Over the years, knowledge-based simulation has been a valuable way of delivering certain content of the syllabus in medical education. There have been challenges to undertake any form of educational activities during the COVID-19 pandemic due to a global shutdown 
, let alone face-to-face teaching. Digital education has endeavoured to fill this gap via the increased use of different online platforms to prevent the spread of COVID-19. Nonetheless, one facet of educational strategy that has remained challenging to provide online is teaching and learning with simulation. Currently, a phygital 
method of teaching is being utilized; some learners are with the instructor in the classroom (physical presence) and others are online (digital presence.) The inclusiveness and participation from the online audience have been seen to be poor.
The aims of the study were to deliver an inclusive and effective simulation session to a large cohort of trainees in emergency medicine and to provide an immersive learning environment to learners by enhancing their feeling of being present in the simulation hub.
We delivered a phygital simulation with the aid of digital technology in a way that encouraged participation from all attendees. We sought to overcome known challenges of simulation teaching during the peak period of COVID-19 and identified newer challenges unique to the situation and suggestions for future improvements or simulation.
During the simulation, we utilized a standardized patient (SP) (who did not require further training for our method) and various equipment/components of the room including cameras for the different views required. The room had a limit of five persons (as per COVID-19 restrictions) so we designed a teaching method that enabled us to cater efficiently for the remaining 33 participants of the scheduled regional teaching session. A volunteer candidate was chosen from the online audience to lead in the simulation. Prior to selection, all candidates were shown the brief which explained the expectation of leading and the different camera views available to aid their performance. They viewed the whole room with separate focuses on the SP, the device required to perform a procedure, and their appointed physical presence (PP) who they will instruct to perform the procedure. We identified advantages, challenges and areas of future development and believe that this type of teaching can be applied to a wide range of simulations that required demonstration.