ER-VIPE Simulation Game Builds Medical Students’ Soft Skills for Real-World Emergency Care 

The Faculty of Medicine at Chulalongkorn University developed ER-VIPE, an emergency room simulation game, creating scenarios such as COVID-era operations, cardiac arrest resuscitation, crowded emergency rooms, and elderly accidents. The program allows medical students, nurses, pharmacists, radiologic technologists, and medical technologists to learn collaborative teamwork, enhance critical thinking and life skills, as well as prepare for real-life patient care. 

In the Interprofessional Collaboration for Patient Safety course, held at Chulalongkorn Healthcare Advanced Multi-Profession Simulation Center on the 11th floor of Bhumisiri Mangkhalanusorn Building at King Chulalongkorn Memorial Hospital, fifth-year medical students are fully focused on their computer screens, playing an emergency-room simulation game called ER-VIPE (Emergency Room – Virtual Interprofessional Education). 

This time, the game features a scene simulating a crowded emergency room. The medical students work together as a team, each choosing different roles through avatars representing five professions: physician, nurse, pharmacist, radiologic technologist, and medical technologist. They must quickly determine their roles and coordinate efficiently under time pressure to manage a heavy flow of patients—from critical to moderate and mild cases.  Although the game is fun, everyone takes it seriously. When time runs out, the team ends with a score of 600! 

“A good doctor must be a leader and a good communicator so that others on the team can continue their work,” said Asst. Prof. Dr. Khuansiri Narajeenron, faculty member of the Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University. She shared this with the medical students and invited everyone to reflect on the lessons learned from the simulation game before trying it again. 

  “Chula medical students are second to none in terms of ability. However, when it comes to thinking and working together, challenges remain — and this is a global issue. If we don’t communicate, if each person only performs their own duties without seeing the bigger picture of which patients need to be treated first, or without knowing what the patients and their families need, and if we don’t have the chance to talk and warn one another, medical errors will occur.” 

As the initiator of the ER-VIPE project, Asst. Prof. Dr. Khuansiri firmly believes that “learning through simulated scenarios helps students see that coordinated teamwork is a tremendous force that can greatly benefit patients.” 

Building Immunity and Strengthening Teamwork Skills  

ER-VIPE, the Emergency Room – Virtual Interprofessional Education, has been supported by Chulalongkorn University’s Second Century Fund (C2F) since 2020. The program was designed with the goal of enabling learners from various medical and health-related disciplines to study together across professions — a concept known as IPE (Interprofessional Education). 

The platform was created to bring together students from five health-related professions—medicine, nursing, pharmacy, radiologic technology, and medical technology—to learn collaboratively. “We use TeamSTEPPS, a training program designed to improve teamwork and communication in healthcare settings, as the core of the learning experience to enhance patient safety and the effectiveness of care.” 

TeamSTEPPS (Team Strategies & Tools to Enhance Performance and Patient Safety), developed by the AHRQ (Agency for Healthcare Research and Quality), consists of four key components: Leadership, Communication, Situation Monitoring, and Mutual Support. These are essential soft skills that interdisciplinary teams should apply to ensure safe and effective patient care. 

“If we train students from different health professions to use ER-VIPE before they face real-world situations, they will be much more confident. Our research found that ER-VIPE can also reduce students’ stress. They are highly capable, but in the real world, mistakes can happen. Some may resign or harm themselves—things we absolutely do not want to see. We need to build resilience in them. It serves as a kind of vaccine, reducing stress, fostering a growth mindset, and lowering the risk of burnout. We must instill this resilience so that the teams we build can work happily and help as many people as possible,” said Asst. Prof. Dr. Khuansiri. 

The development of the ER-VIPE program involved collaboration across several faculties. Faculty members from the Faculty of Architecture first visited the emergency department to draft the simulation layout. After that, professors from the Faculty of Engineering wrote the code and developed the simulation program. A team from the Faculty of Communication Arts also joined to facilitate communication between the program developers and the medical team, ensuring mutual understanding. 

Pilot Launch: Scene 1 — A COVID-Era Simulation 

Five years ago, during the COVID-19 pandemic, the first ER-VIPE emergency-room simulation scene was developed to help students from different health professions learn how to manage respiratory illness in a crisis. 

“I noticed that fifth- and sixth-year medical students were unable to see real patients because of the COVID-19 outbreak. They had to study 100% online. Once they graduated, they were expected to treat COVID-19 patients, wear PPE, and work together with people from other professions —yet they had never practiced any of it. That became the starting point for creating the first simulation scene. Students learned through a scenario involving a middle-aged man with COVID-19 suffering from respiratory failure, and trainees from different professions learned together. For example, they practiced reporting critical values, taking allergy histories, verifying patient identity, and performing intubation in a patient expected to have an obstructed airway.” 

During the pilot learning session in the first scene, Asst. Prof. Dr. Khuansiri also researched to evaluate the students’ learning outcomes and behavioral changes. 

“We analyzed video clips of their behavior before and after the simulation. The results showed that their teamwork improved, communication became more effective, and overall performance improved across all professions. 

We even had professors from the Faculty of Arts analyze the tone of voice used during the simulation, and they found that the students spoke more politely. In addition, this scene can be adapted for use in future outbreaks of other infectious diseases as well.” 

Survive! Scene 2: Resuscitating a Patient Experiencing Cardiac Ischemia 

Cardiovascular disease is one of the leading causes of death in Thailand, so Scene 2 centers on a patient suffering from cardiac ischemia who requires resuscitation and medication. 

“Scene 2 was developed to see whether an interprofessional team could help the patient in time, because practicing on real patients could be risky—they need experience first. We conducted parallel research to develop tools for assessing situation monitoring: observing the patient, tracking their symptoms, and understanding how the team is functioning.”  

