The Effect of Using Simulation Wars on Emergency Medicine Residents' Reasoning Skills

In 2004, the Accreditation Council for Graduate Medical Education (ACGME) restricted the duty hours of residents training to become doctors in an effort to decrease medical errors. With less time for them to learn medicine at the patient’s bedside, residents may not develop the clinical reasoning skills needed for diagnosing and treating patients. Simulation can remedy this, allowing residents to practice skills, to solve problems, and to develop clinical reasoning. Simulation is based on Kolb’s Theory which emphasizes reflection of one’s actions (Kolb, 1975), Lave and Wegners Theory based on socialization, visualization, and imitation (Hunmg 2002), and Social Constructivism Theory which is based on social interaction (Perkins, 2007). Simulation Wars, a clinical reasoning simulation, has rarely been incorporated into resident curriculum, but it has been shown to improve clinical reasoning skills (Young, Stokes, Denlinger & Dubose, 2007) (Yound, Dubose, Hedrick, Conaway, Nolley, 2007), (Hedrick & Young, 2008). In this study, the effect of Simulation Wars on In-service Board Scores and Global Rating Scale (GRS) Scores of Emergency Medicine (EM) Residents was analyzed. The results showed no significant difference in GRS scores except for Communication and Professionalism. There was no significant difference in the In-Service Board scores between the intervention group and control group. There was no improvement in the majority of subcategory topics on the In-Service board scores, but there was consistent improvement in some subcategories. In conclusion, Simulation Wars has some applicability in providing Clinical Reasoning training in certain EM topics.