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Clinical Decision-Making Case: Pulmonary Embolism.

James H Lee1, Linda Herman1

  • 1Sutter Roseville Medical Center, Department of Emergency Medicine, Roseville, CA.

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This study evaluated a new clinical decision-making (CDM) case format for emergency medicine residents preparing for the American Board of Emergency Medicine (ABEM) exam. The simulation effectively familiarized residents with the CDM format and reinforced pulmonary embolism (PE) diagnosis and management.

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Area of Science:

  • Emergency Medicine
  • Medical Education
  • Cardiopulmonary Medicine

Background:

  • Pulmonary embolism (PE) is a frequent diagnosis with diverse presentations, necessitating high clinical suspicion for accurate diagnosis and management.
  • Effective work-up and management of PE are crucial for emergency medicine physicians, involving pretest probability assessment, diagnostic algorithms, and treatment strategies.
  • The American Board of Emergency Medicine (ABEM) is introducing a new clinical decision-making (CDM) case format for its certification examination starting in 2026.

Purpose of the Study:

  • To assess the utility of a simulated clinical decision-making (CDM) case in preparing emergency medicine residents for the new ABEM certifying examination format.
  • To reinforce residents' knowledge and skills in the diagnosis and management of pulmonary embolism (PE) within the context of the new CDM case format.
  • To evaluate resident familiarity and comfort level with the novel ABEM CDM case format prior to its official implementation.

Main Methods:

  • A simulated clinical decision-making (CDM) case focusing on pulmonary embolism (PE) was developed based on the new ABEM oral certification examination format.
  • Eighteen emergency medicine residents (PGY 1-2) participated in the mock oral board session.
  • Pre- and post-simulation surveys assessed resident familiarity with the CDM format and the educational value of the case, while evaluators scored resident performance.

Main Results:

  • Residents rated the educational value of the simulation highly (4.9/5), indicating increased understanding of PE concepts and improved comfort with the new ABEM CDM format.
  • A majority of residents (72%) felt more comfortable with the new testing process after the simulation but desired more practice.
  • Residents demonstrated strong performance in routine PE work-up and management but showed less familiarity with high-acuity, unstable PE presentations.

Conclusions:

  • The simulated CDM case served as an effective educational tool for familiarizing residents with the new ABEM certifying examination format.
  • The simulation reinforced core concepts of pulmonary embolism diagnosis and management, particularly for stable presentations.
  • Further practice with the CDM format is recommended for both residents and educators to ensure preparedness for the ABEM certification exam, with a need to focus on unstable PE management.