Issue 10:5
Simulation-Based Preparation for the American Board of Emergency Medicine Certifying Exam: A Comprehensive Curriculum for Residents
DOI: https://doi.org/10.21980/J8.53814The goal of this curriculum is to equip residents with the knowledge and skills needed to succeed on the ABEM Certifying Exam. It includes a comprehensive set of case types expected to appear on the Certifying Exam, with a focus on assessing competencies not currently evaluated by the existing written Qualifying Exam and retiring Oral Exam. The curriculum is designed to be delivered to current residents in a single-day exam format to closely replicate the structure and experience of the new Certifying Exam.
Difficult Conversation Case: Missed Testicular Cancer
DOI: https://doi.org/10.21980/J8.52336This difficult conversation case is intended to assess the examinee’s ability to disclose sensitive, unexpected information to a patient regarding a missed diagnosis of testicular cancer. By the end of this session, learners should be able to, 1) demonstrate effective communication, including establishing rapport, acknowledging a prior misdiagnosis, and disclosing a revised diagnosis of cancer, 2) elicit and react to the patient’s emotional and informational needs in an empathetic and professional manner, and 3) convey a patient-centered plan of care, including appropriate next steps and coordination with specialist services.
Difficult Conversation Case: Death Notification
DOI: https://doi.org/10.21980/J8.52354This Observed Structured Clinical Examination (OSCE) is intended to cover the topic of Difficult Conversations. The overarching educational goal of this case is to assess learners’ communication skills, emotional responsiveness, and ability to facilitate a death notification conversation. Participants will be evaluated on their ability to communicate in an empathic, patient-centered manner while leading a difficult discussion. Successful participants will establish rapport, actively listen, disclose sensitive information clearly and compassionately, and respond appropriately to emotional reactions. By the end of the session, learners should be able to: (1) establish rapport with the patient’s family by initiating introductions and creating a supportive environment, (2) assess the family’s baseline understanding of the patient’s condition by using open-ended questions and active listening to elicit their perspective, (3) communicate the patient’s death clearly and compassionately, using concise, non-technical language, (4) demonstrate empathy by responding appropriately to emotional reactions, validating concerns, and addressing questions thoughtfully, and (5) provide closure to the conversation by summarizing key points, offering emotional support, and clarifying the next steps in the patient’s care.
Managing Conflict Case: Admission of a Patient with Decompensated Schizophrenia, Hypertension, and Diabetes
DOI: https://doi.org/10.21980/J8.52341The following objectives, which align with ABEM’s recommended objectives, address the nuances of managing conflict. By the end of the session, learners should be able to: 1) demonstrate familiarity with the ABEM Managing Conflict case format and structure, 2) establish rapport by developing connection and trust with the admitting physicians, 3) demonstrate understanding of the other party's position by verbalizing thoughtful and specific questions about his/her concerns, 4) explain his/her own position clearly and insightfully, 5) acknowledge divergent positions with thoughtfulness and insight, 6) identify interests shared by both the psychiatrist and hospitalist as well as what is in the best interest of the patient, and 7) propose a path forward which accounts for the interests of all parties involved.
Managing Conflict Case: The Difficult Consultant
DOI: https://doi.org/10.21980/J8.53815By the end of the session, the learner should be able to: 1) review format and have become familiar with an ABEM Certifying Exam conflict management communication case, 2) demonstrate the ability to initiate the consultation call, establish rapport, and present a concise, evidence-based summary of the patient’s STEMI findings, 3) recognize concerns raised by the cardiologist and respond with an empathetic acknowledgment (eg, validating workload, uncertainty, or resource constraints) to support a collaborative tone, 4) articulate differing viewpoint by referencing objective clinical data (eg, ST-segment elevations, ongoing chest pain, risk from delays) when conflict is encountered and justify why urgent catheterization lab activation is indicated, and 5) identify shared goals in optimizing patient care (reducing myocardial damage and preventing deterioration) and use these to negotiate a mutually acceptable plan.
Patient-Centered Communication Case: Threatened Miscarriage
DOI: https://doi.org/10.21980/J8.52360By the end of this certifying exam practice case, learners will be able to: 1) establish a supportive and compassionate environment through verbal and non-verbal communication when engaging with a patient experiencing distress, anxiety, or grief related to potential pregnancy loss, 2) actively explore the patient’s understanding, concerns, values, and goals related to their pregnancy and presenting symptoms, 3) recognize and normalize a range of emotional reactions, offering validation and support regardless of the patient’s obstetric history or desired pregnancy outcomes, 4) clearly explain the diagnosis of a “threatened miscarriage,” outlining its clinical implications, inherent uncertainty, and potential outcomes, 5) review the results of any imaging or lab studies succinctly and empathetically, while verifying the patient's understanding, 6) collaborate with the patient to develop a mutually agreeable care plan, including medical recommendations, appropriate follow-up, monitoring, and return precautions.
Reassessment Case: Acute Pulmonary Edema in a Boarding Patient
DOI: https://doi.org/10.21980/J8.52353By the end of the case, the learner should will be able to: 1) demonstrate competency with the new ABEM Certifying Exam Reassessment case format, 2) demonstrate the ability to evaluate new information and integrate it into an existing care plan, 3) recognize signs and symptoms of pulmonary edema, 4) review possible etiologies of acute respiratory distress and the evaluation/work up to differentiate and diagnose those causes, and 5) manage pulmonary edema including implementing afterload reduction, positive pressure ventilation, and diuresis.
Procedural Case: Neonatal Lumbar Puncture
DOI: https://doi.org/10.21980/J8.52364This is a Procedure case involving a neonatal LP. The overarching educational goal of this case is to assess learners’ clinical decision-making, technical proficiency, and communication skills when performing a neonatal LP. Participants will be evaluated on their ability to identify indications and contraindications, obtain informed consent, prepare for and perform the procedure with sterile technique, and implement appropriate post-procedure care. By the end of the session, learners should be able to: 1) describe the indications and contraindications associated with performing a neonatal LP, 2) obtain informed consent for a neonatal LP, using clear, patient-centered language to explain the procedure and to discuss risks, benefits, and alternative options, 3) demonstrate proper preparation for a neonatal LP, including equipment setup, patient positioning, patient monitoring, use of sterile technique, and analgesia, 4) perform a neonatal LP on a procedural task trainer with technical proficiency, demonstrating proper needle insertion, cerebrospinal (CSF) collection, and adherence to sterile technique, and 5) outline appropriate post-procedure management for the patient, including interpreting CSF results, initiating appropriate treatment, monitoring for complications, and providing caregivers with clear follow-up guidance.