The Problem
Psychiatric and substance use disorder complaints comprise up to 12% of all Emergency Department (ED) visits.1–3 These conditions can present in a multitude of ways, making it essential for emergency physicians (EPs) to be aware of nuanced diagnostic characteristics of psychiatric illnesses in order to provide timely and appropriate care for these patients.
The Innovation
We sought to create a fun and interactive activity to review common presentations and management decisions of psychiatric and substance use disorders in the ED. We transformed the Food Network cooking show Chopped into a clinical vignette competition. Residents were given a basket with mystery psychiatric “ingredients” needed to create a narrative around a fictional patient. As in the show, residents could add additional “ingredients” from their knowledge of psychiatric and substance use disorders, but all of the basket’s signs and symptoms had to be used to construct the vignette. The narrative “dish” was then served to a panel of faculty physician judges for detailed evaluation.
Target Learners
Residents of all post-graduate levels (i.e., PGY 1-3) from the EM residency at Thomas Jefferson University Hospital participated in this educational activity during weekly scheduled conference time.
Group Size
This activity was performed with 6 groups of 5-6 residents per group.
Description of the Innovation
- We modified the structure of the Food Network cooking show Chopped into our weekly emergency medicine (EM) conference during the psychiatry block of the curriculum.
- Residents were divided into six teams composed of 5-6 residents each.
- Each group received the same basket of “ingredients” (Figure 1) which contained pre-selected mystery items to form the clinical vignette “dish.” Residency leadership was responsible for making these selections.
- Common signs and symptoms of psychiatric and substance use disorders encountered in the ED were appropriately identified and suggested as potential ingredients. Ingredients could include history of present illness (HPI) elements, physical examination (PE) elements, and diagnostic elements.
Figure 1. Residents were provided with a “basket” of “ingredients” from which to construct a narrative.
- Six basket ingredients were selected for this iteration of Chopped EM: altered mental status (HPI), history of ingestion (HPI), psychomotor agitation (PE), diaphoresis (PE), elevated creatinine (diagnostic data), and prolonged QT interval on electrocardiogram (diagnostic data).
- The teams were given 20 minutes to use these “ingredients” to formulate a logical patient narrative using every single of the items provided in the basket. Residents were free to integrate additional components to create a robust vignette.
- A representative from each small group presented their respective narrative to the large group, including a panel of attending physician judges. Faculty judges included educational leadership from the department. Judges were asked to evaluate and score the presented vignette through the use of a pre-developed scoring rubric (Figure 2).
Figure 2. The scoring rubric included 3 categories: creativity, diagnostic accuracy, and argument for best diagnosis.
- The highest combined score determined the Chopped EM
- The goal of the session was to promote collaborative and active learning during a 1-hour time frame of EM conference.
Lessons Learned
- Overall, the activity was well received. A post-session survey showed that 77% of residents would like to see this activity incorporated into future resident educational events.
- Multiple learners pointed out that the activity would be improved upon by having multiple “baskets” with varying ingredients, instead of all teams using the identical set of ingredients to construct their narratives.
- The residents described being the most engaged while interacting in small groups and constructing their narratives.
- Creativity and broad differential diagnoses were encouraged through the use of ambiguous “ingredients.”
- The session proved to be a fun and interactive way to discuss a challenging topic by promoting active learning and collaboration.
Theory Behind the Innovation
- Constructivism4,5 : Learners had to construct knowledge as they used the data provided to them in the basket while applying prior knowledge. While each of them engaged in this activity, residents came together as a group to interact, make meaning of information, and experiment to build a logical and coherent narrative.
- Social Constructivism4,5 : Each individual resident had the opportunity to internalize the experience and build knowledge and skills while interacting with the signs and symptoms provided, as well as with one another. They also learned from one another, scaffolding each other’s learning process.
Read more about the IDEA Series.
References
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