‘We don’t need no education…’ Teaching about delirium in medical schools

Dr Claire Copeland is a Consultant Physician in Care of the Elderly and Stroke Medicine at Forth Valley Royal Hospital. Her paper Development of an international undergraduate curriculum for delirium using a modified Delphi process has recently been published in Age and Ageing. She tweets at @Sparklystar55

Back in 2015 a workshop at the European Delirium Association (EDA) conference was held to bring together a group of delirium experts. Its purpose? To develop a consensus agreement on a delirium curriculum for medical undergraduates.

Most of you reading this I’m sure will be familiar with delirium. It’s technically been around for centuries. However there are many working in healthcare who still do not know about it. Or if they do, they refer to it by every other name except delirium.

With an incidence of ~20% and with one paper stating for every additional 48 hours of active delirium, mortality increased by 11%, ignorance is no longer acceptable. There is a pressing need to do something that goes beyond merely raising awareness.

Going into this work we knew that delirium was already taught in Medical Schools. However its delivery was inconsistent and there was a widespread failure to address attitudes and beliefs.

By introducing delirium at Medical School in a more structured and coherent fashion you are investing in something that could positively impact every aspect of healthcare. We know from previous educational interventions there’s improved delirium recognition, its severity is reduced and you see a reduced length of hospital stay. Trying to put an economic perspective on that previous statement it’s worth noting that complications of delirium are estimated at a mean total cost of £13,000 per admission.

So, how to approach this mammoth task? We decided to use a Delphi process. They have been used in previous education initiatives as a means of defining and refining statements until consensus is reached. A good example within Geriatrics is the work that T Masud et al carried out to define an undergraduate curriculum for geriatric medicine across Europe.

First however we needed to find our experts. The EDA is the largest international meeting for delirium specialists, attracting an international, multi-disciplinary audience including those in the fields of delirium research and clinical practice.  In other words, it was perfect forum from which to get our experts!

Myself, Andy Teodorczuk and James Fisher organised a workshop to gather said individuals together. James opened it with a short presentation on what had been done in the world of delirium education. We then split people into small groups to discuss the crux of the work:

  1. What should be taught?
  2. How should teaching be delivered?
  3. Who should deliver the teaching?
  4. Where should the teaching be delivered?
  5. When should the teaching be delivered?

With the groundwork done, the task to define the criteria and wording began. In order to ensure anonymity and for ease of contact we used SurveyMonkey.

As you might imagine, giving a group of experts the opportunity to share their opinions and to debate and discuss the subtleties of how learning outcomes on delirium ought to be worded, meant there was a lot for us to work through. That said, we got there (80% agreement) after only 3 rounds.

One of the main themes that came out was involvement of carers and families in teaching on delirium. Technology-based learning such as simulation also featured – one could argue its role is invaluable as a possible surrogate when relatives or carers are not available. Both are huge drivers of reflective learning and in turn can challenge attitudes and behaviours.

We appreciate that undergraduate curricula are already over-crowded and that trying to fit in even more isn’t always possible. However, we would argue that the prevalence of cognitive disorders including delirium, is only set to rise in the future and therefore we must consider delirium to be core business for the doctors of tomorrow.

It is our hope that by calling on Medical Schools to integrate this curriculum we are laying a foundation of excellence in delirium care.

The full article, development of an international undergraduate curriculum for delirium using a modified delphi process, can be read on the Age and Ageing website.

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