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Background: Emergency medicine (EM) physicians often practice in dynamic, high‐stress, and uncertain settings with limited resources. Although simulation has been shown to enhance various aspects of student development, its impact on medical students' personal growth initiative, resourcefulness, and tolerance of uncertainty—crucial traits for managing future crises as emergency physicians—remain unclear. The purpose of this study, therefore, was to determine a high‐fidelity prehospital simulation's impact on medical students' resourcefulness, personal growth, and tolerance of uncertainty. Methods: We surveyed 107 fourth‐year medical students before and after a multiday, high‐fidelity prehospital simulation. The survey included items from the Intolerance of Uncertainty Scale‐12 Item Form, the Personal Growth Initiative Scale, and the Resourcefulness Skills Scale. We compared students' pre‐ and post‐simulation responses to investigate any change in their uncertainty intolerance, personal growth initiative, and resourcefulness following simulation participation. Results: Students' scores significantly increased following the simulation for both resourcefulness (t(106) = −6.89, p < 0.001, d = −0.67) and personal growth initiative (t(106) = −6.22, p < 0.001, d = −0.60). Effect size calculations suggest that participating in the simulation had a medium to large effect on participants' resourcefulness and personal growth initiative. However, participants' tolerance of uncertainty scores prior to and following the simulation did not significantly differ (t(106) = 1.66, p = 0.100, d = 0.16), indicating that the simulation had little effect on participants' tolerance of uncertainty. Conclusions: Our results indicate that simulation is a promising educational tool for developing students' resourcefulness and personal growth initiative so they can navigate high‐stress, low‐resource environments. Follow‐on research is needed to determine how to leverage simulation to enhance students' uncertainty tolerance in high‐stress, low‐resource environments. [ABSTRACT FROM AUTHOR]

Training needs of Special Operations Forces (SOF) medics were surveyed and new training initiatives have been created to meet their needs. SOF medics perform an array of medical procedures in austere environments with minimal supervision. Medical skills decay over time after initial training and the perceived training needs of active SOF medics were unclear. To fill this gap, active SOF medics (n=57) completed a survey that included confidence ratings and indications of whether additional training would make them more proficient in 70 medical knowledge and procedural skills, assembled into categories by a panel of experts (airway, trauma, neuro, differential diagnosis, administrative, infection, critical care, environmental, other). Data were analyzed with analysis of variance (ANOVA) and nonparametric statistics at P<.05. Confidence was highest in the trauma, administrative, and airway categories, and lowest in the infection, differential diagnosis, and neuro categories (P<.05 or less). Categories indicating the greatest need for additional training were environmental and critical care, while those indicating lowest need were the airway and trauma categories (P=.05). Additional training was endorsed by >75% of participants in each category. SOF medics also wanted additional training in all areas, preferably hands-on with live patients in realistic scenarios, taught by experienced medics. Findings highlight the training needs of SOF medics and demonstrate the value of bottom-up feedback toward optimizing sustainment training. Based on present findings, two TACMED (Tactical Medicine) Divisions at the SOF Echelon III level were created to meet the sustainment training needs of SOF medics., Competing Interests: The authors have no financial relationships relevant to this article to disclose., (2024.)

Pharyngitis is a common presentation, but it can also be associated with life-threatening processes, including sepsis and airway compromise. Other conditions, such as thyroid disease and cardiac disease, may mimic pharyngitis. The emergency clinician must sort through the broad differential for this complaint using a systematic approach that protects against early closure of the diagnosis. This issue reviews the various international guidelines for pharyngitis and notes controversies in diagnostic and treatment strategies, specifically for management of suspected bacterial, viral, and fungal etiology. A management algorithm is presented, with recommendations based on a review of the best available evidence, taking into account patient comfort and outcomes, the need to reduce bacterial resistance, and costs.