Hypertensive Emergency Team-Based Learning
Abstract
Audience: The target audiences for this team-based learning (TBL) activity are resident physicians andmedical students.
Introduction: According to the Centers for Disease Control and Prevention (CDC), nearly half of the adults inthe United States have hypertension,1 which is a leading cause of cardiovascular disease and prematuredeath.2 In extreme cases, patients may present in hypertensive emergencies, defined as an acute, markedelevation of systolic blood pressure >180mmHg or diastolic blood pressure >120mmHg with evidence oforgan dysfunction.3,4 Patients presenting to the emergency department (ED) with symptoms of hypertensiveemergencies must be promptly diagnosed and treated to prevent further morbidity and mortality. This TBLutilizes four clinical cases to educate resident physicians and medical students not only on the recognition ofhypertensive emergencies, but also on the workup, management, and disposition of patients who present tothe ED with hypertension.udience: The target audiences for this team-based learning (TBL) activity are resident physicians andmedical students.
Educational Objectives:By the end of this TBL session, learners should be able to: 1) define features ofasymptomatic hypertension versus hypertensive emergency, 2) discuss which patients with elevated bloodpressure may require further diagnostic workup and intervention, 3) identify a differential diagnosis forpatients presenting with elevated blood pressures, 4) recognize the features of different types of end-organdamage, 5) review an algorithm for the pharmacologic management of hypertensive emergencies, 6) indicatedosing and routes of various anti-hypertensive medications, 7) choose the appropriate treatment for apatient who is hypertensive and presenting with flash pulmonary edema, 8) identify an aortic dissection oncomputed tomography (CT), 9) choose the appropriate treatment for a patient who is hypertensive andpresenting with an aortic dissection, 10) identify intracranial hemorrhage on CT, 11) choose the appropriatetreatment for a patient who is hypertensive and presenting with an intracranial hemorrhage, and 12)describe the intervention for warfarin reversal.
Educational Methods: This is a classic TBL that includes an individual readiness assessment test (iRAT), amultiple-choice group readiness assessment test (gRAT), and a group application exercise (GAE).
Research Methods: Learners and instructors were given the opportunity to provide verbal feedback aftercompletion of the TBL. Learners included senior medical students and first-, second-, and third-yearemergency-medicine residents. Learners were specifically asked if they felt the cases were educational,relevant, and useful to their training.
Results: Six resident physicians and three medical students volunteered their verbal feedback, and agreedwhen they were specifically asked if the cases were educational, relevant, and useful to their training. Thesame learners also agreed when asked if they felt the TBL was a more enjoyable activity than a direct lectureto refresh their knowledge and skills. One instructor observed that interns and medical students weregenerally able to reach a correct diagnosis; however, they seemed to struggle more with describingappropriate pharmacologic interventions when compared to more senior learners.
Discussion: Hypertension is a common complaint and incidental finding in patients presenting to the ED.Given its non-specific value, it can be a difficult topic for the novice healthcare provider to master. Thedifferential diagnosis for a patient presenting with hypertension is vast, ranging from benign to emergent,and can sometimes necessitate minimal to substantial workups. Thus, this TBL is a useful, relevant, andeffective exercise for residents-in-training to review and understand the management of hypertension.