for Clinical Accuracy:
Estimated time to complete:
Background: Dementia, delirium, and depression are core minimum competencies outlined by the AAMC (Association of American Medical Colleges) for medical students by graduation. Focus groups with Hopkins’ medical students found that they had variable clinical experiences with 3Ds during neurology and psychiatry rotations and found it challenging to take a history from a patient with cognitive impairment.
Methods: A joint curriculum was established with psychiatry and neurology core clerkship directors for third and fourth year medical students. Pre-session: PowerPoint with information on 3Ds, mini-cog, 4AT, and PHQ-9. Using pre-recorded simulated videos, students completed worksheets and discussed in class. Additionally we incorporated an in person caregiver interview. We assessed students’ knowledge with in-class audience response questions, pre and post evaluations on how well learning objectives were addressed, and three month post didactic to assess behavior change. This curriculum will be repeated 4 more times during 2015-2016 academic year.
Results: In the first 3 quarters, 64 students completed didactic. Students scored 44-78% correct on 3/6 knowledge test questions (other 3 questions scored >90% correct). Students demonstrated most improvement in use and interpret mini-cog for dementia screen and 4AT for delirium screen as well as communication skills with patients and caregivers. No self-reported change pre and post didactic for students’ ability to differentiating between dementia and depression, or between dementia and delirium. Most importantly, a majority of students identified the importance of communicating with caregivers and providing support not only for the patient, but also for the caregiver. At three months follow up survey (75% completion rate), students identified communication techniques and understanding caregiver’s challenges as the most useful “take home” points from didactic.
Conclusions: Overall the 3D didactic was well received by medical students. They improved in identifying when to use screening tools for 3Ds, which may translate from knowledge to behavior at their next rotations. They also overwhelmingly identified the importance of communicating and assessing caregivers’ needs. More data will be collected during additional sessions this academic year. This curriculum could be easily disseminated without much additional resources.
Knowledge & Skills objectives:
1. Recognize, compare and contrast delirium, dementia, and depression in various clinical presentations.
2. Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits delirium, dementia, or depression by evaluating video interviews among patient, caregiver, and provider triad communication skills.
3. Assess an older patient with delirium, initiate a diagnostic work-up to determine the root cause (etiology), by identifying predisposing factors and differential diagnosis of delirium, by utilizing non pharmacologic strategies for delirium.
4. Perform and interpret a cognitive assessment in older patients for whom there are concerns regarding memory or function by demonstrating the ability to differentiate the result of 4AT (rapid assessment test of delirium) based on video interview of delirious patient. Proficiency to use Mini-Mental Status Exam (MMSE)and mini-cog to determine cognitive impairment.
• ≥ 95% of medical students in neurology and psychiatry rotation will attend the dementia day.
• Of students who attended didactic in person, 100% of the medical students will have demonstrated the ability to distinguish dementia, delirium, and depression using worksheets based on video interviews.
Publications from, presentations from, and/or citations to this product:
AGS poster presentation 2016
AGS Educational Showcase 2016
Date Submitted or Reviewed/Updated for Clinical Accuracy:
3D (dementia, depression, delirium) Flipped Classroom Didactic for Medical Students. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1052