MedEdPORTAL (Oct 2013)
TBL: Navigating Delirium, Polypharmacy and Home Care Services with an Elderly Emergency Department Patient
Abstract
Abstract Residency Programs must comply with the ACGME's Next Accreditation System (NAS) milestone performance tracking and reporting requirements and consider Entrustable Professional Activities (EPAs) to measure resident performance. At the Medical College of Wisconsin (MCW), geriatricians and emergency medicine physicians worked together to create and implement a geriatrics education Team-based Learning (TBL) for emergency medicine (EM) residents. Key curriculum content gaps (delirium, polypharmacy, and available home care services) were identified through EM resident knowledge/ performance gaps on a needs assessment survey/pretest. Curriculum content was delivered using a TBL approach: a performance-based instructional approach emphasizing what learners must “know” through individual assessment of pre-work followed by what learners must “do” through small group application exercises. Residents self-assessed their competency level in those EPAs both pre and post TBL curriculum intervention (Unable to Perform (1) - Teach Others (5)). Residents' pre-session work included reading of a delirium review article and reviewing a list of high risk medications in geriatric patients. Class session work included readiness assessment through individual and group assessment questions, and then knowledge application exercises with structured debriefing/discussions using a geriatric emergency medicine patient case and an interactive home care respondent panel discussion. Results of the Post TBL session evaluations showed 63% (N=16) of residents rating “Instructional strategies advanced my learning about geriatrics” as very good/excellent. Session strengths included, “multifaceted educational approach was very helpful”, and “great discussions.” Pre/post EPA ratings revealed shift to competence: “Identify delirium using history taking and cognitive exam” (can perform independently), PGY1 (0 to 100%), PGY2 (50 to 63%), PGY3 (43 to 100%). The EPA item, “Discuss available home care services” (can perform with minimal supervision) showed pre/post change PGY1 (29 to 100%), PGY2 (25 to 63%), PGY3 (28-100%). Our curricular session demonstrated that TBL is an effective, well received instructional method to teach and assess resident EPAs in geriatrics related ACGME Competencies/Milestones.
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