SimWars: A High-Stakes, High-Learning Emergency Medicine Competition

POSTED: March 21st, 2025
POSTED IN: EM Pulse Q1 2025,

Written by: Christopher Sampson, MD, FACEP, Vice Chair-Research ; Assistant Medical Director, MU Emergency Medical Services; Chair, UP Professionalism Committee

Clinical Professor, University of Missouri School of Medicine, Department of Emergency Medicine

What if you had to take care of a patient in the emergency department when suddenly the lights went out, and you had to figure out how to manage care in the dark? Or what if you had 10 patients arrive over the course of a few minutes, each with various complaints—some major and some minor? This may seem like a normal ED shift for most, but what if you also had an audience voting on your performance?

This is the basic premise of SimWars, a simulation competition that has been taking place at ACEP and SAEM national meetings for over a decade. I served as a national co-chair of this simulation competition for almost ten years and have participated as a case writer and actor for nearly twice that.

Simulation is a very common form of education used today in emergency medicine, medical student, and resident training. An important aspect of simulation education is psychological safety—where the learner feels secure enough in their environment to accept a detailed review of their thinking and behaviors that led to their successes or failures in managing a case. However, psychological safety does not always imply a comfortable situation. The simulation cases are often high-acuity and sometimes low-occurrence cases in a setting that will naturally raise one’s heart rate.

When SimWars takes place at our national meetings, it is a resident competition. A lottery occurs in which eight teams are selected to compete in a single-elimination bracket format. Each team represents a residency program from around the United States. Teams compete in an eight-minute case that may involve single or multiple adult and/or pediatric patients. Teams are expected to work together to manage the patient and may be required to perform procedures, interact with family or friends, all while handling medical or trauma cases. At the end of the eight minutes, a debriefing occurs with expert judges, followed by an audience vote. Of the two teams that compete head-to-head, one advances to the next round until the finals, where the SimWars champion for that event is crowned. The winner then returns a year later to defend their title.

Even as an audience member, there are many learning opportunities that arise during the debriefing, where management tips and educational pearls are shared. I encourage anyone attending our national meetings, ACEP or SAEM, to look for the SimWars event on the schedule and drop in. You are not required to stay for the whole event and can come for a short period of time to watch the competitors. I guarantee you will not only be entertained but will also learn something new in EM.