MedEdPORTAL (Apr 2013)
Three Standardized Patient Cases to Teach the Confusion Assessment Method to Diagnose Delirium
Abstract
Abstract Introduction Delirium is a serious and underrecognized medical condition associated with increased mortality and morbidity. As the population ages, almost all health professionals will need to know how to diagnose, evaluate, and manage delirium. This workshop was developed by geriatricians and emergency medicine physicians, as part of The Donald W. Reynolds Next Steps in Physicians' Training in Geriatrics grant, to allow learners the opportunity to practice the Confusion Assessment Method. Methods Three 20-minute standardized patient encounters that are designed for learners of all levels and backgrounds to teach the Confusion Assessment Method and the diagnosis, evaluation, and management of delirium. The standardized cases include the following scenarios: (1) older man with active delirium after taking Tylenol PM, (2) older woman with delirium in the setting of possible alcohol withdrawal, (3) older woman with terminal cancer presenting with delirium. Each case is designed to require the learner to interact with the patient's family member to obtain information about the acuity of the mental status change. There are no physical exams included but these could be added if desired. Feedback to the learners is provided by faculty facilitators who are geriatricians or specialty faculty trained by geriatricians. Provided materials include standardized patient training materials, facilitator training materials, PowerPoint materials for a pre- and postsession didactic lecture, and pre- and postsurveys to evaluate the learners and the workshop. Results The workshop has been used to train 18 faculty learners, ranging from department heads to medical school deans, 16 emergency medicine residents, four nurses, and nine hematology-oncology fellows. Pre- and posttests incorporating a Likert scale (1 = poor, 5 = excellent) were used to evaluate the program for the 16 emergency medicine residents and four nurses. The average score for the overall effectiveness of the workshop was a 4.28 (SD = 0.50). The average score for the reality of the standardized patients was 4.61, (SD = 0.67). Additionally, both aggregate knowledge and confidence scores increased from pre- to posttest. Initial knowledge scores, (2.80, SD = 0.83), increased to (3.28, SD = 0.58). Discussion This curriculum provides an active learning environment with standardized patients to teach about delirium. Pre- and posttest results indicate statistically significant improvement in knowledge about delirium and confidence in caring for patients with delirium.
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