Emergency Medicine and Patient Simulation:
Opportunities for Teaching, Evaluation, and Scholarship
James A. Gordon, MD, MPA
Massachusetts General Hospital/Harvard Medical School
Chair, SAEM Simulator Task Force
The Institute of Medicine’s report “To Err is Human” iden-
tified patient simulation as an opportunity for enhancing med-
ical safety in the same way that flight simulation is used to
enhance quality in aviation. With over 100 million emergency
department (ED) visits per year, emergency physicians are
uniquely qualified to bring instructive patient encounters or
good teaching cases “to life” using simulation technology. In
fact, as the 23rd specialty of the American Board of Medical
Specialties (ABMS), the field of emergency medicine (EM) has
always used simulation in its training and evaluation methods.
Most notably, the oral examinations administered by the
American Board of Emergency Medicine (ABEM) are based
entirely on simulated patient encounters. Other kinds of
objective structured clinical examinations (OSCEs) are now
widely used throughout undergraduate medical training, and
have been adopted as part of the physician licensure process.
Of course, situated role-playing and procedural simulation
have always played a prominent role in standardized emer-
gency training courses (CPR “mega-code” and procedure
labs).
While “simulation” can range from standardized patient
encounters to computerized virtual environments, a new gen-
eration of sophisticated robot-mannequins—high-fidelity
patient simulators—promises to revolutionize medical educa-
tion worldwide. In the last decade, emergency physicians
have played an increasing role in helping to develop the field
of medical simulation as a unique forum for teaching, evalua-
tion, and research. Building on years of work by the SAEM
Simulation Interest Group (which continues), the SAEM Board
of Directors established the Simulator Task Force in 2005 to
further explore the role of technology-enhanced simulation in
emergency medicine. The Task Force conso