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{
    "pk": 9253,
    "title": "Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?",
    "subtitle": null,
    "abstract": "Introduction:\n 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.\nMethods:\n 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.\nResults: \nNinety-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).\nConclusion:\n 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.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Task-switching, multitasking, emergency, milestones"
        }
    ],
    "section": "Education",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/03m4q9mf",
    "frozenauthors": [
        {
            "first_name": "Dustin",
            "middle_name": "",
            "last_name": "Smith",
            "name_suffix": "",
            "institution": "Loma Linda University, Department of Emergency Medicine, Loma Linda, CA",
            "department": "None"
        },
        {
            "first_name": "Daniel",
            "middle_name": "G.",
            "last_name": "Miller",
            "name_suffix": "",
            "institution": "University of Iowa, Department of Emergency Medicine, Iowa City, Iowa",
            "department": "None"
        },
        {
            "first_name": "Jeffrey",
            "middle_name": "",
            "last_name": "Cukor",
            "name_suffix": "",
            "institution": "University of Massachusetts, Department of Emergency Medicine, Worcester, Massachusetts",
            "department": "None"
        }
    ],
    "date_submitted": "2015-07-22T23:01:42Z",
    "date_accepted": "2015-07-22T23:01:42Z",
    "date_published": "2016-02-11T01:29:34Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/9253/galley/5228/download/"
        }
    ]
}