Original Publication
Open Access

TBL: Navigating Delirium, Polypharmacy and Home Care Services with an Elderly Emergency Department Patient

Published: October 30, 2013 | 10.15766/mep_2374-8265.9599

Included in this publication:

  • Confusion Assessment Method Test.docx
  • Curriculum Session Agenda Educator Version.docx.docx
  • Curriculum Session Agenda Resident Version.docx
  • Curriculum TBL Case Educator Version.doc
  • Curriculum TBL Case Resident Version.doc
  • Delirium in brief.ppt
  • Instructor's Guide.docx
  • List of High Risk Medications in Geriatric Patients.pdf
  • Session Competency Needs Assessment & Pre.Post Test Resident Version.docx
  • iRAT.gRAT Questions Educator Version.doc
  • iRAT.gRAT Questions Resident Version.doc

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Residency Programs must comply with the ACGME’s Next Accreditation System (NAS) milestone performance tracking and reporting requirements and consider Entrustable Professional Activities (EPAs) to measure resident performance. At the Medical College of Wisconsin (MCW), geriatricians and emergency medicine physicians worked together to create and implement a geriatrics education Team-based Learning (TBL) for emergency medicine (EM) residents. Key curriculum content gaps (delirium, polypharmacy, and available home care services) were identified through EM resident knowledge/ performance gaps on a needs assessment survey/pretest.

Curriculum content was delivered using a TBL approach: a performance-based instructional approach emphasizing what learners must “know” through individual assessment of pre-work followed by what learners must “do” through small group application exercises. Residents self-assessed their competency level in those EPAs both pre and post TBL curriculum intervention (Unable to Perform (1) - Teach Others (5)). Residents’ pre-session work included reading of a delirium review article and reviewing a list of high risk medications in geriatric patients. Class session work included readiness assessment through individual and group assessment questions, and then knowledge application exercises with structured debriefing/discussions using a geriatric emergency medicine patient case and an interactive home care respondent panel discussion.

Results of the Post TBL session evaluations showed 63% (N=16) of residents rating “Instructional strategies advanced my learning about geriatrics” as very good/excellent. Session strengths included, “multifaceted educational approach was very helpful”, and “great discussions.” Pre/post EPA ratings revealed shift to competence: “Identify delirium using history taking and cognitive exam” (can perform independently), PGY1 (0 to 100%), PGY2 (50 to 63%), PGY3 (43 to 100%). The EPA item, “Discuss available home care services” (can perform with minimal supervision) showed pre/post change PGY1 (29 to 100%), PGY2 (25 to 63%), PGY3 (28-100%).

Our curricular session demonstrated that TBL is an effective, well received instructional method to teach and assess resident EPAs in geriatrics related ACGME Competencies/Milestones.

Educational Objectives

  1. Identify agitated and hypoactive delirium using history taking and cognitive exam.
  2. Assess patient medical decision making capacity by history taking and performing a cognitive exam.
  3. Identify high risk medications in geriatric patients.
  4. Assess elderly patient’s ability (medically, cognitively, functionally) to return home safely.
  5. Discuss with patients at safety risk, available/needed home care services.

Author Information

  • Kathryn Denson, MD: Medical College of Wisconsin
  • Gabriel Manzi: Medical College of Wisconsin
  • Colleen Crowe: Medical College of Wisconsin
  • Judith Rehm: Medical College of Wisconsin

None to report.

This resaerch was supported by the Donald W. Reynolds Foundation.


Denson K, Manzi G, Crowe C, Rehm J. TBL: navigating delirium, polypharmacy and home care services with an elderly emergency department patient. MedEdPORTAL. 2013;9:9599. https://doi.org/10.15766/mep_2374-8265.9599