Simulation Curriculum Improves Emergency Medicine Resident Preparedness for the New American Board of Emergency Medicine Certifying Exam

Western Journal of Emergency Medicine · 2026-01-04

INTRODUCTION: In 2024, the American Board of Emergency Medicine (ABEM) announced the launch of a new certifying exam that emergency medicine (EM) residency graduates must pass to achieve specialty certification. To date, there are no comprehensive curricula published in the available literature to aid residents in exam preparation. METHODS: In this pre-post pilot study, 44% (24/55) of postgraduate year 1 (PGY-1) through PGY-4 EM residents at a single site participated in a four-hour simulated certifying exam curriculum. Learners were asked to complete a four-point Likert scale survey rating self-reported preparedness (very unlikely - very likely) to take the ABEM Certifying Exam, as well as comfort with the ABEM tested competencies, preceding and following the simulation session. RESULTS: Survey respondents (n = 21; 87.5%) reported an improvement in overall preparedness to take the ABEM Certifying Exam, yielding a pre-post mean difference score of +1.2 (1.9 [unlikely] pre to 3.1 [likely] post, P < .001). Additionally, there was an improvement in all ABEM-tested competencies; pre-post mean difference score ranged from +0.5 (3.0 pre to 3.5 post) for patient-centered communication to +1.1 (2.2 pre to 3.3 post) for clinical decision-making (P < .001 for all competencies). CONCLUSION: Given the critical need, and self-reported improvement in preparedness, EM training programs nationwide could consider incorporating a similar simulation curriculum into their didactic experience to help better prepare their learners for the new ABEM Certifying Exam.

Senior Resident Bootcamp: An Interactive Curriculum for Rising EM Senior Residents

Western Journal of Emergency Medicine · 2025-06-15

included patients per hour, sign-up to disposition times, patient acuity, procedures, consults, and bouncebacks.A guide was created to explain the rationale and derivation of these metrics.Departmental data analysts extracted the relevant EHR data and created individualized reports for each resident that included class-year comparisons using medians and interquartile ranges.Metrics were shared quarterly with all 60 residents over 2023-2024 through individualized Google Drive folders.Impact: During biannual surveys, 57 residents responded to the following question, "This year we started providing you with your individual clinical metrics.How have you used this information thus far?" Responses were categorized by an institutional ChatGPT as 39% positive, 46% neutral, and 16% negative.An author independently categorized the responses with 91% agreement; all discrepancies were labeled neutral by ChatGPT and positive by author.Positive themes included motivation to selfreflect, objective benchmarking, and support for performance improvement.Negative themes focused on difficulties accessing and interpreting the data.Collectively, this suggests that metrics can add value to a resident's experience when properly contextualized.

Regional Anesthesia as a New Required Core Procedure for Emergency Medicine Residents: A Step in the Right Direction

Annals of Emergency Medicine · 2025-08-20

Resuscitation Leadership Training: A Simulation Curriculum for Emergency Medicine Residents

MedEdPORTAL · 2022 · 9 citations

• Political Science
• Medical education
• Medicine

Introduction: Throughout training, emergency medicine (EM) residents must learn to work within, and eventually lead, multidisciplinary teams in high-acuity dynamic situations. Most residents do not undergo formal resuscitation team leadership training but learn these skills through mentorship by and observation of senior physicians. We designed and implemented a formal simulation-based leadership training program for EM residents. Methods: We developed a resuscitation team leadership curriculum in which 24 junior EM residents participated in an initial simulation of a critically ill patient before undergoing a didactic presentation regarding crisis resource management (CRM) principles. Residents applied those principles in three subsequent simulations. Faculty observers evaluated each case using EM Milestones, the Ottawa Global Rating Scale (GRS), and critical actions checklists. Residents then completed surveys evaluating their own leadership and communication skills before and after the course. Results: Scores from the Ottawa GRS, critical actions checklists, and several of the EM Milestones were significantly better in the latter three cases (after completing the CRM didactics) than in the first case. After completing this curriculum, residents felt that their ability to both lead resuscitations and communicate effectively with their team improved. Discussion: Implementation of the resuscitation team leadership curriculum improved EM residents' leadership performance in critically ill patient scenarios. The curriculum also improved residents' comfort in leading and communicating with a team. Similar formal leadership development curricula, especially when combined with simulation, may enhance EM physician training. Future studies will include other multidisciplinary team members to create a more realistic and inclusive learning environment.

Geographic Modeling to Quantify the Impact of Primary and Comprehensive Stroke Center Destination Policies

Stroke · 2018-02-28 · 7 citations

BACKGROUND AND PURPOSE: We evaluated the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and used geographic modeling to evaluate expected changes for a comprehensive stroke center policy. METHODS: We identified suspected stroke emergency medical services encounters from 1/1/2004 to 12/31/2013 in Philadelphia, PA. Transport times were compared before and after initiation of a PSC destination policy on 10/3/2011. Geographic modeling estimated the impact of bypassing the closest hospital for the closest PSC and for the closest comprehensive stroke center. RESULTS: There were 2 326 943 emergency medical services runs during the study period, of which 15 099 had a provider diagnosis of stroke. Bypassing the closest hospital for a PSC was common before the official policy and increased steadily over time. Geographic modeling suggested that bypassing the closest hospital in favor of the closest PSC adds a median of 3.1 minutes to transport time. Bypassing to the closest comprehensive stroke center would add a median of 8.3 minutes. CONCLUSIONS: Within a large metropolitan area, the time cost of routing patients preferentially to PSCs and comprehensive stroke centers is low.

