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. 2019 Jan;20(1):145-156.
doi: 10.5811/westjem.2018.10.39781. Epub 2018 Nov 20.

Simulation-based Remediation in Emergency Medicine Residency Training: A Consensus Study

Nur-Ain Nadir  1   2 , Danielle Hart  3 , Michael Cassara  4 , Joan Noelker  5 , Tiffany Moadel  4 , Miriam Kulkarni  6 , Christopher S Sampson  7 , Suzanne Bentley  8 , Neel K Naik  9 , Jessica Hernandez  10 , Sara M Krzyzaniak  1   2 , Steven Lai  11 , Gregory Podolej  1   2 , Christopher Strother  12
Affiliations

Simulation-based Remediation in Emergency Medicine Residency Training: A Consensus Study

Nur-Ain Nadir et al. West J Emerg Med. 2019 Jan.

Abstract

Introduction: Resident remediation is a pressing topic in emergency medicine (EM) training programs. Simulation has become a prominent educational tool in EM training and been recommended for identification of learning gaps and resident remediation. Despite the ubiquitous need for formalized remediation, there is a dearth of literature regarding best practices for simulation-based remediation (SBR).

Methods: We conducted a literature search on SBR practices using the terms "simulation," "remediation," and "simulation based remediation." We identified relevant themes and used them to develop an open-ended questionnaire that was distributed to EM programs with experience in SBR. Thematic analysis was performed on all subsequent responses and used to develop survey instruments, which were then used in a modified two-round Delphi panel to derive a set of consensus statements on the use of SBR from an aggregate of 41 experts in simulation and remediation in EM.

Results: Faculty representing 30 programs across North America composed the consensus group with 66% of participants identifying themselves as simulation faculty, 32% as program directors, and 2% as core faculty. The results from our study highlight a strong agreement across many areas of SBR in EM training. SBR is appropriate for a range of deficits, including procedural, medical knowledge application, clinical reasoning/decision-making, communication, teamwork, and crisis resource management. Simulation can be used both diagnostically and therapeutically in remediation, although SBR should be part of a larger remediation plan constructed by the residency leadership team or a faculty expert in remediation, and not the only component. Although summative assessment can have a role in SBR, it needs to be very clearly delineated and transparent to everyone involved.

Conclusion: Simulation may be used for remediation purposes for certain specific kinds of competencies as long as it is carried out in a transparent manner to all those involved.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Study design. CORD-EM, Council of Emergency Medicine Residency Directors; SAEM, Society for Academic Emergency Medicine.
Figure 2
Figure 2
Simulation modalities best suited to specific deficiencies. PTT, partial task trainers; HFPS, high fidelity patient simulators (mannequins); SP, standardized patients. Tabletop: oral board-style simulations; Virtual (e) Sims Online web-based virtual simulations.
See this image and copyright information in PMC

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