Approaching and Coping With Difficult Patient Care Scenarios: A Simulation-Based Curriculum

Stress is pervasive in emergency medicine; while some stress is adaptive, uncontrolled stress contributes to burnout. Other fields have adopted training to optimize performance under stress. We developed a program integrating stress-management strategies into simulation workshops to help residents navigate difficult clinical scenarios.

Our simulation-based curriculum, informed by andragogy and Kolb’s experiential learning theory, was delivered to 43 EM residents in winter 2024/25. A needs assessment, completed via convenience sample, indicated that stressors varied by stage of training. Therefore, workshops were tailored: •R1: cognitive pause to reset at times of uncertainty •R2: managing difficult interpersonal interactions •R3: effective debriefing During each workshop, techniques were introduced and then deliberately applied at clinical simulation stations. Each workshop included a mindfulness debriefing station. We administered the Maslach Burnout Inventory- Human Services Survey for Medical Personnel pre- and 8 weeks post-implementation. Semi-structured interviews assessed program impact.

Pre-intervention burnout (81% survey response) increased throughout training (R1 18%, R2 50%, R3 56%; p = 0.08), consistent with prior published data. The post-intervention survey (42% completion) demonstrated a 5% relative reduction in burnout rates, greatest in the R2 class (34% relative reduction). 88% reported using techniques at least monthly. Qualitative interviews, reviewed using an inductive analysis, described success incorporating these techniques into clinical practice. Residents requested additional opportunities for intentional practice.

We designed a simulation-based curriculum to teach stress-management strategies for difficult clinical scenarios. Techniques were utilized and perceived as useful by residents. Burnout decreased in this pilot study, although interpretation is limited by small sample size.