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Clinical Decision-Making Case: Thyroid Storm.

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This case study offers emergency physicians valuable training in managing thyroid storm, a critical endocrine emergency. It enhances clinical decision-making skills essential for the American Board of Emergency Medicine certifying examination.

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Area of Science:

  • Emergency Medicine
  • Endocrinology
  • Medical Education

Background:

  • Thyroid storm (TS) is a rare, life-threatening endocrine emergency with high mortality if not managed promptly.
  • Early diagnosis and intervention in the emergency department are crucial for improving patient outcomes.
  • The American Board of Emergency Medicine (ABEM) emphasizes TS as a core condition requiring EP proficiency.

Purpose of the Study:

  • To develop and evaluate a clinical decision-making case for emergency physicians (EPs) focusing on thyroid storm management.
  • To align with the ABEM's updated certifying examination format, emphasizing diagnostic reasoning and management skills.
  • To provide a realistic, high-stakes simulation for EPs to practice critical skills.

Main Methods:

  • A certifying exam board format case was co-developed by simulation and emergency medicine experts.
  • The case underwent external peer review and multi-site piloting with faculty facilitators and residents.
  • Iterative revisions were made based on feedback from the Simulation Scenario Evaluation Tool (SSET) and usability surveys.

Main Results:

  • SSET evaluations were strongly positive, with facilitators rating case objectives, critical actions, and materials as clear and appropriate.
  • Facilitators and residents found the case highly useful for ABEM certifying exam preparation, noting its realism and alignment with exam format.
  • Learners reported clear instructions and beneficial practice for the ABEM exam.

Conclusions:

  • The thyroid storm clinical decision-making case is an effective educational tool for preparing EPs for the ABEM certifying examination.
  • The case successfully meets its objectives, providing relevant and realistic practice in a simulated high-stakes scenario.
  • Future refinements will focus on aligning with evolving ABEM examination metrics to maximize educational impact.