The Effect of Simulation Wars on EM Residents' Global Rating Scales and In-Training Examination Scores

Medical student education simulation competitions

BACKGROUND

Sim Wars is a simulation-based competition wherein teams of medical trainees are presented a clinical scenario and provide patient care in front of a live audience. This non-traditional educational offering is a form of serious games in medical education and allows for experiential learning via direct observation. Although a well-described educational modality within graduate medical education, there is a dearth of literature regarding Sim Wars as an educational tool within undergraduate medical education. In this paper, we aim to share student perspectives after participating in Sim Wars.

APPROACH

The Sim Wars competition was designed as a double-elimination bracket tournament with arena-style direct observation to maximise student engagement. Teams were provided formative feedback in areas of medical knowledge, clinical management and communication skills. A total of 64 students participated in a regional Sim Wars tournament over the course of 2 years.

EVALUATION

A total of 36 students completed Likert-based surveys immediately after the Sim Wars competition. Quantitative data and open-ended responses were analysed. Fourteen students participated in focus groups held a few months after Sim Wars regarding their experiences during the competition. Thematic analysis was systematically performed on the qualitative data.

IMPLICATION

Participation in Sim Wars was viewed by students as a high-yield learning experience that increased competence on subsequent clinical rotations. We conclude that this form of serious game can be a highly beneficial educational format for medical students especially if they spend time preparing for the competition and receive structured feedback on their performance.

The impact of fellowship-trained medical toxicology faculty on emergency medicine resident in-training examination scores

BACKGROUND

The American Board of Emergency Medicine (ABEM) In Training Exam (ITE) gauges residents' medical knowledge and has been shown to correlate with subsequent performance on the ABEM board qualifying examination. It is common for emergency medicine (EM) residencies to employ subspecialty-trained faculty members with the expectation of improved resident education and subspecialty knowledge. We hypothesized that the presence of subspecialty faculty in toxicology would increase residents' scores on the toxicology portion of the ITE.

METHODS

We assessed ABEM ITE scores at our institution from 2013-2022 and compared these to national data. The exposure of interest was the absence or presence of fellowship-trained toxicology faculty. The primary outcome was performance on the toxicology portion of the ITE, and secondary outcome was overall performance on the exam.

RESULTS

Residents who had ≥1 toxicology faculty were 37% (95% CI: 1.01-1.87) more likely to surpass the national average for toxicology scores, and those who had ≥2 toxicology faculty were 77% (95% CI: 1.28-2.44) more likely to surpass the national average for toxicology scores on the ABEM ITE. With the presence of ≥2 toxicology faculty, there was also an increase in toxicology score by years in training, with residents being 63% (95% CI: 1.01-2.64), 68% (95% CI: 1.08-2.61), and 92% (95% CI: 1.01-3.63) more likely to surpass the national average for toxicology score in first, second, and third years of residency, respectively. There was no significant relationship between the presence of toxicology faculty and the overall ABEM ITE scores.

CONCLUSIONS

The presence of fellowship-trained toxicology faculty positively impacted residents' performance on the toxicology portion of the ABEM ITE but did not significantly impact the overall score. With the presence of ≥2 toxicology faculty we noted an improvement in toxicology scores throughout the 3 years of training, indicating that an individual rotation or educational block is probably less important than spaced repetition through a longitudinal curriculum.