CASE-SIMULATION REVIEW - CCS + CDM

YEAR 4 / PGY-1 | PAGE 71A - UNIVERSAL ENGINE -> PRIORITY -> ACTION -> REASSESSMENT -> DISPOSITION

A. UNIVERSAL SIMULATION ENGINE - PRESERVED + EXPANDED

Step	Action	Decision checkpoint
1. Stabilize	Identify immediate threats; address airway, breathing, circulation and time-critical therapy before completeness.	What can harm the patient in the next minutes?
2. Acquire	Focused history/exam and tests that can alter diagnosis, treatment, location or monitoring.	What information changes my next action?
3. Interpret	Update the differential using new data; prune unsupported branches.	What is now most likely or most dangerous?
4. Treat	Start evidence-based therapy; stop harmful or irrelevant interventions.	What treatment changes outcome now?
5. Monitor	Reassess symptoms, vitals, labs and adverse effects after intervention.	Did the patient improve, worsen or need escalation?
6. Prevent / counsel	Vaccines, screening, medication counseling, risk reduction, adherence and safety when appropriate.	What preventable harm comes next?
7. Disposition	Admit, discharge, transfer, consult and arrange follow-up based on stability and care needs.	Where can this patient safely receive the next phase of care?

1. PRIORITY OUTRANKS COMPLETENESS

DEEP EXPLANATION	WHY STUDENTS MISS IT	EASIEST CLUE
In simulation, the safest sequence matters. The first minutes should address physiology and reversible threats before broad diagnostic completeness. Later steps can become more comprehensive after stabilization.	Learners want a complete history, exam and workup before acting because that resembles a written case presentation.	If delay could worsen outcome, act before finishing the differential.
2. EVERY TEST SHOULD HAVE DECISION VALUE
DEEP EXPLANATION A useful test changes diagnosis probability, treatment, monitoring, consultation, location or disposition. A test	WHY STUDENTS MISS IT Large order menus reward the feeling of doing more, and written	EASIEST CLUE Ask: If this result is normal or abnormal, what will I do
with no plausible management consequence adds noise and may waste time or resources.	exams often hide the cost of unnecessary testing.	differently?
3. REASSESSMENT IS A NEW DECISION POINT
DEEP EXPLANATION Treatment creates new information. After fluids, oxygen, insulin, antibiotics, analgesia or another intervention,	WHY STUDENTS MISS IT Students mentally end the problem when the initial treatment is	EASIEST CLUE After every major intervention ask: Did it work, and what
reassess response and toxicity before advancing the case.	correct.	should change now?

1. PRIORITY OUTRANKS COMPLETENESS — ORIGINAL PAGE 71 ERROR TYPES - RETAINED

Delayed stabilization; shotgun testing without decision value; correct treatment in the wrong sequence; failure to reassess; missing prevention/counseling/follow-up; unsafe disposition or failure to escalate. 2026/27 CCS + CDM case-simulation expanded edition - verify current USMLE/NBOME and residency/program guidance before testing