Prioritization: Run This Board: Septic Shock, Acute Coronary Syndrome, Small Bowel Obstruction, and Penetrating Chest Trauma
Correspondence should be addressed to Colleen Donovan, MD at donovac1@rwjms.rutgers.edu
DOI: https://doi.org/10.21980/J8.52355
ABSTRACT:
Audience: This case was specifically designed for senior emergency medicine (EM) resident physicians as a preparatory tool for the American Board of Emergency Medicine (ABEM) Certifying Exam. However, it is applicable for EM residents at all levels of training.
Introduction: “A hallmark of emergency medicine is the ability to triage or prioritize care. This case will require the physician to evaluate and treat multiple patients while ensuring those who require immediate care receive it quickly. The physician may face the arrival of additional patients, the deterioration of existing patients, and realistic workflow interruptions during the case. A successful candidate will identify and stabilize high acuity patients.”1 With the introduction of the new Certifying Exam by ABEM and the current lack of resources to practice prioritization in an assessment setting, resident physicians will need practice material in order to adequately prepare for their board examination.
Educational Objectives: By the end of this case learners will be able to: 1) Become familiar with format of a prioritization case (a component of the ABEM Certifying Exam), 2) Practice their ability to prioritize multiple patients and provide stabilizing care, 3) Consider changes in status/patient acuity/new cases as presented, 4) Understand how to utilize team resources appropriately.
Educational Methods: This encounter is a structured, oral simulation case designed as a prioritization exercise for emergency medicine resident trainees. It follows an interview-based format in which an examiner presents evolving patient information in a time-limited scenario, and the examinee responds in real time with clinical reasoning, prioritization of care, and management decisions. The case mimics the structure of the Prioritization Case in the ABEM Certifying Exam, allowing the examinee to verbalize thought processes while receiving updated clinical data from the examiner. This format emphasizes critical thinking, triage under pressure, and the delegation of tasks within a simulated emergency department environment.
Research Methods: We first alpha-tested the case with board-certified emergency medicine physicians, who evaluated both the facilitator and learner aspects of the simulation. Their feedback was used to refine the structure, flow, and clinical realism of the case. Following these edits, the revised case was implemented with emergency medicine residents across varying levels of training. This staged approach allowed us to ensure educational fidelity and enhance realism, while also confirming that the case structure aligned with ABEM exam standards and expectations.
Results: We conducted multi-site alpha and beta testing of a novel ABEM-style prioritization case with a total of 18 emergency medicine residents (eight individual residents and two 5-person PGY2 teams) and three facilitators. Surveys were completed by two facilitators (Simulation Scenario Evaluation Tool, SSET) and eight resident participants or teams (modified usability survey). Facilitators rated the case highly, with an average global score of 87.5/100, and learners reported strong overall quality (4.4/5) and exceptional educational value (4.9/5), though clarity of instructions was rated lower (3.6/5). Participants were predominantly senior residents (62.5% PGY-3, 25.0% PGY-2, and 12.5% PGY-4). Qualitative comments emphasized the usefulness of practicing the new case format and highlighted a need for clearer explanations of structure and rules.
These results suggest the case was well-received across training levels, with iterative revisions improving clarity and usability. Based on preliminary beta testing, a Total Score of 70-75% indicates passing for this case.
Discussion: This oral board-style prioritization case offers learners the opportunity to practice essential but often underemphasized skills, including rapid prioritization, task switching, and real-time decision-making. The case format reinforces critical concepts such as situational awareness and resource management within the dynamic environment of the emergency department. During initial implementation, participants reported strong engagement and found the exercise particularly valuable in preparing for the ABEM Certifying Exam. Many noted that the structure and expectations closely mirrored those of the actual prioritization station based on the example video provided by ABEM.
From the instructor perspective, the standardized format promotes consistent delivery and assessment. To minimize examiner cognitive load during this high-complexity simulation, we developed a modular toolkit including a structured script, stimuli slides, and an automated scoring sheet, modeled in part after ABEM’s dual-examiner approach. A suite of Appendices supports both digital and paper-based use, allowing flexibility across educational settings.
To further support formative practice, we created a scoring rubric to guide examiner feedback and learner self-assessment. However, as ABEM has not released its internal scoring criteria, this rubric is unofficial and should be interpreted with caution. It is intended for educational use only and is not designed to predict performance on the actual certification exam.
Topics: Prioritization, triage, stabilization, delegation, task switching, vaginal bleeding, pediatric injury, altered mental status, septic shock, acute coronary syndrome, headache, abdominal pain, small bowel obstruction, penetrating chest trauma, urinary tract infection.
