Herein, we present a new collaborative clinical simulation (CCS) model for the development of medical competencies by medical students. The model is a comprehensive compendium of published considerations and recommendations on clinical simulation (CS) and computer-supported collaborative learning (CSCL). Currently, there are no educational models combining CS and CSCL. The CCS model was designed for the acquisition and assessment of clinical competencies; working collaboratively and supported by technology, small groups of medical students independently design and perform simulated cases. The model includes four phases in which the learning objectives, short case scenarios, materials, indices, and the clinical simulation are designed, monitored, rated and debriefed.

La simulación clínica apoya el desarrollo de competencias clínicas de los estudiantes^6-8. Sin embargo, se utiliza mayoritariamente para conseguir competencias de forma individual^7,9, lo que no será la realidad del desarrollo profesional en un medio clínico. En este contexto, es importante enseñar las competencias médicas a los estudiantes dentro de ambientes de equipo y colaborativos^2,9, incorporando formalmente este tipo de metodologías innovadoras al currículum^10-12 y estimulando el trabajo en equipo.

Background: The collaborative clinical simulation (CCS) model is a structured method for the development and assessment of clinical competencies through small groups working collaboratively in simulated environments. From 2016 onward, the CCS model has been applied successfully among undergraduate and graduate medical students from the Universidad de Talca, Chile; the Universität de Barcelona, Spain; and the Universidad de Vic-Manresa, Spain. All the templates for building the clinical cases and the assessment instruments with CCS were printed on paper. Considering the large number of CCS sessions and the number of participating students that are required throughout the medical degree curriculum, it is impossible to keep an organized record when the instruments are printed on paper. Moreover, with the COVID-19 pandemic, web platforms have become important as safe training environments for students and medical faculties; this new educational environment should include the consolidation and adaptation of didactic sessions that create and use available virtual cases and use different web platforms. Objective: The goal of this study is to describe the design and development of a web platform that was created to strengthen the CCS model. Methods: The design of the web platform aimed to support each phase of the CCS by incorporating functional requirements (ie, features that the web platform will be able to perform) and nonfunctional requirements (ie, how the web platform should behave) that are needed to run collaborative sessions. The software was developed under the Model-View-Controller architecture to separate the views from the data model and the business logic. Results: MOSAICO is a web platform used to design, perform, and assess collaborative clinical scenarios for medical students. MOSAICO has four modules: educational design, students’ collaborative design, collaborative simulation, and collaborative debriefing. The web platform has three different user profiles: academic simulation unit, teacher, and student. These users interact under different roles in collaborative simulations. MOSAICO enables a collaborative environment, which is connected via the internet, to design clinical scenarios guided by the teacher and enables the use of all data generated to be discussed in the debriefing session with the teacher as a guide. The web platform is running at the Universidad de Talca in Chile and is supporting collaborative simulation activities via the internet for two medical courses: (1) Semiology for third-year students (70 students in total) and (2) Medical Genetics for fifth-year students (30 students in total). Conclusions: MOSAICO is applicable within the CCS model and is used frequently in different simulation sessions at the Universidad de Talca, where medical students can work collaboratively via the internet. MOSAICO simplifies the application and reuse of clinical simulation scenarios, allowing its use in multiple simulation centers. Moreover, its applications in different courses (ie, a large part of the medical curriculum) support the automatic tracking of simulation activities and their assessment.

Background: Testing, traceability, and isolation actions are a central strategy defined by the World Health Organization to contain the COVID-19 pandemic. In this sense, the countries have had difficulties in counting the number of people infected with SARS-CoV-2. Errors in reporting results are a common factor, as well as the lack of interoperability between laboratories and governments. Approaches aimed at sending spreadsheets via email expose patients’ privacy and have increased the probability of errors due to retyping, which generates a delay in the notification of results.Objective: This study aims to design and develop an interoperable platform to report polymerase chain reaction (PCR) SARS-CoV-2 tests from laboratories to the Chilean government.Methods: The methodology to design and develop the interoperable platform was comprised of six well-structured stages: (1) creation of a minimum data set for PCR SARS-CoV-2 tests, (2) modeling processes and end points where institutions interchange information, (3) standards and interoperability design, (4) software development, (5) software testing, and (6) software implementation.Results: The interoperable Fast Healthcare Interoperability Resources (FHIR) platform to report PCR SARS-CoV-2 tests from laboratories to the Chilean government was successfully implemented. The platform was designed, developed, tested, and implemented following a structured methodology. The platform’s performance to 1000 requests resulted in a response time of 240 milliseconds, throughput of 28.3 requests per second, and process management time of 131 milliseconds. The security was assured through a private network exclusive to the Ministry of Health to ensure confidentiality and integrity. The authorization and authentication of laboratories were implemented with a JavaScript Object Notation Web Token. All the PCR SARS-CoV-2 tests were accessible through an application programming interface gateway with valid credentials and the right access control list.Conclusions: The platform was implemented and is currently being used by UC Christus Laboratory. The platform is secure. It was tested adequately for confidentiality, secure authorization, authentication, and message integrity. This platform simplifies the reporting of PCR SARS-CoV-2 tests and reduces the time and probability of mistakes in counting positive cases. The interoperable solution with FHIR is working successfully and is open for the community, laboratories, and any institution that needs to report PCR SARS-CoV-2 tests.

