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Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?

INTRODUCTION: 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 compe...

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Autores principales: Smith, Dustin, Miller, Daniel G., Cukor, Jeffrey
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786234/
https://www.ncbi.nlm.nih.gov/pubmed/26973740
http://dx.doi.org/10.5811/westjem.2015.12.28269
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author Smith, Dustin
Miller, Daniel G.
Cukor, Jeffrey
author_facet Smith, Dustin
Miller, Daniel G.
Cukor, Jeffrey
author_sort Smith, Dustin
collection PubMed
description INTRODUCTION: 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). CONCLUSION: 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.
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spelling pubmed-47862342016-03-11 Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents? Smith, Dustin Miller, Daniel G. Cukor, Jeffrey West J Emerg Med Education INTRODUCTION: 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). CONCLUSION: 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. Department of Emergency Medicine, University of California, Irvine School of Medicine 2016-03 2016-02-10 /pmc/articles/PMC4786234/ /pubmed/26973740 http://dx.doi.org/10.5811/westjem.2015.12.28269 Text en Copyright: © 2016 Smith et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Education
Smith, Dustin
Miller, Daniel G.
Cukor, Jeffrey
Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?
title Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?
title_full Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?
title_fullStr Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?
title_full_unstemmed Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?
title_short Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?
title_sort can simulation measure differences in task-switching ability between junior and senior emergency medicine residents?
topic Education
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786234/
https://www.ncbi.nlm.nih.gov/pubmed/26973740
http://dx.doi.org/10.5811/westjem.2015.12.28269
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