The use of “war games” to enhance high-risk clinical decision-making in students and residents

Abstract 

Background

Initial studies found that residents and students performed poorly in simple clinical scenarios. We hypothesized that repeated simulations in the “war games” format would improve performance.

Methods

Participants included medical students and residents on the trauma and surgical intensive care unit (SICU) services. Subjects were given a nursing report of an unstable patient and asked to verbalize management of the situation. Responses were transcribed and graded.

Results

Eighty subjects and 5 experts participated in 227 simulations. Naive medical students, postgraduate year (PGY)-1, and PGY-2+ subjects performed worse than experts (P <.05). After participation in ≥3 war games sessions, trainees' scores were similar to experts. Subjects with the least amount of clinical experience demonstrated the most improvement.

Discussion

We have designed an educational system that rapidly enhances the cognitive performance of students and residents. This may represent an important tool in assessing and enhancing the competencies of medical trainees in a safe environment.

Keywords: Decision-making, Cognition, Medical errors, Simulation, Surgical education