Study Finds Simulation Useful to Boost Awareness of Osteomyelitis in SCD Among Residents, Fellows


A simulation case for emergency medicine residents was found to be helpful as a review of the medical diagnosis and management of osteomyelitis in patients with pediatric sickle cell disease (SCD).

Information provided in a simulation case was found to be helpful for emergency medicine (EM) residents and fellows to gain a better understanding of optimal communication with patients who have been diagnosed with osteomyelitis in pediatric sickle cell disease (SCD) and their families, according to a study published in MedEdPORTAL. Learning to optimize care through knowledge about communication biases was also found to be useful to participants.

EM has had a hard time setting standards for pain management, as many people misuse emergency department (ED) visits, which leaves those with sickle cell anemia to suboptimal care due to biases, according to the authors of the study. Their research aimed to “explore and improve communication as a source of bias concerning SCD in the emergency room setting among medical teams and patients with their family members.”

The simulation was developed to help the evaluation of unique needs of patients with sickle cell anemia through learners’ systematic approaches. The simulation helped to develop strategies to advocate for better communication practices while discussing sickle cell anemia. The simulation was targeted toward EM residents and pediatric emergency medicine (PEM) fellows that were previously acquainted with simulations.

The case was administered in a simulation lab that was set to emulate a pediatric ED with a working space away from the patient. In a small, empty room, necessary equipment was used to mimic the clinical setting. This included a mannequin and bedside equipment, all set up before the arrival of learners. Laboratory reports, radiology results, and vital signs were communicated through PowerPoint and projection screens. Learner groups were set to consist of 4 to 6 EM residents, pediatric residents, and/or PEM fellows, with no more than 1 PEM fellow in any group.

The simulation started with a nurse standardized participant opening a case, explaining the triage of the patient, and giving the first iteration of biased language for the learners to address. A medical student would then provide a second iteration of biased language with an opportunity to correct bias toward a patient with SCD. A participant acting as a parent would augment the medical history and advocated for their child’s care. The simulation was approximately 40 minutes long, with 20 minutes dedicated to debriefing.

The simulation was implemented in a single day over the course of several hours. There were 40 participants in this study who ranged from medical students in their fourth year to PEM fellows. The group was split evenly by gender. All participants were divided into 6 groups of 5 to 8 learners, with each group representing diversity in training.

The researchers found that, although there were 20 minutes dedicated to debriefing, the participants often needed closer to 30, with the debriefing feeling rushed in the 20 minute time frame. The groups were also unevenly distributed, as some learners arrived later, which made the later groups slightly larger. Medical students also participating made the groups expand to 8 individuals at times.

All participants were asked to take a survey afterward that included 6 questions. The first 3 questions asked for quantitative feedback on the medical simulation, the next 2 were open-ended questions, and the final question asked for demographic categorization. Only 9 participants took the survey but offered positive feedback, with learners stating that it went over multiple topics in patient management and covered a relevant clinical case and a review of bias. All researchers contributed field notes to evaluate if the course objectives had been addressed.

There were a couple limitations to this study. Survey participation was relied on to gather information on the perceptions of the simulation case. Participation in this survey was also not mandatory, which left many participants without a response. Behavior change and knowledge retention could not be measured after the simulation.

The researchers concluded that learners who had taken part in the medical simulation were able to learn more about the diagnosis and management of osteomyelitis in a child with SCD and learn of the biases in communication and how it can affect patient care.


Kosoko AA, Alford YR, Upplegger KA, Stevens GS. Not just a pain: a medical simulation case about biased communication and osteomyelitis in pediatric sickle cell anemia. MedEdPORTAL. 2023;19:11335. doi:10.15766/mep_2374-8265.11335

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