EMSimCases.com | A not-so-boring take on Simulation

In Mentorship by Teresa ChanLeave a Comment

In the spirit of true FOAM-y collaboration, we are taking some time to feature a recent #FOAMed initiative that has been lead by two Canadian PGY4 residents.  As depicted in Eve Purdy’s post earlier this week, however, these two actually collaborated at a distance to bring this initiative to life.  Kyla Caners is a co-Chief Resident at McMaster University (Hamilton, ON, Canada) and Martin Kuuskne is a senior resident at McGill University (Montreal, QC, Canada).

Funny enough, I have known both of them separately for quite some time (Martin was once-upon-a-time a medical student who helped me on a paper; and Kyla is only a few years behind me in residency here at Mac), and only just realized that they were working on this project together. 😀

We caught up recently to chat about their EMSimCases.com project:


TC:  So, Kyla & Martin, could you explain the inspiration/need for an online sim case repository? Who is the intended audience?

MK: Generally speaking, simulation is a resource heavy teaching method. It requires a high instructor-to-learner ratio, a dedicated space, specialized equipment, and time for running the simulations. Planning for and creating quality cases that run smoothly also takes a significant amount of time. Every site needs their own instructors, but not all sites need to have unique cases. If we learn from similar resources and complete common exams across Canada, why can’t we collaborate to create shared simulation resources?

KC: We’ve talked to a lot of different simulation educators along the way and we each took a look online to see if there was anything like this. We weren’t very impressed by the databases we did find. Simulation educators want something that is searchable and has a variety of cases in a wide range of topic areas and skill levels. Further, educators want to be able to modify a case so it can suit their specific educational needs. Some cases are specifically designed for a certain type of mannequin. The trick isn’t programming your mannequin. It’s ensuring that the case progression is logical and anticipates most likely learner actions. Mannequin sellers also sell pre-made cases…but that’s expensive! Clearly, EM simulation educators are keen to find easier ways to create and use new high-quality cases!

MK: The blog is intended for simulation educators in the field of EM. However, many of the cases would also be relevant to other critical care specialties (trauma, ICU, anesthesia). Similarly, we feel that EM residents and medical students could learn a lot by reviewing the case content. Finally, we will be featuring a biweekly segment on medical education & simulation theory, tips, and tricks. This could apply to anyone involved in simulation or medical education.

TC:  It says on your website that your resources are peer reviewed.  What is your peer review process?

MK: All submitted cases are first vetted by Kyla and I for face validity. They are then reviewed and initially edited by a senior emergency medicine resident member of our associate editor team. They are then reviewed by two members of our advisory board. The board member’s job is to ensure that the medical content is accurate, that the case has clear learning objectives, and that the learning objectives align with the case and its progression. Lastly, Kyla and I incorporate any improvements derived from the peer review process before it is published.

KC: Our advisory board consists of leaders in simulation and medical education who are spread across the country. The goal was to ensure a wide and expert perspective on the cases.

TC: So, that’s great that the content is vetted and reviewed a prioi.  But with simulation cases, reviewing them on paper is one thing…. But, tell me, are your cases tested before they are posted? If so, how?

KC: Absolutely! It’s incredibly important that cases work in real time with real learners. Some cases look great on paper or in theory, but fall flat when used in real life. So we make sure all cases are tried before publication by either Martin, myself, or one of our advisory board members in a simulated environment. We incorporate the cases into our simulation curriculum that we provide to our own residents.

TC: I’ll be honest with you, there are a LOT of other repositories for educational resources.  How is your site different than the other simulation repositories online? (e.g. MedEdPORTAL, SAEM case library)?

MK: We worked really hard to ensure that all the cases are formatted in the same way for consistency and ease of use. We created the EMSimCases template for this reason. Many existing sites have unstructured requirements for case publication; cases are presented in different and sometimes confusing formats. We thought we could improve on this and also create a platform for posts on simulation medical education – or simeducation as we call it – and to highlight innovative efforts in simulation happening across the country.

KC: We also wanted to ensure that all cases had gone through a peer review process. The sites you mentioned have a peer review process, but for some sites, it’s not explicit or hasn’t been completed for every case before they are published for use. Our goal was to front load that process, like a journal does, to ensure quality content.