Aims: This paper evaluates the feasibility of piloting the collaborative clinical simulation (CCS) model and its assessment instruments applicability for measuring interpersonal, collaborative, and clinical competencies in cardiologic emergency scenarios for medical students. The CCS model is a structured learning model for the acquisition and assessment of clinical competencies through small groups working collaboratively to design and perform in simulated environments supported by technology. Methods: Fifty-five students were allocated in five sessions (one weekly session) conducted with the CCS model within the course Cardiovascular Diseases. The applied practice aimed at the diagnosis and treatment of tachyarrhythmias in a simulated emergency department. In addition to the theoretical classes four weeks before the simulation sessions, students were sent a study guide that summarized the Guide to the European Society of Cardiology. For each simulation session, one clinical simulation instructor, one cardiologist teacher, and the principal investigator participated. Students were divided into three groups (3-5 students) for each-session. They designed, performed, role-played, and debriefed three different diagnoses. Three instruments to assess each group's performance were applied: 1. peer assessment used by groups, 2. performance assessment, created and applied by the cardiologist teacher, and 3. individual satisfaction questionnaire for students. Results: The applicability of the CCS model was satisfactory for both students and teachers. The assessment instruments internal reliability was good, as was internal consistency with a Cronbach Alpha of 0.7, 0.4, and 0.8 for each section (Interpersonal, Clinical, and Collaborative competencies, respectively). The performance groups evaluation was 0.8 for the two competencies assessed (Tachyarrhythmia and Electrical Cardioversion) and 0.8 for the satisfaction questionnaire's reliability. Conclusions: The CCS model for teaching emergency tachyarrhythmias to medical students was applicable and well accepted. The internal reliability of the assessment instruments was considered satisfactory by measuring satisfaction and performance in the exploratory study.

Background: The creation of computer-supported collaborative clinical cases is an area of educational research that has been widely studied. However, the reuse of cases and their sharing with other platforms is a problem, as it encapsulates knowledge in isolated platforms without interoperability. This paper proposed a workflow ecosystem for the collaborative design and distribution of clinical cases through web-based computing platforms that (1) allow medical students to create clinical cases collaboratively in a dedicated environment; (2) make it possible to export these clinical cases in terms of the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) interoperability standard; (3) provide support to transform imported cases into learning object repositories; and (4) use e-learning standards (eg, Instructional Management Systems Content Packaging [IMS-CP] or Sharable Content Object Reference Model [SCORM]) to incorporate this content into widely-used learning management systems (LMSs), letting medical students democratize a valuable knowledge that would otherwise be confined within proprietary platforms. Objective: This study aimed to demonstrate the feasibility of developing a workflow ecosystem based on IT platforms to enable the collaborative creation, export, and deployment of clinical cases. Methods: The ecosystem infrastructure for computer-supported collaborative design of standardized clinical cases consists of three platforms: (1) Mosaico, a platform used in the design of clinical cases; (2) Clavy, a tool for the flexible management of learning object repositories, which is used to orchestrate the transformation and processing of these clinical cases; and (3) Moodle, an LMS that is geared toward publishing the processed clinical cases and delivering their course deployment stages in IMS-CP or SCORM format. The generation of cases in Mosaico is exported in the HL7 FHIR interoperability standard to Clavy, which is then responsible for creating and deploying a learning object in Moodle. Results: The main result was an interoperable ecosystem that demonstrates the feasibility of automating the stages of collaborative clinical case creation, export through HL7 FHIR standards, and deployment in an LMS. This ecosystem enables the generation of IMS-CPs associated with the original Mosaico clinical cases that can be deployed in conventional third-party LMSs, thus allowing the democratization and sharing of clinical cases to different platforms in standard and interoperable formats. Conclusions: In this paper, we proposed, implemented, and demonstrated the feasibility of developing a standards-based workflow that interoperates multiple platforms with heterogeneous technologies to create, transform, and deploy clinical cases on the web. This achieves the objective of transforming the created cases into a platform for web-based deployment in an LMS.