All Scenarios

Engage in shared decision-making for a knee injection with a patient who is skeptical of conventional medicine and has researched alternative treatments online.

Obtain consent for emergent intubation from a panicked family member in a high-stakes, time-sensitive crisis.

Obtain consent for a blood transfusion from a patient with deep-seated, historical fears about the safety of the blood supply.

Obtain consent for a lumbar puncture from a young man who is terrified of paralysis, requiring you to address specific fears with clear explanations.

Obtain consent for a thoracentesis from an elderly patient who is anxious about the procedure and its risks.

Obtain consent for a central line from the overwhelmed daughter of a critically ill ICU patient, justifying the need for an invasive procedure.

Obtain consent for a palliative paracentesis from a jaded patient with end-stage liver disease who questions the point of further procedures.

Call the on-call cardiology fellow about a patient with concerning chest pain, justifying the need for an urgent consult.

Call the palliative care team for help with a medically stable patient whose discharge is stalled by complex family conflict over goals of care.

Call the GI fellow about a stable patient with an upper GI bleed to discuss the appropriate timing for endoscopy.

Call the hematology fellow for a mild, incidental lab finding and learn to justify the consult's appropriateness while being guided to an initial workup.

Call the ID fellow about a complex patient with persistent fevers despite antibiotics, practicing how to organize and present a multi-day case.

Call the on-call nephrology fellow about a patient with acute kidney injury, preparing to be grilled on the lab data.

Call the ICU fellow to advocate for a higher level of care for a patient with worsening respiratory distress, justifying the need for an ICU bed.

Call the on-call orthopedics resident about a simple, non-displaced fracture, practicing the art of the 30-second, ultra-efficient consult.

Call the on-call psychiatry resident for medication recommendations for an agitated, delirious patient, and be challenged to confirm you've exhausted non-pharmacologic options first.

Call the on-call surgery resident about a patient with a classic acute abdomen, practicing a data-driven and concise presentation.

Call the on-call neurology resident about an elderly patient with a first-time seizure, focusing on a precise description of the event.

Hand off a complex patient with resolving DKA to the night-team resident, ensuring they know what to watch for.

Hand off a high-risk patient with an active GI bleed, focusing on transfusion triggers and parameters for urgent consultation.

Guide a family in denial to shift from cure-focused to comfort-focused care for a 95-year-old patient with multi-organ failure.

A patient with a clear viral URI is demanding a Z-Pak 'just in case,' testing your ability to say 'no' constructively.

A patient with capacity has expressed a desire for comfort-focused care, but their child at the bedside insists that you 'do everything.'

A healthy 30-year-old with a classic tension headache is demanding an MRI, fueled by health anxiety and online research.

Navigate a request for an early opioid refill from a patient with chronic pain who is exhibiting some red flags.

The family of a cancer patient wants to stop chemotherapy in favor of a non-evidence-based 'natural' cure they found online.

Use motivational interviewing techniques to explore a long-time smoker's ambivalence about quitting.

Use MI techniques to counsel a patient with newly diagnosed Type 2 Diabetes who is overwhelmed by the need for lifestyle changes.

You suspect a senior colleague is impaired on the job. Practice the high-stakes conversation of confronting them to ensure patient safety.

Advocate for your patient while calling a consult to a rude and dismissive senior colleague, testing your ability to maintain professionalism under pressure.

You must speak with an angry, yelling family member who is upset about a perceived delay in care, testing your de-escalation skills.

A patient makes flirtatious or inappropriate comments during an exam, testing your ability to set firm, professional boundaries.

The family of a competent 80-year-old man with a new lung cancer diagnosis asks you not to tell him the truth, testing your ability to uphold patient autonomy.

A patient with a serious infection requiring IV antibiotics is demanding to leave the hospital. Practice the AMA conversation.

A critical medication for your patient is out of stock. Call the hospital pharmacist to discuss and approve a suitable, available alternative.

Call an insurance medical director to appeal a prior authorization denial for a necessary medication, testing your ability to advocate within a bureaucratic system.

Coordinate with a busy case manager to halt a discharge after discovering the patient's home situation is unsafe, requiring a change in the discharge plan.

Address a family member who is live-streaming from the hospital room, testing your de-escalation and privacy management skills.

Take a history from a patient with symptoms of depression and practice the critical skill of directly assessing for suicide risk.

Address the concerns of an anxious new parent who is hesitant about routine childhood vaccinations due to misinformation they have read online.

Practice the foundational steps of delivering bad news to a patient's spouse in a controlled setting.

Deliver bad news to a highly anxious and demanding patient's spouse, testing your ability to maintain control and empathy under pressure.

Deliver news of an unexpected surgical complication to a family member in the waiting room, managing their shock and pivoting expectations.

Practice the difficult conversation of disclosing a medical error (a missed fracture) to a patient, focusing on accountability and rebuilding trust.

Help the son of a delirious patient with a DNR honor his father's wishes, even when the patient is crying out for 'help'.

Facilitate a proactive goals of care discussion with a stoic, pragmatic patient newly diagnosed with a terminal illness.

Navigate a conversation with a capacitant patient with end-stage COPD who is refusing life-sustaining treatment, focusing on autonomy and comfort.

Navigate a goals of care discussion with a deeply religious family member who is praying for a miracle and sees withdrawing care as 'playing God'.

Deliver the news of brain death to a young wife in disbelief, helping her reconcile the visual evidence of life with the medical reality of death.

Guide a wife through the difficult decision about a feeding tube for her husband with end-stage Alzheimer's, addressing the fear of 'starving' him.

Mediate a goals of care discussion with the healthcare proxy who is torn between his mother's wishes and his sister's demands.