“This scene was created to promote the greatest possible chance of patient survival, while also encouraging team members to take note when their colleagues are overwhelmed. Good leadership means assigning tasks appropriately, ensuring people are doing work that suits them, and following up through monitoring and evaluation.” 

“At the end of the simulation, we debrief to reflect on how we performed: What equipment was missing? Did we communicate effectively? What can we do better next time? This is a form of team training, something that didn’t exist before—we only had individual training. Each person is highly skilled, but when they’re on the job, they might not talk to one another. Sometimes hierarchy gets in the way; people from different faculties may speak differently, feel hesitant about correcting a doctor, or doctors may not listen. Through training, we can build an appropriate culture of safety within the organization.”  

Unity Is Strength: Scene 3 — Overcrowded Emergency Department   

Scene 3 is the current simulation used in ER-VIPE instruction. It is designed to be easier to understand and more engaging. The scene simulates an emergency department with patients of varying severity—serious, moderate, and mild cases. Once patients arrive, they must be screened, have their medical histories taken, be tagged for identification, undergo ECGs, be examined by physicians, have blood drawn by nurses, have lab results processed by medical technologists, receive the correct non-allergenic medications from pharmacists, and get x-rays safely performed by radiologic technologists. The goal is to manage multiple patients efficiently so they can either be discharged or admitted promptly. 

“This game is designed to closely resemble real work in an emergency room. It can be played by up to six people at once, or at least one. There are cartoon avatars representing the five professions: one physician, two nurses, one pharmacist, one radiologic technologist, and one medical technologist—allowing players to learn as much as possible about each profession’s role.”  

“Pre-clinical students can play this game, or even high school students. Even national-level gamers have tried it and enjoyed it. They only need an introduction to medical equipment. This scene can be taught to undergraduate students from year 5 or final-year cohorts preparing to enter their professions, and those who have already graduated—physicians, nurses, and even administrators can all play.” 

Students Learn Together across Institutions and Disciplines  

Asst. Prof. Dr. Khuansiri continued, “When different health professions study together, the faculty overseeing each program must plan in advance—deciding which day in the semester the joint learning will begin, assigning instructors who can teach together, scheduling a mutually available date, and preparing all necessary equipment. This ensures that everyone has an equal and consistent learning experience.” 

“Last year, we were kindly allowed to use facilities at the Srisavarindhira Thai Red Cross Institute of Nursing. We organized multidisciplinary students from four hospitals into groups. Each hospital had three sub-teams competing to determine the winning team. We then used the winning team as a demo case, allowing everyone to observe what made the winning team’s performance stronger and to reflect on their own strategies—who led, which tactics worked, and why this team outperformed the others.  We taught using the principles of TeamSTEPPS, which can also be applied in real-world practice. Experienced instructors from each profession provided examples of real-life situations, explaining how to act and communicate effectively in actual practice.” 

Enhancing and Developing Medical Personnel  

ER-VIPE teaching is not limited to the undergraduate curriculum only, but has also been taught to graduate students and faculty members for two years now. 

“We aim to strengthen interprofessional learning skills, so we introduced the ER-VIPE curriculum to graduate students and faculty—our future role models who can pass these skills on to students more effectively. Our current focus is on developing instructors who can teach simulation-based training and integrate these competencies into their teaching.” 

Last year was the first year we brought all 280 first-year resident doctors from King Chulalongkorn Memorial Hospital, regardless of their department, to study together. We found that teams developed System Thinking instead of Silo Thinking, including improved communication and teamwork efficiency, with significantly reduced errors in examination and treatment. This year, we will bring scholarship doctors (3-year commitment), emergency medicine residents to learn together with nurses, pharmacists, radiologic technicians, and medical technologists who have just graduated and started working in the hospital to observe the outcomes. 

“Thailand’s public health system has been recognized worldwide since COVID-19. We hope it can advance even further. Teamwork skills, or soft skills, are very important. We want these skills to reach rural hospitals. The Collaborative Project to Increase Production of Rural Doctors (CPIRD) has shown interest and invited our team to share knowledge and this new teaching approach. This is a great honor for our team and a valuable opportunity to support the work of distinguished faculty who are key to training rural doctors. If this collaboration succeeds, it will enhance the quality of physician training and contribute to the sustainable development of health services in rural areas.” 

Preparing Scene 4: Accidents in Older Adults  

Scenes 1, 2, and 3 have already been patented. When asked about the next development for the ER-VIPE, Asst. Prof. Dr. Khuansiri said, “We have now requested funding from Chulalongkorn University’s Innovation Fund to develop a scene on accidents in older adults. There are ethical considerations, such as obtaining consent for blood transfusions and ensuring patient safety. We will focus on team clinical reasoning, allowing the team to solve problems together, make accurate and timely diagnoses, and measure soft skills concretely. Anything that can be measured can be developed. This will be the world’s first simulation focused on accidents in older adults to train interprofessional teams.” 

Scene 4 is expected to be completed by the end of this year, and AI will be used to measure soft skills, creating a database to further develop human resources in Thailand’s public health sector.  

After the medical students completed their first round of the crowded emergency room simulation game with a score of 600, Asst. Prof. Dr. Khuansiri led them in a debriefing to review whether any mistakes had been made during the simulation—for example, delayed treatment, making patients wait too long, patients having allergic reactions, infections, or failing to warn staff to stay clear of X-ray radiation. 

When the students played the game again, their score rose to 1,930—more than three times higher than before! 

“We learn from our mistakes. We don’t scold each other. We focus on behavior and communication, then debrief together. We discuss how to do it differently and better. We don’t expect students to be perfect; we just want them to improve from their previous performance,” concluded Asst. Prof. Dr. Khuansiri. 

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