The Effect of a Simulation-based Intervention on Emergency Medicine Resident Management of Early Pregnancy Loss.

Background: The evaluation of patients with first-trimester vaginal bleeding and concern for early pregnancy loss (EPL) frequently occurs in the emergency department (ED), accounting for approximately 1.6% of all ED visits.¹ Unfortunately, these patients consistently report negative experiences with ED care.^2-8 In addition to environmental concerns, such as long wait times, patients often describe negative interactions with staff, including a perceived lack of empathy, the use of insensitive language, and inadequate counseling.^2,3 These patients and their partners often view EPL as a traumatic loss of life and commonly experience prolonged grief reactions, including anxiety and depression.^9-11 Poor satisfaction with care has been associated with worse mental health outcomes.¹² These complaints represent an important opportunity for improvement in emergency medicine (EM) training.¹³ While no published literature to date describes the performance of EM residents in managing patients presenting with EPL, studies suggest that even obstetrics and gynecology (OB/GYN) residents find these interactions challenging.^14,15 Simulation- and didactic-based training has been shown to be beneficial in improving OB/GYN resident EPL counseling and has been associated with improved patient outcomes.¹⁶ To our knowledge, this has yet to be replicated in EM residency training.

Objectives: We aimed to develop and evaluate a simulation-based educational intervention to improve EM resident management of patients presenting with EPL.