MedEdPORTAL (Jul 2006)
The “Three D's” of Cognitive Impairment: An Interactive Card-sorting Exercise
Abstract
Abstract Introduction Diagnoses related to cognitive impairment (i.e., delirium, depression, and dementia) have presentation, diagnosis, and/or treatment elements that are be closely related to one another or are controversial. We created an activity that involves an interactive and cooperative card-sorting exercise that provides an opportunity for participants to test their knowledge of diagnoses related to cognitive impairment in a small group. Methods The activity involves providing a group of third- and fourth-year medical students with a series of cards that list a characteristic of one of the three diagnoses. The group then sorts the cards into the three diagnostic categories. Since the intention of the game is to mirror the ambiguous presentations of cognitive impairment in the elderly, many of the items were meant to be applicable to two or more categories. This then would obligate the participants to reason out loud their choices to the group. Although there may be debate over which category some characteristics fit best, the items were rated by experts (geriatricians, and geriatric psychiatrists) on a 0 to 2 scale in order to establish a consensus opinion on which items might best be used in the evaluation exercise. Each item was determined by each rater for a best fit in dementia, delirium, or depression. Results Evaluation of this activity has been ongoing at the University of Miami Leonard M. Miller School of Medicine. On a 5-point Likert scale, the majority of the student participants in 2005 (N = 72) felt the objectives of the card sorting session were clearly specified (M = 4.3), understood the activity (M = 4.3), and were able to participate actively (M = 4.4). In a self-reported pre- and postactivity survey, the majority of participants felt their ability to distinguish between dementia, delirium, and depression was improved after participating in this activity (pretest M = 3.7, posttest M = 4.5). Furthermore, the majority felt their ability to distinguish between the tools to screen or diagnose dementia, delirium, and depression was improved after this activity (pretest M = 3.6, posttest M = 4.3). Discussion This card sorting exercise is an interactive small-group exercise that helps third- and fourth-year medical students distinguish between aspects of dementia, depression, and delirium. At the same time, the teaching modality promotes peer teaching and self-directed learning.
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