Incorporating Simulation into Graduate (Resident) Medical Education. With Special Reference to the Emergency Department

The use of high-fidelity simulation in Emergency Medicine has rapidly expanded over the past decade. Complex scenarios required that instructors read aloud from written scripts to describe the patient's changing conditions, forcing the learners to contribute a significant amount of imagination. Where adequate simulators did not exist, students would be taught by first observing one or several procedures, followed by performing the procedure on a patient under supervision, and eventually on their own. Emergency procedures were learned in this apprenticeship manner. The integration of part-task trainers and full-body high-fidelity robotic patient simulators into clinical education has dramatically changed medical educators' ability to suspend disbelief and utilize preprogrammed scenarios to achieve standardization and complexities that were not previously possible. Utilizing this approach for training allows them to minimize the risks to patients, challenging the limitations of the traditional "see one, do one, teach one" axiom. Advanced clinical simulation is also useful to achieve the new Accreditation Council for Graduate Medical Education guidelines established for resident training in patient evaluation and management. This chapter describes authors' experience with incorporating simulation technology into an emergency medicine residency training curriculum as it relates to teaching and evaluating various patient management skills.