1. A SMART Curriculum - Simulated Milestone Assessment for Residency Training
Jonathan dela Cruz, M.D., Jason A Kegg, M.D.
Division of Emergency Medicine
Southern Illinois University School of Medicine, Springfield, IL
Background
While the ACGME Milestones provide more explicit and transparent expectations of performance using competency-based outcomes, some Milestones are difficult to evaluate and require direct observation of resident performance. Such efforts performed in the ED are time intensive and somewhat informal. Simulation provides a platform where direct observation can occur in a more formal and educational setting but developing unique standardized cases that cover a variety of chief complaints is labor intensive and resource heavy.
Results
Six residents and 4 academic EM faculty were involved in the experience. Overall, faculty found building the cases around the assessment form in real time helpful and easy. Faculty found they had a more active role in resident assessment by not having the constraints of a standardized simulation script, and could better assess resident performance with this added freedom. Residents found the experience enlightening and, in fact, gave feedback to have more assessments like this in the future.
Discussion
Objectives
We propose an innovative simulation curriculum framework centered on a single standardized assessment form whereby chief complaint-based simulated scenarios can be implemented with minimal case development.
Methods
A standardized assessment form was developed evaluating 9 patient care, communication, and management milestones for PGY1 residents. Three different cases were written with the complaints of chest pain, abdominal pain, and weakness. A simulated construct was created where residents were observed in history taking, documentation, and planned orders for a case. The case and plan were then presented to an evaluating faculty. Residents then received word of a change in patient condition and were observed in their re-evaluation and disposition plan. Faculty built their cases in real time to comply with the assessment form. Feedback on the experience was then collected from both faculty and residents.
Conclusions
Developing a simulation curriculum based upon a single standardized assessment tool rather than multiple unique standardized encounters allows for a novel method to obtain evaluation of resident Milestone performance. These patient care scenarios can be built with minimal developmental costs compared to building multiple standardized simulation scripts.

2. Bridging the Gap - Collaborative and Simulated M&M Conferences
Jason A Kegg, M.D., Jonathan dela Cruz, M.D., James Waymack, M.D.
Division of Emergency Medicine
Southern Illinois University School of Medicine, Springfield, IL
Background
Mortality and morbidity (M&M) conferences remain vital opportunities for learning and the avoidance of medical errors. We propose a novel and educationally innovative approach to the M&M conference by restructuring the format to a collaborative simulated patient encounter.
Results
This trial of collaborative simulation and M&M was performed with 11 residents. In this cohort, 7 diagnosed an AMI and 5 of those gave anticoagulants before the true diagnosis of aortic dissection was known. In the 4 situations where an AMI was not declared, the resident evaluated the patient for aortic dissection and obtained appropriate studies. In 3 cases, a chest x-ray was not obtained and in 1 case the study was ordered but not reviewed. Milestone assessment for PC1 and PC3 were generally consistent with the resident’s level of training. Feedback from the residents suggested this was a worthwhile educational activity and a collaborative activity was a valuable alternative to the traditional M&M presentation.
Objective
We propose a framework to combine an M&M conference and a simulated patient encounter to evaluate not only the ACGME Competencies but also the American Board of Emergency Medicine (ABEM) Milestones. Such exercises could allow for further involved evaluation of resident competency in situational conditions and allow for the testing of teamwork skills and behavioral targets for assessment and feedback.
Discussion
The integration of simulation into the morbidity and mortality has provided a new avenue for evaluation of medical errors and decision-making as well as direct observation of resident patient management. Areas of further opportunity could include further identification of resident M&M cases that would be appropriate for the combined venue of simulation and M&M conference. From there other milestones can be assessed. Future trials of this method should also include more formalized feedback for the resident as well as a formal evaluation tool to assess resident opinion of this new product.
Methods
An adverse patient encounter in which an aortic dissection was treated as a myocardial infarction and anticoagulants were given, was kept confidential by the presenting resident and the case was written and structured as a simulated patient case. The overall goal of the simulation case was to assess, based on the patient’s presentation and limited historical and diagnostic information, whether 11 other residents would duplicate the error and pursue a diagnosis of acute myocardial infarction.
Conclusions
The integration of simulation with the M&M conference proved to be an enjoyable and useful educational experience allowing a novel opportunity to evaluate and debrief a clinical scenario outside of the confines of the traditional M&M conference. This provided additional insight into the resident’s thought process. The exercise also provided the faculty ways to assess the milestones in a direct observation manner.