Do or Die: A Rapid-Fire Tabletop Review of “Must Know” Emergency Medicine Pathologies

Abstract

Background

Emergency medicine (EM) physicians must rapidly recognize and manage time-critical conditions; however, standardized methods to teach and assess competency in these scenarios remain limited and resource-intensive.

Objective

To develop and implement a low-resource, standardized tabletop simulation to evaluate EM residents' ability to manage high-risk, time-sensitive pathologies.

Methods

Twenty-five critical EM pathologies were identified through expert consensus. We designed “Do or Die” (DoD), a rapid-fire, case-based program grounded in progress testing principles that required a faculty facilitator, laptop and 25 index cards. Residents independently prepared using a provided pathology list. During timed sessions, residents completed five randomly assigned cases, each scored using dichotomous critical action checklists. Performance thresholds varied by postgraduate year (PGY).

Results

The program was piloted with 54 residents during the 2025–2026 academic year. Fifty-six percent of residents passed on the first attempt with variation noted across training levels. Iterative attempts led to progressive improvement, and all residents ultimately achieved passing performance thresholds. The exercise identified both individual learner gaps and curricular opportunities.

Conclusions

The DoD program is a feasible, low-resource innovation that provides standardized, formative evaluation of EM residents' management of time-critical conditions. It offers a reproducible and adaptable approach to educational assessment and curricular refinement.