Playing the game of emergency medicine

The best way to learn a subject is to teach it. This has become obvious to me during the last few months, when I have been responsible for the teaching of the new doctors in our emergency department. Since they are not enrolled in any residency program, it has been all up to me to decide how and what to teach.

Not only have I had to revise all the subjects we have been discussing, I have also tried to learn how to become a better teacher. Therefor we have concluded every four-hour session with an evaluation. In general no one has anything negative to say. I don’t think they like to be critical when they can see how much effort I put into this, but something that does come up frequently is the request for more interactivity. Saying interesting things is just not enough to keep people awake and receptive. So I decided to try a concept I had come up with before: Brainstorm for meducation.

Brainstorm is a quiz-style board game, that I play with my friends. The question takes the form of a topic, and the playing team has to rapidly mention as many things fitting under that topic as possible. When the time is up, the players’ answers are checked against a checklist on the question card. Every answer found on the checklist is worth one point, or two points for more difficult ones. The original game has topics like ”Things you eat at a birthday party”. My version has topics that we have covered during earlier sessions, such as ”Signs and symptoms of hypocalcemia” or ”Possible causes of lower back pain”.

So, this is how it works. A team should have three or four members and I think it is hard to handle more than four teams. To involve as many people as possible in every question I let someone from the opposite teams read the question and mark the correct answers on the card. Every card has a topic with five to ten correct answers. I choose relevant answers from Medscape, so that it is easy to go back to the source if there is any controversy. To avoid unnecessary frustration and endless debates, I thoroughly inform the participants that if an answer is correct, but not on the card, they won’t get any points. Another person writes all the answers on the white board. I have tried both two and three minutes per question and I think two minutes are usually enough.
So for two minutes the whole team is brainstorming around the subject, creating an atmosphere where saying the right thing is less important than coming up with many suggestions. Often wrong answers are corrected by other team members, but it is somehow less intimidating and embarrassing to say stupid things when you are playing a game. And misconceptions are always important to bring out, so they can be replaced by a deeper and more correct understanding.

When time is up, the answers on the board are compared to the ones on the card. Now the group’s collective knowledge has been brought out, and this is when the actual teaching takes place. I highlight and elaborate on some of the answers and also address the wrong ones. It is brief and intense, and nobody dozes off.

The first time we tried this everyone was extremely positive and when it wasn’t included in the next session, they were disappointed. So now I have decided to make it a part of every session. With three teams they can do two questions each in one hour. Normally, a board game gets boring when you use old questions, because you already know the answers, but here that is exactly the point. The old cards can be used over and over, and new ones can be included. My plan is to add at least two new cards after every session, to repeat what has been taught that day. I am also considering adding bonus cards with more specific questions like ”How to calculate the osmolar gap” or ”Branches of the celiac trunk”, for teams that score a certain point.

Unfortunately, I won’t be able to develop this any further, since I am leaving my position. I will keep the cards, though, and maybe challenge some of the other EM nerds over a beer sometime.