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Open Access Publications from the University of California

Case-Based Curriculum for Assessing Decision Making Capacity in the ED

Creative Commons 'BY' version 4.0 license

Learning Objectives: The goal of this curriculum is to provide emergency medicine residents a framework for assessing decision making capacity in the ED and apply these skills to several case scenarios to practice making nuanced capacity decisions.

Introduction: In the ED, physicians often meet patients for the first time during critical, time-sensitive situations. The ability to quickly and effectively assess decision making capacity is a crucial skill. We are unaware of any formal curricula about assessing decision-making capacity tailored to the challenges faced in the ED. Thus, we designed a curriculum to provide EM residents a framework to evaluate decision-making capacity.

Educational Objectives: By the end of this workshop, EM residents should be able to: -List the four elements of a capacity assessment -Apply these four elements to specific cases to assess a patient’s capacity -Differentiate between functional status, capacity and competency.

Curricular Design: This was a two hour in person workshop for PGY-2 EM residents. It consisted of a 30 minute didactic session followed by small group case discussions of three clinical scenarios commonly encountered in the ED. Each case aimed to highlight different challenges in assessing capacity and allow learners to apply content from the lecture. An attending physician led each small group and was equipped with a facilitator guide to direct the discussion. The content of the lecture and case discussions were informed by a comprehensive literature review and designed by two EM physicians, as well as an emergency psychiatrist. A curriculum evaluation was distributed to all participants.

Impact Effectiveness: This is the first curriculum that addresses evaluating decision making capacity in the ED. Given the comprehensive facilitator guide, it can be easily reproduced at other institutions. It was extremely effective as evidenced by 100% (11/11) of the participants being able to identify the components of the capacity assessment and 90% (10/11) feeling more confident in determining decision-making capacity in high stress situations. Going forward, we plan to alter some of the case details based on feedback from residents.

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