MP24: Contagion: An innovative approach to learning the Orange Book and Choosing Wisely Canada guidelines around antimicrobial treatment

Innovation Concept: The Orange Book (OB) identifies drugs approved on the basis of safety and effectiveness by the FDA and serves as the gold standard reference for correct pharmacological therapies. It ties in closely with Choosing Wisely Canada (CWC) modelling good stewardship in antimicrobial prescriptions. The book focuses on passive didactic learning instead of active learning, which was shown to have a greater influence on prescribing behaviour. Educational video games, a form of active learning, have been shown to improve clinical skills in medical training. Contagion is a role-playing video game providing an active way of teaching antimicrobial components of the OB and CWC guidelines. Method: Phase I of Contagion was qualitatively tested on students and physicians at McMaster University for teaching effectiveness, applicability to real-life scenarios, and enjoyability. Post-game play 12 participants scored different aspects of the game on a Likert scale. Curriculum, Tool, or Material: The player is a rural physician treating infections in various communities. Each round, the player is given a crate of antibiotics. As communities are infected, the player is provided with clinical symptoms the patients present with. The player must identify the pathology and then correctly treat the communities. The player can treat empirically or order tests to identify the infectious organism. The player strategically navigates which communities to treat as there are limited actions per turn and the player must prevent communities from dying or infecting neighboring regions. Communities tend to build antibiotic resistance over time making first-line treatments unviable, thus careful strategizing and stewardship is essential. Active learning will occur when players are tasked with finding the correct answer to different presentations. After each turn, players will learn about the infecting organism, its phenotypes, and common infectious symptoms. This is considered passive learning. Conclusion: Contagion was well-received by physicians and medical students as an active learning tool to teach the OB and CWC guidelines. On preliminary user testing Contagion scored 5 in effectiveness in teaching treatments and 4.6 in teaching stewardship. An objective of this project is to perform large scale testing across schools to demonstrate the effectiveness of the learning components of the game. We hope to eventually create a tool that can be incorporated in continuing medical education for physicians.

Substance misuse disorders on the psychiatric ward

The focus of this chapter is the management of substance misuse and addiction on the psychiatric ward in patients who have presented with a psychiatric disorder. Some patients will display other forms of addictive behaviour such as gambling, sexual activity, or Internet use. Where this is not the primary focus, the same principles of broad-based biopsychosocial management apply. There are a number of guidelines available, such as those from the Department of Health (the ‘Orange Book’) and the National Institute for Health and Care Excellence, and prescribing advice, such as the British Association for Psychopharmacology guidelines and The Maudsley Prescribing Guidelines in Psychiatry, that are useful references for the treatment of patients with substance misuse disorders and addiction. This chapter does not seek to replicate this advice, but does include useful and common scenarios that will be encountered on the general psychiatric ward.