title: Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?
abstract: BACKGROUND
  Work interruptions during patient care have been correlated with error. Task-switching is identified by the Accreditation Council for Graduate Medical Education (ACGME) as a core competency for emergency medicine (EM). Simulation has been suggested as a means of assessing EM core competencies. We assumed that senior EM residents had better task-switching abilities than junior EM residents. We hypothesized that this difference could be measured by observing the execution of patient care tasks in the simulation environment when a patient with a ST-elevation myocardial infarction (STEMI) interrupted the ongoing management of a septic shock case.
  
  
  METHODS
  This was a multi-site, prospective, observational, cohort study. The study population consisted of a convenience sample of EM residents in their first three years of training. Each subject performed a standardized simulated encounter by evaluating and treating a patient in septic shock. At a predetermined point in every sepsis case, the subject was given a STEMI electrocardiogram (ECG) for a separate chest pain patient in triage and required to verbalize an interpretation and action. We scored learner performance using a dichotomous checklist of critical actions covering sepsis care, ECG interpretation and triaging of the STEMI patient.
  
  
  RESULTS
  Ninety-one subjects participated (30 postgraduate year [PGY]1s, 32 PGY2s, and 29 PGY3s). Of those, 87 properly managed the patient with septic shock (90.0% PGY1s, 100% PGY2, 96.6% PGY 3s; p=0.22). Of the 87 who successfully managed the septic shock, 80 correctly identified STEMI on the simulated STEMI patient (86.7% PGY1s, 96.9% PGY2s, 93.1% PGY3s; p=0.35). Of the 80 who successfully managed the septic shock patient and correctly identified the STEMI, 79 provided appropriate interventions for the STEMI patient (73.3% PGY1s, 93.8% PGY2s, 93.8% PGY3s; p=0.07).
  
  
  CONCLUSIONS
  When management of a septic shock patient was interrupted with a STEMI ECG in a simulated environment we were unable to measure a significant difference in the ability of EM residents to successfully task-switch when compared across PGY levels of training. This study may help refine the use of simulation to assess EM resident competencies.
authors.affiliation: Loma Linda University, Department of Emergency Medicine, Loma Linda, California.
authors.forename: Dustin
authors.initials: D
authors.lastname: Smith
authors.affiliation: University of Iowa, Department of Emergency Medicine, Iowa City, Iowa.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Miller
authors.affiliation: University of Massachusetts, Department of Emergency Medicine, Worcester, Massachusetts.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cukor
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D016544:Patient Simulation; D011446:Prospective Studies; D013647:Task Performance and Analysis; D013663:Teaching