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

Abstract

IntroductionWork 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.MethodsThis 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.ResultsNinety-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).ConclusionWhen 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.

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2016

“…Similar to prior years, the most common study populations were medical students (21/75; 28%) and residents (48/75; 64%) . Interestingly, this year only one study addressing medical students was highlighted for excellence, in contrast to prior years.…”

“…Can simulation measure differences in task‐switching ability between junior and senior emergency medicine residents? West J Emerg Med 2016;17:149–52 …”

“…Three of these studies with an experimental design were highlighted . There was a decline in the number of observational studies (35/75; 47%), compared to 2015 (36/61; 59%), but an increase in the number of studies using survey methodology (19/75; 25%) in 2016 compared to 10 of 61, 16% in 2015, and 0% in 2014. It should be noted that all survey studies in this review drew data from participants from multiple institutions per the predetermined selection criteria.…”

“…Excluding surveys, 10 studies (13%) were conducted at two or more institutions. This is similar to 2015 where 10 of 61 (16%) were multi‐institutional.…”

Human Factors and Simulation in Emergency Medicine

“…[17][18][19] Investigators have applied HF principles to the study of trauma resuscitation, cardiac arrest, and other areas of emergency care. 13,[20][21][22][23][24][25][26][27][28][29] In particular, HF methods have been used to examine aspects of individual performance, such as task switching exhibited by EM residents 28,30 and clinical decision-making for medical students, paramedics, and nurses. [31][32][33][34][35] Human factor methods have also been used to examine EM team performance, such as communication in trauma settings 36,37 and task saturation for those involved in rapid response and critical care transport.…”