University of North Carolina at Chapel Hill School of Medicine
Three twenty-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. Standardized cases include the following:
Older man with hypoactive delirium after taking Tylenol PM
Older woman with delirium in the setting of possible alcohol withdrawal
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 who have been trained by geriatricians.
Submission includes standardized patient training materials, facilitator training materials, and PowerPoint materials for a didactic pre- and post-session. Finally, pre- and post-surveys to evaluate the learners and the workshop are included.
- To evaluate all older adults for delirium using the Confusion Assessment Method Use.
- To interview an older adult's family member to obtain baseline health information, including activities of daily living and cognitive status.
- To manage delirium without using physical or chemical restraints.
- To consider alcohol withdrawal in an older adult presenting with altered mental status.
- To discuss goals of care with a patient's family member when the patient lacks capacity.
- To consider an adverse medication event as a cause of an older adult's altered mental status.
This workshop may be modified for use by learners from different specialty backgrounds. At our institution, the workshop has been modified for Physical Medicine and Rehabilitation learners. In addition to changes in the patient conditions, patient presentation was changed to the Acute Inpatient Rehabilitation service or the Orthopedic Unit, two places were these learners see patients. The SP/CI pairs were re-trained prior to the workshop when changes were made. As a result, our SP/CI pairs received more training than the recommended two hours. We believe two hours is sufficient to train the SP/CI pairs as long as no changes are made between workshops. We highly recommend that the training sessions be led by a clinical content expert and an educator with experience in training standardized patients.
Finally, due to scheduling conflicts, we were unable to use the same actor pair for the same case with each workshop. Each case was portrayed by at least two actors, which highlighted the fact that some actors perform better than others. We highly recommend that the clinical content expert review the actors' portrayal of the cases before the workshop to ensure accuracy.
This workshop also requires training of faculty facilitators. Learners need feedback from faculty facilitators regarding their evaluation and management. Faculty facilitators must undergo a thorough, standardized training in order to function as effective teachers in this workshop setting. Our faculty facilitators, all of whom had already participated in a faculty development retreat on Geriatric Medicine topics, completed a 1 hour training session led by a geriatrician prior to the workshop. Again, we highly recommend that the facilitators undergo training led by a clinical content expert and receive additional information and training as needed depending on their clinical experience and background.
We recommend that the session occur in a clinical skills lab or an environment that simulates a clinical setting.
This entire workshop takes about 2 to 3 hours to complete when the full didactic session, pre- and post- tests, and program evaluation are included.