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Sharing is caring: How EM Sim Cases ( has created a collaborative simulation education culture in Canada

Published online by Cambridge University Press:  23 June 2020

Kyla Caners
Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON
Jared Baylis*
Department of Emergency Medicine, University of British Columbia, Vancouver, BC
Christopher Heyd
Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON
Teresa Chan
Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON
Correspondence to: Dr. Jared Baylis, Kelowna General Hospital, 2268 Pandosy St, Kelowna, BCV1Y 1T2; Email:


Free open access medical education (FOAM) resources in emergency medicine (EM) have grown exponentially in recent years. Within this movement, there are relatively few resources dedicated to simulation in EM. EM Sim Cases is a FOAM resource that was started in 2015 with the goal of creating a central database of simulation cases and scholarly articles that could be shared worldwide and thus reduce needless duplication of effort. Since 2015, EM Sim Cases has grown to have an annual average of 8,148 views per month from a total of 161 countries. It has an editorial team of 18 members as well as a leadership team of three. There is a robust, peer-reviewed case bank ranging in topic from neonatal resuscitation to end-of-life care as well as a number of simulation-relevant educational posts.



Le matériel didactique consultable sur la plateforme FOAM (Free Open Access Meducation : enseignement médical en libre accès) en médecine d'urgence (MU) a connu une croissance exponentielle au cours des dernières années. Toutefois, la documentation spécialisée sur la simulation est relativement peu abondante. C'est ainsi qu'EM Sim Cases, une ressource disponible sur FOAM, a vu le jour en 2015, dans l'optique que soit constituée une base de données centrale de cas simulés et d'articles savants mis à la disposition des utilisateurs partout dans le monde, d'où réduction de la redondance du travail. La base de données se développe depuis 2015 et atteint maintenant une moyenne annuelle de 8148 vues par mois, qui proviennent de 161 pays. L’équipe de rédaction compte 18 membres et l’équipe de direction, 3. EM Sim Cases est une banque robuste de cas évalués par les pairs, dont les sujets varient de la réanimation néonatale aux soins de fin de vie, et contient aussi un certain nombre de billets pédagogiques portant sur la simulation.

Educational Innovation
Copyright © Canadian Association of Emergency Physicians 2020


Most postgraduate emergency medicine (EM) programs in Canada describe having a simulation curriculumReference Russell, Hall, Hagel, Petrosoniak, Dagnone and Howes1 and yet, to our knowledge, these curricula largely act in isolation. Traditionally, simulation case banks and curricula have been compiled at local educational sites out of a need for simulation-based education. Often, these cases are designed such that they are only applicable to that local site and are not usually peer reviewed to ensure accuracy and rigour. Furthermore, the simulation curriculum design process is quite labor intensive, requiring expansive case development in addition to costly technical resources and simulation facilitation expertise. Not only does isolated simulation resource development result in cumulative wasted effort due to the inefficiency of creating separate case banks at each training program, but it furthers a silo mentality within simulation-based education.

The creation of EM Sim Cases was an attempt to shift culture within simulation education to a collaborative process where contributors are recognized for their work, the work is widely disseminated, and it is available for all to use in a free, open access, and easily shareable format. It also sought to bring a level of scholarly rigour to the case development process with all cases having been trialled in a simulation setting and peer reviewed by two expert simulation educators. Recently, EM Sim Cases has been involved in efforts to distribute comprehensive simulation curricula, such as Queen's University “Nightmares Course.”Reference McMurray, Hall, Rich, Merchant and Chaplin2 Additionally, it has led to several academic projects, such as the collaborative development of a national simulation template, based on the original EM Sim Cases template, through the Emergency Medicine Simulation Educators Research Collaborative.


EM Sim Cases was created as a potential culture change medium within simulation-based education to foster collaboration and sharing of resources. This strategy was accomplished by curating peer-reviewed simulation cases, up-to-date simulation education articles, and a universal simulation case template accessible worldwide in a Free Open Access Medical education (FOAM) Web-based format.

Description of Innovation

EM Sim Cases was created in 2015 by K. Caners and M. Kuuskne. It has since grown to have 16 educational posts, 80 simulation cases, and 8,148 average monthly views from a total of 161 countries. Topics range from neonatal resuscitation to end-of-life care.

The case repository initially consisted mainly of cases written by the co-founders. The complete case collection has now published submissions from 32 individuals from 14 unique sites in three countries. A recent re-launch with a simulation-expert-developed, consensus-derived simulation template, a complete case series, and an online needs assessment occurred in the Fall of 2019.

EM Sim Cases is a robust, nontraditional repository of peer-reviewed, FOAM simulation material. It is unique in several ways, and in preparation for this manuscript, we embarked on an audit and reflective exercise to review our past and present procedures.

First, while other organizations have applied robust peer review processes in the FOAM world,Reference Thoma, Chan, Desouza and Lin3,Reference Sidalak, Purdy, Luckett-Gatopoulos, Murray, Thoma and Chan4 peer review is still not the norm within open access education blogs, so the successful and sustained application of these processes is worth reporting.

Second, EM Sim Cases represents a case study for creating a repository for digital scholarship. Over time, it has come to be an internationally respected source of simulation cases, and has been cited in the peer reviewed literature frequently since its inception.Reference Gottlieb, Chan, Sherbino and Yarris5Reference Baylis, Miloslavsky, Woods and Chan8 Its cases are now used across multiple EM training sites in Canada and have been used to develop entire simulation curricula for training programs around the world. This demonstrates a successful facilitation of a culture of collaboration and sharing of intellectual content within simulation education.

Finally, EM Sim Cases has also become an increasingly popular publication venue for many simulation educators seeking to create peer reviewed works of digital scholarship.


In 2020, EM Sim Cases will have been in existence for 5 years. As such, the editorial board will be seeking to refresh and revive the scholarly repository. Future directions include initiating a leadership transition for the editorial board, conducting a needs assessment of the authors and audience in part to measure impact, creating and releasing a revised pan-Canadian EM simulation case template (with iterative design changes based on real-life use), and release of case bundles designed to address educational needs. Attempts will also be made to address some of the limitations of the EM Sim Cases resource including difficulties navigating the website, editorial delays, and a relative paucity of interprofessional content.

Our author group believes there are three key elements that likely have contributed to the growth of the EM Sim Cases platform: a robust and active editorial board, a peer review mechanism for ensuring high quality content, and a common simulation template. These are detailed in Table 1.

Table 1. Three elements that have contributed to the growth EM Sim Cases


EM Sim Cases is a unique FOAM repository that was created out of a desire to reduce duplication of effort within simulation-based education. The website provides a peer-reviewed case bank and simulation-based articles that are used by simulation educators around the world.

Competing interests

None declared.



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Table 1. Three elements that have contributed to the growth EM Sim Cases