Purpose: The purpose of this paper is to describe an example of how universities can develop unique synchronous educational opportunities to engage students in an online environment, especially since study abroad opportunities have slowed or halted due to the COVID-19 pandemic crisis. Design/methodology/approach: Two affiliated universities, in the United States and Scotland, selected a simulated root cause analysis (RCA) of a medical error for a collaborative activity. Findings: Together the students analyzed the event within assumed roles of healthcare professions in a systematic way using the "Swiss Cheese Model," identified opportunities for improvement, debriefed using the Promoting Excellence and Reflective Learning in Simulation (PEARLS) method and submitted a reflective assignment. The RCA resulted in several process improvement suggestions and positive feedback from the participants. Research limitations/implications: The approach was for graduate students from two affiliated universities, in the United States and Scotland, to simulate a RCA of a medical error as a collaborative activity. Practical implications: This example using simulation of healthcare roles demonstrates the application of international collaboration, problem-solving models and methodologies and recognition of the similarities and differences between the United Kingdom and the United States approaches to patient safety. Especially with the ongoing COVID-19 pandemic, the students' ability to internationally collaborate can be limited without such unique opportunities. Social implications: The students were provided with a side-by-side comparison of the patient safety efforts in each country and written and didactic material about an RCA and the Swiss cheese model. Originality/value: Students come from different perspectives of health services administration, nursing and nursing leadership from Scotland and the United States to solve patient safety problems.