MedEdPORTAL (Apr 2016)
Training Residents in a Best-Practice Approach to the Diagnosis and Management of Alzheimer's Disease
Abstract
Abstract Introduction Alzheimer's disease (AD) is the most common cause of dementia, affecting 5.4 million Americans, yet the diagnosis is frequently missed by physicians. Potential challenges in evaluating AD include both cultural and medical origins. As a result, the approach to delivering an AD diagnosis is variable in the medical community and has the potential to emotionally impact the patient and caregiver. To address this an observed structured clinical examination (OSCE) was developed to provide neurology residents with a foundation for the diagnosis and management of AD. Methods An introductory instructional video, dementia curriculum, and case study were circulated 1 week prior to the exercise to establish expectations for the OSCE. For the exercise, neurology residents within their postgraduate training years one to four (PGY1-PGY4) were asked to communicate the news of an AD diagnosis to a standardized patient–caregiver dyad. Neurology faculty remotely evaluated residents on their ability to provide an accurate diagnosis and prognosis, respond to family's questions, and formulate a treatment plan that included both pharmacological and nonpharmacological interventions. In addition, learners were scored based on their communication skills. Results Seventeen neurology residents completed the OSCE with a mean performance score of 70.5%. In anticipation of the simulation, 82% (14/17) of residents reviewed the preparatory educational materials. In postfeedback surveys the majority of faculty (N = 6) agreed that they received useful information about trainees' skills from the session. Discussion We conclude that the assessment of a resident's ability to deliver an AD diagnosis in a simulated environment is an effective method to assess and enhance a learner's ability to effectively communicate bad news to patients and families.
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