MedEdPORTAL (Mar 2014)
An Atypical Cause of Chest Pain: An Octopus Trap
Abstract
Abstract Introduction This clinical case-based simulation is intended to provide learners with experience evaluating acute chest pain in a safe and controlled environment while challenging them to think about the underlying physiology and to develop alternative diagnoses (e.g., Takotsubo cardiomyopathy), as well as to examine rare causes when confronted with unexpected results. The simulation is based on a real patient case seen by one of the authors wherein a patient received an incorrect diagnosis at an outside hospital and was transferred to the author's hospital for catheterization for a presumed myocardial infarction. The simulation is targeted at second-, third-, or fourth-year medical students, residents, and/or cardiology fellows. Methods Students working in groups of four to eight are expected to (1) evaluate the patient with acute chest pain in a hospital setting, (2) demonstrate the ability to asses a differential diagnosis by ordering appropriate testing, and (3) exercise both critical thinking and communication/teamwork in arriving at a differential diagnosis and determining next steps in the evaluation of the patient. Results The simulation was well received by participants (medical students) during a session. They felt that the material covered reinforced their knowledge of topics discussed and that it was quite realistic compared to situations they had experienced in the emergency department. The participants were all satisfied with the experience. Discussion This simulation works best when students are encouraged to think for themselves and use their physiologic reasoning to reach a new conclusion and broaden their differential. Ideally, students would have sufficient background to reach the correct diagnosis, although we have not always found this to be the case in practice. We feel that a preceding lecture involving causes of acute coronary syndrome including Takotsubo cardiomyopathy would be beneficial as it may enable students to more appropriately address the case and reach the correct conclusion. Finally, it is our hope that this simulation will encourage students to engage in physiologic thinking rather than pure pattern recognition (i.e., “Why would a woman with sudden onset chest pain become acutely hypotensive?” vs. “chest pain + troponins = M/I = balloon”).
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