Identifying and Transmitting the Culture of Emergency Medicine Through Simulation

Background: Simulation is commonly used in medical education. It offers the opportunity for participants to apply theoretical knowledge and practice nontechnical skills. We aimed to examine how simulation may also help to identify emergency medicine culture and serve as a tool to transmit values, beliefs, and practices to medical learners. Methods: We undertook a focused ethnography of a simulated emergency department exercise delivered to 98 third-year medical students. This ethnography included participant observation, informal interviews, and document review. Analysis was performed using a recursive method, a simultaneous deductive and inductive approach to data interpretation. Results: All 20 staff (100%) and 92 of 98 medical students (94%) participated in the study. We identified seven core values-identifying and treating dangerous pathology, managing uncertainty, patients and families at the center of care, balancing needs and resources at the system level, value of the team approach, education as integral, and emergency medicine as part of self-identity-and 27 related beliefs that characterized emergency medicine culture. We observed that culture was transmitted during the simulation exercise. Conclusion: This study contributes to the characterization of the culture of emergency medicine by identifying core values and beliefs that are foundational to the specialty. Simulation facilitated cultural compression, which allowed for ready identification of values, beliefs, and practices and also facilitated transmission of culture to learners. This study expands understanding of the culture of emergency medicine and the role of simulation in the process of cultural exchange.