Vulvar inflammation as a manifestation of Crohn's disease

World Journal of Emergency Medicine · 2017-01-01 · 10 citations

Crohn's disease is a chronic inflammatory bowel disease that is also associated with extra-intestinal complications, such as arthritis, erythema nodosum, deep venous thrombosis, and uveitis. Involvement of the vulva, however, is a rare fi nding in female patients with Crohn's disease. We present a case of vulvar Crohn's disease and discuss the disease process and treatment options for affected patients.

Inter-Rater Reliability of Select Emergency Medicine Milestones in Simulation

eScholarship (California Digital Library) · 2017-01-01 · 4 citations

Impact/Effectiveness: Based on the feedback from our alumni and current residents, the PEC has made adjustments to our curriculum including the elimination of our inpatient medicine rotation, the inclusion of ENT and Orthopedic morning report didactic sessions, and evidence-based medicine lectures.We will continue this work longitudinally to ensure that our curricular changes make a difference in our graduates' assessment of their preparedness.We will continue to dynamically adapt our curriculum based on current resident and alumni feedback in an attempt to meet their needs in their future Emergency Medicine careers.

Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice

Frontiers in Neurology · 2017-09-14 · 20 citations

BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom duration <6 h. In a multivariable model, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5-9, OR 2.62, 95% CI 1.41-4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29-9.09) and weakness (OR 2.28, 95% CI 1.35-3.85), and negatively associated with symptom duration >270 min (OR 0.41, 95% CI 0.25-0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration <6 h. CONCLUSION: Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification.

Adult Female with Hand Pain

Visual Journal of Emergency Medicine · 2016-03-17

Ultrasound diagnosis of diverticulitis

World Journal of Emergency Medicine · 2016-01-01 · 17 citations

Diverticular disease accounts for approximately 312 000 hospital admissions in the United States annually, and costs nearly 2.6 billion dollars.[1,2] Approximately 20% of Americans with diverticular disease will experience at least one episode of acute diverticulitis, necessitating a visit to their physician’s office or the emergency department (ED) for treatment.[3] As the risk of developing diverticulitis rises with age (nearly 50% of people aged over 60 years have colonic diverticula), the incidence is rising as the elderly population grows.[4] The majority of the patients are treated non-operatively, with a course of oral antibiotics and diet modification. Although computed tomography (CT) imaging is considered the “gold standard” for the diagnosis of acute diverticulitis in the United States, ultrasound is routinely used in Europe, Asia, and Africa as the initial imaging modality of choice in the evaluation of patients with suspected diverticulitis. Recent studies[5,6] have suggested that there is no significant difference in the test performance characteristics of CT as opposed to ultrasound for the diagnosis of diverticulitis. We present two cases in which point-of-care ultrasound was used to diagnose acute uncomplicated diverticulitis in the ED. Case 1 A 30-year-old man with no significant history of medication or surgery presented to the ED because of abdominal pain for several days. He stated that the pain began four days before presentation after breakfast at home, and subsequently deteriorated as a constant, non-radiating pressure. There were no alleviating or aggravating factors. The patient had no history of similar abdominal pain, nor nausea, vomiting, hematemesis, change in bowel habits, fever, anorexia, dysuria, testicular pain, back pain, or rash. On presentation, his temperature was 98.1 °F, heart rate 77 beats per minute, blood pressure 143/92 mmHg, respiratory rate 16 breaths per minute, and oxygen saturation 99% while breathing room air. The patient was alert and oriented and in no acute distress. His sclerae were anicteric. His abdomen was soft with mild tenderness in the left lower quadrant. No rebound or voluntary guarding was noted. There was no costovertebral angle (CVA) tenderness to palpation. In addition, there was no tenderness at McBurney’s point. His genital examination was normal. An emergency physician (EP) performed a point-of-care abdominal ultrasound, paying particular attention to the left lower quadrant of the abdomen. The sigmoid colon was identified in the left lower quadrant of the abdomen, with evidence of bowel wall thickening (Figure 1). In addition, a single diverticulum, visualized as an echo-poor protrusion from the colon wall with surrounding hyperechoic fat stranding, indicative of active inflammation, was noted at the point of maximal tenderness (Figure 2). The EP determined that the patient’s presentation combined with the point-of-care ultrasound images was consistent with a diagnosis of acute diverticulitis. The EP offered the patient the option of further testing with CT imaging versus empiric treatment with oral antibiotics. The patient opted to forego further radiologic testing and was subsequently discharged with a course of oral antibiotics and close primary care follow-up. Open in a separate window Figure 1 This figure demonstrates a measurement taken by the EP of the bowel wall that is approximately 1 cm. A measurement of >4–5 mm is indicative of bowel wall thickening.