MK: And it was most important to us that this would serve as a free, open access, collaborative project. We want contributions from across the country! And we want it to be clear who wrote the cases. We want the cases to be clearly organized by content area. Ultimately, our blog will be searchable and will serve as a great way to look for a new version of a case you may have already run or to look for ideas for new cases.

TC: Can tell us a bit of the origin story for EMsimcases?

KC: I’ve spent the past year doing a fellowship in medical education and simulation. As a large part of my fellowship project, I’ve been designing a simulation component for our curriculum at the Royal College EM program at McMaster. Throughout the process, I’ve written a full curriculum of simulation cases for our residents. Writing cases is time-intensive. In fact, simulation is a very time-intensive way to teach. I kept thinking that if we couldn’t offload the amount of instructor time required for quality simulation, there should be a way that educators across the country could offload the case writing process. And hence, the idea of case repository was born.

MK: I had gone through a similar process at McGill; I developed and was leading the EM residency simulation curriculum with a resident colleague of mine, Wayne Choi. During my fellowship year in medical education and simulation, I thought about how incredible it would be for simulation educators to share their work to enhance the variety of cases that could be incorporated into their respective programs. I knew Jonathan Sherbino from my medical school training at McMaster and was aware of his expertise as a clinician educator. I contacted him regarding ideas about simulation based learning objectives and brought up the idea of creating a national repository of cases; he put me in contact with Kyla and the rest is history!

TC:  You two are at different universities and hundreds of kilometres away… How did you find it working on creating this project together?

KC: Right after we were put in contact by our mutual mentor, we both happened to be at the 2014 Simulation Summit in Toronto. It was so helpful to meet each other in person. The more we talked, the bigger and better the idea became. Our goal transformed from a small case book to a collaborative, FOAMed inspired blog! Having had that initial brainstorming session in person was such a great way to get things started.

MK: It’s surprisingly easy to collaborate via skype, email and even texting! Also, the fact that we both have access to editing the blog and have predetermined roles in terms of taking charge on selected blog posts is really helpful. Lastly, I think that being transparent and honest with our goals and opinions has made the process both successful and fulfilling.

KC: We also made a point of having regular meetings. We record minutes and action items after each meeting. And we always set the date for our next meeting before we end our current meeting. Setting clear timelines and goals also made our expectations of each other really clear.

TC:  What are your tips to med students doing sim for the first time?

MK: My advice would be to dive into the simulated environment as much as you can, regardless of the level of fidelity or realism! Treat the mannequin like a real patient. Talk to it; ask it questions. If you have to start compressions, give it your all and don’t be afraid to work up a sweat. Go through the motions of listening for breath sounds or putting in an IV. The more realistic learners treat the scenario, the more realistic the scenario becomes and the more it can mimic learning from a real patient encounter. Also, I think if you make the experience memorable, it will be easier to remember the learning points that you took away from the case.

KC: Remember that simulation is, above all else, a teaching modality. Just like a lecture is designed to deliver content, simulation is designed to teach a specific objective. Sometimes it feels like simulation is set up to make you fail. Particularly because any gaps in your knowledge feel like they are on display. But it’s actually the exact opposite. Why not jump in and make use of an excellent opportunity to realize what concepts you don’t fully understand? The point of simulation education is to help you learn content without needing to compromise patient care. The process of not knowing an answer is always uncomfortable. But in simulation, you should be happy to fail. And I bet you $10 that you’ll remember exactly what to do the next time you’re faced with a similar situation!

MK: I can vouch for that: I will NEVER forget about giving stress dose steroids for suspected adrenal insufficiency to a septic patient not responding to fluids or vasopressors after missing it in a simulated scenario during the CAEP Simulation Olympics 2 years ago!!

TC:  Okay, one last What’s your favourite flavour of ice cream?

KC: Mint chocolate chip. No question.

MK: I know its boring… but vanilla all the way!

Teresa Chan

Senior Editor at CanadiEM
Emergency Physician. Medical Educator. #FOAMed Supporter, Producer and Researcher. Chief Strategy Officer of CanadiEM. Associate Professor, Division of Emergency Medicine, Department of Medicine, McMaster University.