Abstract
IntroductionResident 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).MethodsWe 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.ResultsFaculty 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.ConclusionSimulation 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.
Highlights
Resident remediation is a pressing topic in emergency medicine (EM) training programs
We identified relevant themes and used them to develop an open-ended questionnaire that was distributed to EM programs with experience in simulation-based remediation (SBR)
SBR is appropriate for a range of deficits, including procedural, medical knowledge application, clinical reasoning/ decision-making, communication, teamwork, and crisis resource management
Summary
Resident remediation is a pressing topic in emergency medicine (EM) training programs. The last two decades have seen an increase in the use of simulation pedagogies, such as simulation-based mastery learning (SBML) in EM resident education,[8,9,10,11] and there are reports of SBML successfully being used for procedural education.[9,12] SBML lends itself to the CB approach in that it is time-independent, allowing learners to achieve mastery over time.[9,10,13] There are anecdotal reports of success with other kinds of simulation models in EM Simulation modalities such as high-fidelity patient simulators (mannequins), standardized patients, partial task trainers, computer screen-based simulation, virtual reality environments, and tabletop role-playing exercises such as oral board exam-style simulations have been used to create opportunities and safe environments for clinical training[14] and anecdotally for remediation. In general, support the incorporation of simulation into curricula for instruction, identification of knowledge gaps, evaluation and remediation.[8,16,17,18,19,20,21,22,23,24]
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