High fidelity simulation can discriminate between novice and experienced residents when assessing competency in patient care.

Background: High fidelity (HF) simulators have become more common in residency training programs.

Aims: We hypothesized that high fidelity (HF) simulation-based assessment of patient care competency could differentiate novice from experienced residents.

Methods: Prospective study of 44 emergency medicine residents. A simulated case of anaphylactic shock was administered to each participating resident utilizing a HF patient simulator. Management of the case required epinephrine, airway management including a surgical airway, and i.v. fluids. Data was recorded using a standardized form and stop watch.

Primary Outcome: Time to completion of surgical airway.

Secondary Outcomes: Times to administration of epinephrine/attempt intubation/start surgical airway/complete case; checklist items: epinephrine as first action, pre-oxygenation, cricoid pressure and type of surgical airway.

Results: Novice residents took significantly longer than the experienced residents to achieve our primary outcome, time to completion of surgical airway (621/512 sec; p = 0.03). The novice residents took significantly longer to achieve three of our secondary outcomes: time to start of surgical airway (534 versus 442 sec; p = 0.04), time to case completion (650 versus 513 sec; p = 0.006), and epinephrine as a first action (73% versus 100%; p = 0.02).

Conclusions: HF simulation-based assessment using objective measures, particularly time to action, discerned our novice from our experienced residents.