Sim Case Series: Incorporating ABEM Milestones

In this week’s simulation case, you will notice the addition of a table which is a description of ABEM Milestone #9 – General approach to Procedures (PC9). I created this table after attending a workshop from Dr. Danielle Hart (Assistant Residency Director and Director of Simulation at Hennepin County Medical Center). During the 2013 CORD assembly in Denver, Dr. Hart held a session in which she described a novel method by which to incorporate the ABEM milestones into simulation cases. This would accomplish two things:

  1. Provide an evaluation tool for the learners
  2. Easily incorporate milestones to evaluate residents



Sim Case: Cocaine toxicity and placental abruption

Case Synopsis
17 yo girl, 24 weeks pregnant, is brought to the ED with an overbearing, controlling, and older boyfriend (BF). The chief complaint is abdominal discomfort and vaginal spotting. The patient is initially reluctant and quiet, but then gets hysterical as the case progresses. Upon questioning, the patient admits that she took cocaine prior to arrival to induce an abortion, because her BF is married and does not want her to keep the baby.



Simulation cases: How to write the storyboard

Last week I wrote about the important components in writing a simulation case. It is an exhausting list, but the thoroughness pays off.

The next big task is writing the actual case storyboard, which can be done in many ways. All revolve around the concept of action and reaction. The key to a well written simulation case is understanding the actions that the learners will take, the actions that they should take, the actions they shouldn’t take.



Writing a Medical Simulation Case

It can be a daunting task to write a medical simulation cases. Regardless of prior experience in simulation, writing cases is a different skill set than programming or working a high fidelity simulator. It’s more similar to writing a play– at times an impromptu play!

What is a Medical Simulation Case?

It usually entails a patient encounter with a healthcare provider (learner) where an event occurs, and the learner is expected to perform actions. After some time, or after certain actions are performed, the facilitator stops the simulation, and debriefing ensues.



SimWars: A “warring tigers” competition


You’ve seen this word on the agenda at the most recent Emergency Medicine conference that you attended. It sounded interesting… but you ended up going to a happy hour and missed out on the event. And so you are left with the burning question, what is SimWars?

I have now heard Dr. Haru Okuda (Director of VA SIMLEARN) introduce SimWars a few times at the start of competitions at conferences. He usually has a photo of two cute little kittens with great big sweet eyes juxtaposed with a photo of two warring tigers fighting each other. He uses this comedic relief to illustrate the difference between a standard simulation session and SimWars competition.



What is debriefing in simulation education?

Medical education high-fidelity simulation allows for deliberate practice in a safe environment. We are able to miss the intubation repeatedly or botch up the management of aspirin overdose without the demise of the patient.  At the end of each session, we gather in a pow wow and debrief….

I have been involved with debriefings, and often wonder what residents are thinking:

  • Do they understand what debriefing means?
  • Do they think this is the time where they are scolded for mistakes?
  • Do they think it is a valuable part of the simulation?

What does debriefing even mean?