- Emergency medicine residents showed inadequate preparedness for toxic terrorism; no participant completed all five OSCE stations, radiation exposure station was most challenging.
- Only 33.3% passed the botulism station; overall performance improved with over 24 months residency, prior CBRN training, and simulation experience.
- Study recommends integrating standardized simulation based OSCE assessments into residency curricula to identify training gaps and enhance preparedness for low frequency, high impact incidents.
Ulus Travma Acil Cerrahi Derg. 2026 Oct;32(10):1289-1300. doi: 10.14744/tjtes.2026.63739.
ABSTRACT
BACKGROUND: Toxic terrorism is a rare but potentially catastrophic threat that can result in mass casualties and overwhelm healthcare systems. Effective management of such incidents requires specialized clinical competencies and preparedness that may be underemphasized in standard emergency medicine training. This study aimed to assess emergency medicine residents’ competencies in toxic terrorism preparedness and emergency medical management using a structured simulation-based examination.
METHODS: Emergency medicine residents working in the emergency departments of two tertiary university hospitals in Trabzon participated in a simulation-based clinical assessment. The examination comprised five realistic, fully immersive objective structured clinical examination (OSCE) stations designed to evaluate diagnostic decision-making and treatment planning in toxic terrorism scenarios. Each station was scored using standardized checklists developed by medical toxicologists. Factors associated with improved performance were also examined.
RESULTS: Although 33.3% of participants successfully passed the botulism scenario (Station 3), no participant successfully completed all five stations. The radiation exposure scenario (Station 2) was the most challenging. Higher performance was significantly associated with having more than 24 months of residency training, prior chemical, biological, radiological, and nuclear (CBRN) training, and previous exposure to simulation-based education.
CONCLUSION: These findings suggest that current training may not adequately prepare emergency medicine residents to manage toxic terrorism incidents. Incorporating standardized simulation-based assessments, such as OSCEs, into residency curricula may help identify training gaps and improve preparedness for low-frequency, high-impact events.
PMID:42841895 | DOI:10.14744/tjtes.2026.63739
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