Most Missed SIM Case
SpCA0027-Most Missed SIM Case
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SpCA0027-Most Missed SIM Case
Case InfoHistory
Crying. Respiratory distress.
Exam
XR CHEST W/ABD <1YR BABYGRAM
Prior Study
None.
Answer
The Education Gap
Non-Accidental Trauma
FINDINGS
CHEST: The lungs are well-expanded and are without focal infiltrate or consolidation. There is no pleural effusion or pneumothorax. Cardiothymic silhouette is normal.
ABDOMEN: The bowel gas pattern is nonobstructive. No apparent free air in this supine exam. There are no intra-abdominal calcifications.
MUSCULOSKELETAL: There are subacute healing fractures of the right lateral 4th and 5th ribs and the right posterior 7th, 8th and 9th ribs. No additional fractures are identified. There is mild dextrocurvature of the thoracolumbar spine, likely positional.
IMPRESSION
Healing fractures of the right lateral 4th and 5th ribs and the posterior right 7th, 8th and 9th ribs. In a patient of this age without appropriate history, concern is raised for non accidental trauma.
COMMENT
Concern for NAT. A call was made to the pediatric ED attending and a follow-up skeletal survey was recommended.
ACUITY
Priority
STATISTICAL ANALYSIS OF SIM RESULTS
243 residents interpreted this case of non-accidental trauma as one of 65 cases during an 8-hour simulated on-call shift, with a median score of 0 out of 10 and an overall average score of 1.04 out of 10.
Overall, the average number of points lost out of 10 to observational discipline was 8.76. At the same time, 0.04 points were lost due to interpretive errors on the part of the residents.
We define an effective report to be one which achieves scores between 7 and 10. In terms of letter grades, this would be A & B. In this “most missed” case 10% of residents produced effective reports.
We define a report having a critical error to be one with scores between 0 and 2. In terms of letter grades, this would be F & D. In this “most missed” case 89% of residents produced reports with critical error(s).
CHEST: The lungs are well-expanded and are without focal infiltrate or consolidation. There is no pleural effusion or pneumothorax. Cardiothymic silhouette is normal.
ABDOMEN: The bowel gas pattern is nonobstructive. No apparent free air in this supine exam. There are no intra-abdominal calcifications.
MUSCULOSKELETAL: There are subacute healing fractures of the right lateral 4th and 5th ribs and the right posterior 7th, 8th and 9th ribs. No additional fractures are identified. There is mild dextrocurvature of the thoracolumbar spine, likely positional.
IMPRESSION
Healing fractures of the right lateral 4th and 5th ribs and the posterior right 7th, 8th and 9th ribs. In a patient of this age without appropriate history, concern is raised for non accidental trauma.
COMMENT
Concern for NAT. A call was made to the pediatric ED attending and a follow-up skeletal survey was recommended.
ACUITY
Priority
STATISTICAL ANALYSIS OF SIM RESULTS
243 residents interpreted this case of non-accidental trauma as one of 65 cases during an 8-hour simulated on-call shift, with a median score of 0 out of 10 and an overall average score of 1.04 out of 10.
Overall, the average number of points lost out of 10 to observational discipline was 8.76. At the same time, 0.04 points were lost due to interpretive errors on the part of the residents.
We define an effective report to be one which achieves scores between 7 and 10. In terms of letter grades, this would be A & B. In this “most missed” case 10% of residents produced effective reports.
We define a report having a critical error to be one with scores between 0 and 2. In terms of letter grades, this would be F & D. In this “most missed” case 89% of residents produced reports with critical error(s).
