The Attending

The board is yours. The Attending is a management sim about one night in an emergency department. You don't build rooms and you don't place walls — you run the board: assign the beds, staff the cases, and sign the orders that send people home or upstairs.Your doctors are good. They are not always right. Every doctor on your roster works cases their own way — fast or thorough, confident or honest about their doubts. When they bring you a discharge, you see what they did, what they found, and what they never even looked for. Everything they did is on the chart. Stamp the wrong one and the debrief will tell you the minute you did it.Every intervention has a price. Take over a case and be right, and they'll give you the benefit of the doubt later that night. Take over and be wrong, and you've spent trust you'll want back when the board is full and one of them is standing by the lockers ready to walk out the door.The night pushes back. Two patients with the same symptoms — one is drunk, one is dying. A family that knows something the triage note missed. A doctor quietly confessing a med error behind a curtain. The department never asks for your attention politely, and it never asks just once. - A deterministic simulation, not a script — every patient's truth is fixed before the shift starts. The dangerous ones deteriorate in real time, with pause. - Sign-off supervision is the core skill — read the workup, smell the thin ones, verify what matters, and eat the consequences either way. - Twinned cases — the kidney stone and the tearing aorta arrive with the same complaint and the same words on the chart. Only the workup separates them. - The debrief keeps receipts — every miss reconstructed to the minute: when the finding was charted, when the discharge was signed, and which came first. - The hospital upstairs — admitted patients hold their bed until the floor has room. You can lean on the bed manager, but it costs you the minutes you were spending on somebody else. - A named ensemble with skills, flaws, grudges, and breaking points that persist through the night. - 26 authored dilemmas — arguments, walkouts, confessions, a family at the desk with one of them filming. Each one costs time, trust, or both. - Every night generated, one sitting each — case mix, arrival waves, and crew chemistry reroll; no two boards play the same.