing are based on the real presence of the participants. This decisive factor – the intimate nature of simulation training – cannot be transposed 1-to-1 into the virtual space. And is therefore difficult for virtual participants to comprehend.

To create at least partial parity among the real and virtual learners (on site and via web stream), to equalize the experience of these groups, the on-site participants should also be allowed to watch the live transmission of the simulation via the web stream and the debriefing should generally be moved to a digital space for everyone. Comparable conditions = equal experience for all? Hard to say. At least this access could be easily realized technologically with the setups described, if the participants are equipped with laptops on site.

The Confidentiality Agreement

Another difficulty that should not be underestimated is the confidentiality of simulation training. Medical simulations, the training itself and especially the debriefing, are built on a high level of trust among all participants. A safe space must be created for all participants. A transmission to the web to "unknown persons", i.e., to persons who do not actually participate in the training (on site), fundamentally contradicts this premise. Not least when you think of the numerous digital recording possibilities through screenshots, screen capture software etc. ...

And one more thing: So far, our considerations have been more of a technical nature; i.e., how best to implement possible setups through hardware and software extensions. A focus that is not unusual in the technology-heavy simulation industry. However, another aspect is just as important: the correlation of form and content.

The Correlation of Webinar and Content

Finally, we ask ourselves the question of the adequate form of the webinar. Why is this question important? Because not all webinars are the same. Because the form of the webinar also defines the limits of the content that can be transported. Or viewed from the other side: the content to be transported – adapted to the respective methodological and didactic requirements of a simulation training – determine the possible form of the webinar. And it is precisely here that a problem reveals itself: "Real" (i.e., non-virtual) simulation trainings per se contain so many technical and simulation-specific unknowns that they can hardly be represented by the form of a predefined webinar. Generally speaking, the close link between form and content in online formats leaves little room for deviations during events that are difficult to predict. But precisely this – the confrontation with the unpredictable – is one of the fundamental premises of simulation training.

This problem is known in the simulation industry. In numerous congresses, seminars and articles, the opportunities and limitations of possible online/webinar formats are discussed, discarded, and further developed. This productive discussion has already resulted in numerous interesting findings and insights but has not yet reached a final solution. As is so often the case, professional simulation means work in progress. So, we can look forward to seeing what innovations can be expected in this regard!

A Possible Solution: Show Trainings

One solution to the form/content dilemma in webinars that can already be implemented are pre-recorded show trainings. We are talking about an already completed simulation where all participants are aware that the training is deliberately "staged". This renunciation of the authentic claim and the live aspect excludes spontaneous deviations that cannot be represented in the live stream, which in turn enables a targeted analysis of the video stream in the form of a webinar. In addition, some concerns regarding data protection can be easily solved: by participants previewing the video, declarations of consent, etc. This example also illustrates an important rule for webinars with complex content: Content that does not necessarily have to be live should be pre-recorded!

And for recording simulations, you are perfectly equipped with a SIMStation system. In this respect, I would like to point out a software function in the SIMStation Recordings Archive: the export function. This allows you to copy the RAW files (i.e., the individual video and audio tracks) from the system and then use them for educational films in an editing program of your choice. The best prerequisite for you to discover, edit and distribute new webinar content. So take this opportunity and transform your simulation center into a versatile web/film studio. And ... action!

The Technology

• With minimal adaptations, SIMStation systems can be used for live streams and the creation of educational films.
• Use the entire SIMStation infrastructure for webinars and/or online presentations.
• Integrate the "Broadcast to:" signal/the debriefing stream into your webinars.
• A simple setup can be realized with truly little technical and financial effort (from € 100).
• For complex webinars, you can use free software (e.g., OBS Studio) and a mid-range PC (=streaming PC) with a few additional devices to create a professional web studio that knows hardly any limits.

The Webinar Content

• Simulations can not be transferred 1-to-1 as a webinar. The form of the webinar (as well as its possibilities and limitations) must therefore always be considered.
• Plan your webinar based on your simulation sequence and define those sections/phases that need their own implementation for the webinar.
• Keep in mind the different attention spans for complex content that is transmitted virtually.
• There is still a lack of content formats that meet the "safe space" requirement of a simulation. Experiences in this regard and implementation approaches are debated in the simulation community. An illustative example is the following blog post by Tiffani Chidume [zuletzt geöffnet am 06.10.2021].
• Content that does not necessarily have to be streamed live should be pre-recorded and then presented in the live stream.

AV.io HD
A very high-quality video grabber (also in terms of price), with which we were able to run extremely long webinars without any problems.
https://www.epiphan.com/products/avio-hd/

MiraBox
A very inexpensive video grabber that also makes the HDMI signal available to an additional screen. This allows you to use the SIMStation stream simultaneously for the webinar and for display on an additional control monitor.
https://miraboxbuy.com/

OBS Studio
A free streaming software for Windows, MacOS and Android.
The most used streaming software in the gaming community.
https://obsproject.com/

OBS Studio Full Tutorial 2021 Version
A complete guide - from downloading the software to using it
https://www.youtube.com/watch?v=biabH2ayl6U

Voicemeter Potato
Optional: a digital audio mixer to manage different sound devices - very cheap, very effective!
https://vb-audio.com/Voicemeeter/potato.htm

Full Tutorial 2020:
https://www.youtube.com/watch?v=52Rs7tqFYm8