title: High fidelity simulation can discriminate between novice and experienced residents when assessing competency in patient care.
abstract: 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.
authors: Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois 60453, USA. dgirzadasjr@comcast.net
authors: Daniel V
authors: DV
authors: Girzadas
authors: Lamont
authors: L
authors: Clay
authors: Jennifer
authors: J
authors: Caris
authors: Kathleen
authors: K
authors: Rzechula
authors: Robert
authors: R
authors: Harwood
mesh_terms: 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
chemical_list: D004837:Epinephrine