CAEP FEI | The Nightmares Course at Queen’s University

In Education & Quality Improvement, Featured, Featured Education Innovations (FEI) by Andrew HallLeave a Comment

Lilly is a first year resident who is called by the floor nurse about an elderly gentleman who is “feeling unwell”. She walks into the room and notices he is wheezing and appears short of breath. Lilly starts feeling extremely anxious and is unsure of what she should do before rushing to find her staff. She wishes there was a course that would allow her to be exposed to these situations and become competent in the basics of resuscitation. 

Residency programs are increasingly adopting Competency Based Medical Education. As these curriculum changes take place, it is important for residency programs to determine the best ways to teach and assess resuscitation. This Feature Educational Innovation (FEI), titled, “ The Nightmares Course at Queen’s University: A Multidisciplinary Simulation-Based Curriculum for Training and Assessment of Competence in Resuscitation,” was originally posted by the CAEP EWG FEI Team on August 10, 2017 and answers the question: “How can we teach and assess resuscitation medicine in a competency based education model ? A PDF version is available.

Description of Innovation:

The Nightmares Course at Queen’s University is a novel, competency-based curriculum in resuscitation medicine that employs distributed and deliberate practice using high-fidelity simulation over a six-month period. The instructors provide frequent formative feedback as well as a summative assessment. A remediation period is built into the course for residents not meeting our competency threshold.

The course is designed to teach and assess the following Entrustable Professional Activity (EPA): “recognizes an acutely unwell floor patient, calls for appropriate help, and initiates a basic assessment and management plan”. This EPA is common to junior postgraduate trainees from several specialties.

The Course runs from August until December and is offered to residents at the Foundations of Discipline level of training (PGY-1). Currently, 42 residents from Internal Medicine, Orthopedic Surgery, General Surgery, Anesthesiology, Obstetrics and Gynecology, Urology, Ophthalmology, and Neurology participate in the course. Residents self-schedule using an online sign-up sheet for one session every month. Sessions are taught by attending physicians from Emergency Medicine, Internal Medicine, Critical Care, General Surgery, and Anesthesiology. Each session involves three simulated cases that highlight a common “floor call” for an acutely unwell patient (ie. “altered level of consciousness” or “shortness of breath”).

Residents receive formative feedback following each simulated case: the instructors use a “resuscitation assessment tool” to inform an entrustment decision. The instructors hold a multi-station OSCE in December in order to provide a summative assessment of the course EPA. Residents not meeting the predefined competency threshold in the OSCE are required to attend additional training sessions from January to April in hopes of improving resuscitation competency.

The Nightmares Course is unique and offers several advantages as Postgraduate Medicine in Canada moves towards CBME.1,2 Firstly, it recognizes the importance of deliberate practice distributed over time2 , a key ingredient to adult learning. Secondly, it provides a summative assessment of an EPA common to the majority of junior residents. This interdisciplinary model is very attractive to programs that acknowledge the importance of this EPA, thus rather than designing a course de novo within each program, the Nightmares Course serves to teach, assess and remediate the entire cohort. Remediation is built into the curriculum by design, with the infrastructure in place to continue weekly remedial sessions following the summative OSCE.

Bottom Line

The Nightmares Course at Queen’s University is a novel competency-based educational intervention and assessment program in resuscitation medicine applicable to the large majority of postgraduate medical training programs.3 If you are interested in further details, please contact the authors.


More about CAEP FEI

This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Feature Educational Innovations project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive FEI each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.



McMurray L, Hall AK, Rich J, Merchant S, Chaplin T. The Nightmares Course: A Longitudinal, Multidisciplinary, Simulation-Based Curriculum to Train and Assess Resident Competence in Resuscitation. J. 2017;9(4):503-508. doi:10.4300/jgme-d-16-00462.1
Anders Ericsson K. Deliberate Practice and Acquisition of Expert Performance: A General Overview. Academic Emergency Medicine. 2008;15(11):988-994. doi:10.1111/j.1553-2712.2008.00227.x
Frank J, Snell L, Sherbino J. CanMEDS 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada. ; 2015.
Andrew Hall

Andrew Hall

Andrew Hall is Assistant Professor in the Department of Emergency Medicine at Queen’s University. He is a simulation-based resuscitation rounds instructor and runs the simulation-based OSCE assessment program for EM residents. Additionally, he is the CBME Lead for FRCPC-EM training program at Queen’s.

Tim Chaplain

Tim Chaplain is an Assistant Professor in the Department of Emergency Medicine at Queen’s University. His educational interests include simulation-based education, curriculum design, and resuscitation medicine.

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Chirag Bhat

Chirag Bhat is an Emergency Medicine resident at the University of Ottawa. He has interests in medical education and toxicology. He is a basketball fan and cheers for the Toronto Raptors.