The Suicidal Patient in the Emergency Department Team-Based Learning Activity.

Audience: Emergency medicine resident physicians, (PGY1-4), medical students rotating in the emergency department.

Introduction/background: Emergency physicians have a duty to recognize and provide care for patients who attempt to harm themselves or commit suicide. Mental health-related chief complaints account for 12.5% of emergency department (ED) visits.1 Additionally, patients with depressive symptoms who are discharged from the ED are at the highest risk for suicidal thoughts and behaviors.1 Therefore, evaluating and screening for suicide and determining appropriate dispositions for this patient population is extremely important. This team-based learning (TBL) activity will help prepare residents and medical students to evaluate, recognize, and disposition this at-risk patient population.

Educational objectives: By the end of the session, participants will be able to: 1) describe risk factors for suicide; 2) summarize the emergency physician's role in assessing patients with psychiatric emergencies; 3) assess a patient using a mental status evaluation; 4) identify the criteria for involuntary psychiatric hold placement; 5) develop a safe discharge plan for patients experiencing depression; and 6) Formulate a plan for evaluating a suicidal patient who is acutely intoxicated.

Educational methods: This team-based learning activity is a classic TBL that includes learner responsible content (LRC), an individual readiness assessment test (iRAT), a multiple choice group readiness assessment test (gRAT) with immediate feedback assessment technique (IF/AT), and a group application exercise (GAE).

Research methods: A post-TBL survey was provided to each participant. A Likert scale was used for the survey questions to assess the relevance of the session to emergency medicine practice, learner perception of knowledge gained, learner perception of improvement of clinical practice, session engagement, and session delivery.

Results: The post-activity evaluation had a response rate of 33% (11/33). Overall, all the participants "strongly agreed" (Likert 5/5) or "agreed" (Likert 4/5) that the session improved their knowledge of caring for the suicidal patient in the ED with an average score of 4.6/5. All participants "strongly agreed" (Likert 5/5) or "agreed" (Likert 4/5) that the material presented was relevant to their clinical practice in the ED for an average score of 4.6/5. Constructive feedback included requesting learner responsible content (LRC) be sent earlier than one week prior to the activity.

Discussion: Depression and suicidal ideation are common ED complaints. However, it can be difficult to evaluate these patients and select an appropriate disposition because their symptoms can range from benign to life-threatening. The team-based learning (TBL) session allows for discussion of the complexities of the depressed and suicidal patient. Learners found this TBL to be beneficial in providing a diagnostic pathway and treatment algorithm to manage these complex, high-risk patients.

Topics: Suicide, depression, substance abuse, disposition, team-based learning.