High fidelity simulation can discriminate between novice and experienced residents when assessing competency in patient care.
BACKGROUND
High fidelity (HF) simulators have become more common in residency training programs.


OBJECTIVE
We hypothesized that high fidelity (HF) simulation-based assessment of patient care competency could differentiate novice from experienced residents.


METHODS
Prospective study of 44 emergency medicine residents. A simulated case of anaphylactic shock was administered to each participating resident utilizing a HF patient simulator. Management of the case required epinephrine, airway management including a surgical airway, and i.v. fluids. Data was recorded using a standardized form and stop watch.


METHODS
Time to completion of surgical airway.


RESULTS
Times to administration of epinephrine/attempt intubation/start surgical airway/complete case; checklist items: epinephrine as first action, pre-oxygenation, cricoid pressure and type of surgical airway.


RESULTS
Novice residents took significantly longer than the experienced residents to achieve our primary outcome, time to completion of surgical airway (621/512 sec; p = 0.03). The novice residents took significantly longer to achieve three of our secondary outcomes: time to start of surgical airway (534 versus 442 sec; p = 0.04), time to case completion (650 versus 513 sec; p = 0.006), and epinephrine as a first action (73% versus 100%; p = 0.02).


CONCLUSIONS
HF simulation-based assessment using objective measures, particularly time to action, discerned our novice from our experienced residents.
Girzadas
Daniel V
DV
Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois 60453, USA. dgirzadasjr@comcast.net
Clay
Lamont
L
Caris
Jennifer
J
Rzechula
Kathleen
K
Harwood
Robert
R
D000328:Adult; D000402:Airway Obstruction / Q000601:surgery; D000707:Anaphylaxis / Q000628:therapy; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education*; D004837:Epinephrine / Q000008:administration & dosage; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D015146:Midwestern United States; D013647:Task Performance and Analysis; D013996:Time and Motion Studies; D014139:Tracheostomy; D014584:User-Computer Interface
D004837:Epinephrine