Rajagopal Alaina Brinley, Sudario Gabriel, Weiland David, Osborn Megan Boysen
University of California, Irvine, Department of Emergency Medicine, Orange, CA.
J Educ Teach Emerg Med. 2020 Apr 15;5(2):L1-L19. doi: 10.21980/J8D357. eCollection 2020 Apr.
Emergency medicine residents and medical students.
The field of emergency medicine requires learners to build a vast library of illness scripts to be accessible in a rapid manner. Illness scripts are refined and reinforced as senior physicians teach learners common associations between diagnoses, presentation, workup findings, and treatment modalities.1 In order to examine these associations, we developed a didactic session based on the popular television game show "Family Feud" to teach important neurologic conditions related to emergency medicine. This lecture was designed to be an interactive competition, leveraging group participation, competition, and expert opinion.Neurologic emergencies are very common, affecting millions of Americans yearly. It is important for emergency medicine physicians to quickly recognize these conditions and initiate treatment because delay can lead to devastating outcomes.2 The neurologic conditions covered in the lecture were chosen based on the 2016 EM model of clinical practice, sections 7.0: Head, ear, eye, nose, throat disorders, 10.0: Systemic infectious disorders, 12.0: Nervous system disorders, and 19.0: Procedures and skills integral to the practice of emergency medicine, as well as author experience.
By the end of this didactic exercise the learner will: 1) name 13 important neurologic conditions related to emergency medicine: TPA (tissue plasminogen activator) contraindications/TPA eligibility, optic neuritis, botulism, giant cell (temporal) arteritis, viral encephalitis, neurocysticercosis, rabies, myasthenia gravis, neurosyphilis, status epilepticus, Bell's palsy, dementia vs. delirium, acute inflammatory demyelinating polyneuropathy (Guillain-Barré); 2) recognize five pattern words associated with each neurologic condition; 3) understand exam findings, diagnostic tests, and/or treatments for 13 important neurologic conditions.
A survey was sent through a national emergency medicine education listserv (Council of Residency Directors in Emergency Medicine [CORD-EM]) asking educators to list common word or phrase associations that come to mind with a list of neurological diagnoses. A PowerPoint lecture was created in the form of the game, Family Feud, using the data from this national survey. The game Family Feud requires participant teams to guess answers to certain questions by attempting to guess the most popular answers of survey respondents. At our weekly residency conference, residents were divided into teams and offered the opportunity to compete in a game testing knowledge of nervous system disorders. Each neurology topic was then addressed by a mini-lecture to review pertinent concepts in the disease process. There was no formal assessment at the end of this lecture; however, learners actively participated throughout the lecture. Questions were discussed at the end of each round giving learners the opportunity to fully understand topics.
Efficacy of the educational content was assessed based on learner feedback as well as observation of the learners during the exercise.
Learners were engaged with the exercise and verbal feedback was uniformly positive. Learners were enthusiastic about the format and requested more sessions created in a similar game.
Based on feedback as well as observation of the learners, the lecture was both an effective highyield neurology refresher and team-building exercise. Learners enjoyed the opportunity to compete as a team. Gamification seemed to improve student enjoyment, engagement, and attention, which has also been shown in the literature.3 Our residency program intends to implement similar lectures in the future.
Neurology, TPA contraindications, TPA eligibility, upper motor neuron lesion, lower motor neuron lesion, optic neuritis, aphasia, botulism, ACA (anterior cerebral artery) stroke, giant cell (temporal) arteritis, Bell's palsy, viral encephalitis, Todd's paralysis, neurocysticercosis, tonic-clonic seizure, rabies, epidural hematoma, myasthenia gravis, spinal cord injury, neurosyphilis, Glasgow Coma Score (GCS), status epilepticus, Horner's syndrome, subarachnoid hemorrhage, dementia, delirium, Parkinson's disease, acute inflammatory demyelinating polyneuropathy (Guillain-Barré).
急诊医学住院医师和医学生。
急诊医学领域要求学习者构建一个庞大的疾病脚本库，以便能够快速获取。随着资深医师向学习者传授诊断、临床表现、检查结果和治疗方式之间的常见关联，疾病脚本会得到完善和强化。1为了研究这些关联，我们基于广受欢迎的电视游戏节目《家庭问答》开发了一个教学环节，以教授与急诊医学相关的重要神经系统疾病。本次讲座旨在成为一场互动竞赛，充分利用小组参与、竞争和专家意见。神经系统急症非常常见，每年影响数百万美国人。急诊医学医生快速识别这些病症并开始治疗非常重要，因为延误可能导致毁灭性后果。2讲座中涵盖的神经系统疾病是根据2016年急诊医学临床实践模式选定的，包括第7.0节：头、耳、眼、鼻、喉疾病，第10.0节：全身性感染性疾病，第12.0节：神经系统疾病，第19.0节：急诊医学实践中不可或缺的操作和技能，以及作者的经验。
在本次教学活动结束时，学习者将能够：1）说出13种与急诊医学相关的重要神经系统疾病：组织型纤溶酶原激活剂（TPA）禁忌证/TPA适用标准、视神经炎、肉毒中毒、巨细胞（颞）动脉炎、病毒性脑炎、神经囊尾蚴病、狂犬病、重症肌无力、神经梅毒、癫痫持续状态、贝尔麻痹、痴呆与谵妄、急性炎症性脱髓鞘性多发性神经病（吉兰 - 巴雷综合征）；2）识别与每种神经系统疾病相关的五个模式词；3）了解13种重要神经系统疾病的检查结果、诊断测试和/或治疗方法。
通过全国急诊医学教育邮件列表（急诊医学住院医师主任委员会[CORD - EM]）发送了一项调查，要求教育工作者列出与一系列神经系统诊断相关的常见单词或短语关联。利用这项全国性调查的数据，以游戏《家庭问答》的形式创建了一个PowerPoint讲座。游戏《家庭问答》要求参与团队通过尝试猜出调查受访者最常用的答案来猜测某些问题的答案。在我们每周的住院医师会议上，住院医师被分成小组，并有机会参加一场测试神经系统疾病知识的游戏。然后针对每个神经学主题进行一次小型讲座，以复习疾病过程中的相关概念。本次讲座结束时没有进行正式评估；然而，学习者在整个讲座过程中都积极参与。在每一轮结束时讨论问题，让学习者有机会充分理解主题。
根据学习者的反馈以及在活动过程中对学习者的观察来评估教育内容的效果。
学习者积极参与了该活动，口头反馈一致积极。学习者对这种形式很感兴趣，并要求举办更多类似游戏形式的课程。
基于反馈以及对学习者的观察，本次讲座既是一次有效的高产神经学复习课程，也是一次团队建设活动。学习者很享受团队竞赛的机会。游戏化似乎提高了学生的兴趣、参与度和注意力，这在文献中也有体现。3我们的住院医师培训项目打算在未来开展类似的讲座。
神经学、TPA禁忌证、TPA适用标准、上运动神经元损伤、下运动神经元损伤、视神经炎、失语症、肉毒中毒、大脑前动脉（ACA）卒中、巨细胞（颞）动脉炎、贝尔麻痹、病毒性脑炎、托德麻痹、神经囊尾蚴病、强直 - 阵挛性发作、狂犬病、硬膜外血肿、重症肌无力、脊髓损伤、神经梅毒、格拉斯哥昏迷评分（GCS）、癫痫持续状态、霍纳综合征、蛛网膜下腔出血、痴呆、谵妄、帕金森病、急性炎症性脱髓鞘性多发性神经病（吉兰 - 巴雷综合征）。
