Table 1. Applicable emergency medicine milestones for CHAOS in the ED activities per Accreditation Council for Graduate Medical Education (ACGME).

CHAOS: Challenging hazards amidst observational simulation; ED: Emergency department; PC: Patient care; MK: Medical knowledge; ICS: Interpersonal communication skills.

A milestone is a medical specialty-specific element that guides the assessment of the resident-physicians through the six core competencies in residency training (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice). Each core competency may contain a different number of elements, identified with a numeric number. For example, PC8 is the eighth element in the emergency medicine (EM) ACGME patient care milestone that evaluates the resident on his ability to multitask. Each medical specialty has different numbers of elements in the core competency. This table describes relevant EM ACGME milestones for each CHAOS in the ED activity.

CHAOS Round	Activities	Relevant Emergency Medicine ACGME Milestones
Pre-Event Selection	Clinical Question Card	MK – Medical Knowledge
Round 1A	Wilderness Emergencies: stabilization of orthopedic injuries	PC1 – Emergency Stabilization; PC3 – Diagnostic Studies; PC13 – Wound Management; ICS2 – Team Management
Round 1B	Tabletop Mass Casualty Drill: toxicological exposures and traumatic injuries	PC1 – Emergency Stabilization; PC7 – Disposition; ICS2 – Team Management
Round 2A	Critical Care Management: central venous line access, arterial line access, transvenous pacing	PC1 – Emergency Stabilization; PC4 – Diagnosis; PC6 – Observation and Reassessment; PC8 – Multi-tasking; PC9 – General Approach to Procedures; PC12 – Goal-directed Focused Ultrasound; PC14 – Vascular Access; ICS2 – Team Management
Round 2B	Rapid-Fire Ultrasound Diagnosis	PC3 – Diagnostic Studies; PC12 – Goal-directed Focused Ultrasound; ICS2 – Team Management
Round 3	Airway Challenge: securing challenging airway in space-confining situation	PC8 – Multi-tasking; PC9 – General Approach to Procedures; PC10 – Airway Management; ICS2 – Team Management