Challenging Hazards Amidst Observational Simulation in the Emergency Department: Advancing Gamification in Simulation Education Through a Novel Resident-led Skills Competition.

Nicholas Salerno,Kaitlin M Bowers,Sara Paradise,Scott H Pasichow,Priyha Mahesh,Xiao Chi Zhang,Dimitrios Papanagnou

doi:10.7759/cureus.3563

Abstract

Medical simulation competitions have become an increasingly popular method to provide a hands-on “gamified” approach to education and training in the health professions. The most well-known competition, SimWars, consists of well-coordinated teams that are tasked with completing a series of mind-bending clinical scenarios in front of a live audience through ‘bracket-style’ elimination rounds. Similarly, challenging hazards amidst observational simulation (CHAOS) in the emergency department (ED) is another novel approach to gamification in both its structure and feel. Conducted at the Council of Emergency Medicine Resident Directors (CORD) 2018 National Assembly in San Antonio, Texas, instead of assigning premeditated teams, it placed random Emergency Medicine (EM) faculty, residents, and medical students together in teams to test them on a variety of fundamental EM content areas. Additionally, the event incorporated multiple levels within each round, allowing the inclusion of additional information to be shared with participants to support “switching gears,” as is typical for teams working in the ED and augmenting the perceived level of “chaos.”To assess this pilot project, formal quantitative and qualitative feedback was solicited at the end of the session. Quantitative evaluation of the intervention was obtained through an eight-item questionnaire using a five-point Likert-type scale from 19 of the 20 enrolled participants (95% response rate). Responses were generally positive with an overall course rating score of 4.45 out of 5 (SD +/- 0.62). Qualitative feedback revealed that learners enjoyed performing procedures and networking with their EM colleagues. The majority of residents (95%) recommend the activity be integrated into subsequent conferences. Areas for improvement included shorter cases and minimizing technical malfunctions.CHAOS in the ED was a successful pilot study that incorporated gamification as a means to deploy simulation-based training at a national emergency medicine conference in a community of simulation educators. Future studies should focus on incorporating learners’ feedback into subsequent CHAOS iterations and reducing overhead costs to increase its adoption by both regional and national audiences.

Highlights

The rise in team-based simulation as a training modality reflects healthcare’s shift in adopting practicebased educational methods [1]
Conducted at the Council of Emergency Medicine Resident Directors (CORD) 2018 National Assembly in San Antonio, Texas, instead of assigning premeditated teams, it placed random Emergency Medicine (EM) faculty, residents, and medical students together in teams to test them on a variety of fundamental emergency medicine (EM) content areas
The event incorporated multiple levels within each round, allowing the inclusion of additional information to be shared with participants to support “switching gears,” as is typical for teams working in the emergency department (ED) and augmenting the perceived level of “chaos.”

Summary

Introduction

The rise in team-based simulation as a training modality reflects healthcare’s shift in adopting practicebased educational methods [1]. The opportunity for practice-based education is of high importance in the emergency department (ED), as stress and clinical ambiguity challenge clinical teams and patient safety. Simulation-based training is routinely implemented in emergency medicine (EM) post-graduate residency training programs, as it provides residents with a psychologically safe learning environment for them to make mistakes and hone their skills in a setting that replicates the clinical environment. Procedural, clinical, and teamwork skills developed during simulation training have been shown to directly transfer into clinical practice and potentially reduce medical errors while improving increasing clinical performance [6,7].

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