Prioritization: Intracranial Hemorrhage, Testicular Torsion, and Tricyclic Antidepressant Toxicity Presenting to a...

This case is designed for emergency medicine residents preparing for the American Board of Emergency Medicine Certifying Exam (ABEM). While we tested the case with third year emergency medicine residents, it could also be used with first- and second-year residents to develop complex decision-making and prioritization skills in a simulated environment.

Emergency medicine requires physicians to rapidly prioritize care, stabilize critically ill patients, adapt to changing clinical circumstances, and delegate tasks and resources. Traditional oral board cases emphasize single-patient encounters rather than multitasking or task-switching. This prioritization case better aligns with the clinical workflow of a shift in the emergency department, including triage, teamwork, and flexibility. This case forces learners to make timely decisions with incomplete information, giving examiners insight into how the examinee performs in the clinical environment.

By the end of this case learners should: 1) Become familiar with the format of a prioritization case (a component of the ABEM Certifying Exam), 2) demonstrate 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.

A group of five emergency medicine faculty with experience in simulation and oral board case design created a 15-minute practice prioritization case. This case is based on information provided by ABEM on the prioritization case format from the ABEM Certifying Exam. Learners are presented with evolving patient scenarios via tracking boards and prompted to prioritize, stabilize, task switch, and delegate as they manage multiple patients. The case is intended to be administered with two examiners and one examinee at a time. We used a group debrief structure, but this case can also be debriefed with each individual learner.

This case was tested on 18 third-year emergency medicine residents. Following the case, each resident completed an anonymous two-item evaluation. The first item, "This case increased my understanding of the certifying exam format," was scored on a 5-point Likert scale from "strongly disagree" to "strongly agree." The second item, "How would you rate the overall quality of this case?" was scored on a 5-point Likert scale from "poor" to "excellent."

Sixteen of eighteen (89%) examinees completed the post-case evaluation. All respondents (100%) "agreed" or "strongly agreed" that the case improved their understanding of the ABEM Certifying Exam format. Overall case quality was rated 4.88/5, and all learners rated the case "very good" or "excellent."

This case was effective in simulating the competing demands of the clinical environment while also preparing learners for a new exam format. During the group debrief session, learners appreciated the pace, needing to stabilize multiple patients, and reacting to new information as it was presented. This case significantly improved residents' understanding of the prioritization case type that will be tested on the ABEM Certifying Exam. It also provides a controlled environment for program faculty to observe how residents perform managing multiple sick patients simultaneously.

Prioritization, resource utilization, triage and stabilization, task-switching, cognitive load.