First In-Depth Post: Simulation in Emergency Medicine

First In-Depth Post: Simulation in Emergency Medicine


This is the first in a series of articles that we plan to publish every other week. The goal is to go “beyond the headlines” and explore a topic that arrived in my newsfeed; one that merits a more detailed examination.

I decided to start with The Role of Simulation in Training and Competency Evaluation  in Emergency Medicine.

The impetus for the deeper dive is a recent article from the American Medical Association entitled Can simulations help residents uncover social needs affecting health?, which includes this excerpt:

“Use of Social Simulation to Improve Physician Well-Being and Patient Care,” a workshop at the inaugural AMA GME Innovations Summit, outlined an intervention designed by Advocate Christ Medical Center, in Chicago, featuring a simulation to help identify—and streamline protocols for addressing—social needs commonly encountered in its emergency department.

As has been customary with these posts, I will first include a bit of context.

  • ACUTE CARE, INC. is an accredited provider of Continuing Medical Education (CME), and considers a commitment to education as a central tenet of our practice and distinguishing competency.
  • I have taught, since the inception of the practice, American Heart Association (AHA) courses (ACLS, PALS, BLS) as a value-added service to our partner facilities and affiliated providers. As a member of the AHA Regional Faculty for ACLS and PALS, I have been kept current on changes in educational theory regarding training and skill retention.
  • ACUTE CARE, INC. has been fortunate to partner with several innovative organizations in providing simulation training (see below), at both facility partner locations and at dedicated simulation labs.
  • Prior to serving at ACUTE CARE, INC., I was part of an air medical EMS team, and participated in skills practice and verification exercises. As part of my training as a Critical Care Paramedic and part of a paramedic training program, I participated in and taught experiential skills acquisition using animal and task trainer instruction and evaluation.
  • We have tracked and included dissemination of information in our social media and newsletter channels regarding best practices in clinical and interpersonal medicine.

Which leads us back to the study on an innovative approach to training clinicians in ascertaining and addressing social determinants of health needs in patients. The use of Standardized Patients (https://www.newyorker.com/magazine/2018/01/08/standardized-patients-and-the-art-of-medical-maladies) is, at this point, accepted as a best practice and has been integrated into provider training. The significance of the study is, in my opinion, that the tool is, in the case of the article I mentioned in the lead to this post, being used to draw attention to an emerging, and clinically significant issue: Social Determinants of Health.

Our charge and challenge, then, is to expand the scope of simulation to include issues and objectives that extend beyond procedure-based competency learning and validation.

Speaking of which, ACUTE CARE, INC. ‘s experience with procedure training and competency spans over 25 years….

…and started with the American Heart Association Basic Life Support (CPR)’s use of manikins (Resusci-Annie), and the AHA Advanced Cardiac Life Support (ACLS) use of defibrillation and endotrachel intubation task trainers.

The Heart Association has been very progressive in implementing best practices in practical skills acquisition and retention, and we have been fortunate to learn from and adapt to the research and scientific evidence that serves as teh underpinning for those changes.

On a parallel track, ACUTE CARE, INC. has organized and presented Skills Lab opportunities that featured anatomical specimens (for endotrachel intubation and chest tube insertion)  purpose built task trainers (for chest tube insertion and cricothyroidotomy), human models (ultrasonography), and high fidelity mannequins.

Access to this last class of resources is built on partnerships with fixed and mobile programs that possess and allow access to these impressive educational tools.

To date, we have partnered with

We look forward to revisiting these centers, along with future partnerships and events.

In researching material for this article, I believe we have found a roadmap for what lies ahead.

In an article entitled Simulation in Emergency Medicine Training, published in Pediatric Emergency Care, the authors provide this abstract, which I believe serves as a fitting summary for this post.

Simulation provides a range of educational tools that have increasingly been incorporated into emergency medicine (EM) curricula. Standardized patients and some partial task trainers, such as intubation heads, have been used for decades. More recently, a growing number of computer-screen simulations, high-fidelity mannequins, and virtual-reality simulators have expanded the number of procedures and conditions, which can be effectively simulated. The Accreditation Council for Graduate Medical Education transitioned to a competency-based assessment of residency programs in 2001 and included simulation as a method for incorporating the 6 core competencies into graduate medical education curricula. Over the past decade, numerous peer-reviewed publications have promoted simulation as an effective educational tool for each of the core competencies. The advanced technology used to operate many current simulators can erroneously become the focus of efforts to create a simulation-based curriculum. Simulation can most effectively be incorporated into EM curricula through the use of time-proven concepts, which start with defining the targeted learners, assessing their general and specific educational needs, defining learning objectives, and selecting the best educational strategy for achieving each objective. In many, but not all, instances, simulation can be the best tool for achieving EM learning objectives.

We will revisit this topic in the coming months, with a change in emphasis from learning to competency testing and feedback. As we prepare for that post, we would appreciate your thoughts on the matter. Please email me at paulh@acutecare.com.

Paul Hudson, FACHE, Chief Operating Officer