| Summary: | Abstract The case simulation is a patient who had presented previously with chest pain and leg pain who had an acute coronary syndrome evaluation and a negative lower extremity ultrasound. She returned to the emergency department with worsening leg pain, and repeat evaluation demonstrated a distal deep vein thrombosis (DVT). A filling defect on subsequent ventilation perfusion scanning was evident, likely representing a missed pulmonary embolism (PE) during the first evaluation. Feedback on the case was positive. Seventeen of 19 evaluations rated the case as excellent in applicability to emergency medicine and knowledge obtained, with the other two rating the case as very good. No evaluation was rated as good, fair, or poor. There has been no discernable differences noted among PGY-1 and PGY-2 residents. The case had not been run with PGY-3 level residents. The case had been used for education and discussion, not for a specific evaluation of resident performance (i.e., no high stakes evaluation). There is no data regarding changes in behavior or clinical performance. Performers of this case may either manage the case as if the case is a new presentation and “start over,” or review the records of the previous evaluation. Those performers who did not review records are perhaps more likely to do well on this individual case, being more likely to get a lower extremity ultrasound for evaluation of a DVT. In that case, determining why the provider did not review medical records and the problems associated with not reviewing (missing risk factors or previous diagnoses, increased cost) is important.
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