Ken is a second year Emergency Medicine resident who just received the following feedback from his attending: “The shift went well, but as you continue in your training, it is important to think about the flow of the department”. Ken acknowledges that managing the department is something he needs to learn, but he wishes there was a way he could practice his department flow skills even as a junior resident.
This Feature Educational Innovation (FEI), titled, “GridlockED: An Emergency Medicine Game and Teaching Tool” was originally posted by the CAEP EWG FEI Team in 2018 and answers the question: “How can we train residents to manage flow in the Emergency Department?” A PDF version is available.
Description of Innovation
Management of patient flow through the Emergency Department (ED) is a crucial skill for Emergency Physicians to master. Much like resuscitation and multi-patient scenarios, ED management is a skill more suited to learning through real-life or simulation-based education. Unfortunately, it’s generally not feasible to give a trainee the full experience of managing an entire ED in a real-life setting until quite late in their training, if at all. The more typical arrangement is for trainees to manage a subset of emergency patients, while the supervising staff oversees the department. Unfortunately, this tactic falls short in exposing trainees to the true pressures involved in this task, and Emergency Medicine (EM) residents will graduate to a staff position without ever having become proficient in this skill. Simulation-based approaches would be ideal, but are prohibitively resource-heavy for most programs.
GridlockED was developed to address these challenges by creating a simulation-type experience with real-life patient scenarios and barriers to patient flow, such as bed-blocks, staffing shortages, and resource limitations. The authors designed GridlockED as a collaborative, serious board game that would allow EM learners to experience the role of managing the ED, and to experiment with different strategies to optimize patient flow.
Initial Prototype Development
Drs. Teresa Chan and Mathew Mercuri originally brainstormed the idea based on their own research. GridlockED was subsequently prototyped and developed further at the Niagara Regional Campus of McMaster University by a group of undergraduate medical students interested in EM, under the guidance of Dr. Chan. Once the bare bones of the game had been created, along with a prototype, the game was improved via a series of Plan-Do-Study-Act cycles with McMaster trainees and Hamilton Health Sciences/St. Joseph’s Hamilton staff. Over the next 18 months the game was played by a variety of undergraduate medical students, EM residents and staff physicians, non-physician scientists, and nurses. Observations and feedback were incorporated into the game until the final version was developed.
The development process required a lot of person-hours, but more tangible resource requirements were minimal. The original game board was drawn on Bristol board, with game cards printed on regular paper, and game pieces bought from a dollar store. Over the months the components have been upgraded through the time, effort, and financial investments of several collaborators. The authors recruited three high school students with graphic design talents to create the templates for the game board and cards. The team then used an online infographic editor and database to produce the final game and its components.
GridlockED was developed based on information from a comprehensive literature review. The authors found that learners really enjoy learning through serious board games. Serious games are a genre of games wherein the point of the game is to learn a specific teaching point, rather than to engage in fun; Fun is allowed to be, of course, a byproduct of the game. Within medicine, there are several reports of using this strategy for learning a variety of information, but GridlockED will be the first that targets systems learning and skill development, rather than tangible knowledge (e.g. hand washing).
The most important lesson learned is the importance of seeking input from a wide range of healthcare professionals and non-healthcare gaming enthusiasts. With each formal and informal trial group valuable feedback was gleaned and incorporated into gameplay and design. It was this feedback that guided the game’s progression from a vague concept on a napkin to the exciting innovation that exists today!
Learning how to manage patient flow through the Emergency Department is a crucial skill for Emergency Medicine trainees to develop, however, an effective teaching approach has been difficult to establish. GridlockED was designed to tackle this challenge by integrating simulation-based learning and collaboration through a serious, educational, yet entertaining board game. GridlockED allows trainees to improve their patient management skills by applying strategies to a simulated Emergency Department that realistically emulates the wide range of patient presentations, unpredictable nature of each shift, challenges of resource limitations, and importance of prioritizing the most acute patients. Feel free to contact the team (firstname.lastname@example.org) if you have questions. Also check out their website to read more about our exciting innovation!
How does your institution teach your EM learners to manage department flow?
How could the GridlockED game be used at your institution ?
More about CAEP FEI
This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Feature Educational Innovations project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive FEI each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.
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