Cards Against Pulmonology

This card game is designed to cultivate educational discussion among emergency medicine resident physicians about the assessment, treatment, and disposition of key pediatric and adult thoracic-respiratory diagnoses in a fun, casual environment. It could also be played by emergency medicine-bound medical students.

Emergency department visits related to the thoracic-respiratory system are common complaints in both the pediatric and adult populations. In the United States, for several years prior to the Covid-19 pandemic, respiratory system diseases accounted for about 10.6% of ED visits.1 In children, respiratory complaints make up the largest percentage of their ED visits, particularly in the fall and winter seasons.2 This number appears to have only grown higher in both adults and pediatrics in the years following the Covid-19 pandemic.3 Thoracic-respiratory disorders also account for about 7% of the American Board of Emergency Medicine In-Training Exam and qualifying exam content.4 Therefore, it is paramount that resident physicians understand the presentation, management, and treatment of a wide range of both pediatric and adult thoracic-respiratory complaints and pathology that mimics these presentations. This game explores key topics in the thoracic-respiratory system in both the pediatric and adult populations allowing for fun discussion regarding management, treatment, and disposition of these complicated disease processes. Topics range from sick to not sick patients and include bronchiolitis, pulmonary edema, pulmonary embolism, COPD exacerbation, neonatal cyanosis, viral upper respiratory infections, and more.

By the end of this card game, learners will 1) understand the methods of clinical assessment in thoracic-respiratory related diseases, 2) implement escalating levels of respiratory support for thoracic-respiratory pathology in pediatric and adult patients, 3) review and utilize important medications in the management of thoracic-respiratory diseases, and 4) choose appropriate dispositions of patients with various thoracic-respiratory related complaints.

The goal of Cards Against Pulmonology is for learners to further understand the clinical assessment, management, and disposition of various thoracic-respiratory emergencies by providing the next best critical action in a given clinical situation. This game will equip residents to differentiate the sick from non-sick patients and collaboratively discuss the management and disposition of patients with a variety of thoracic-respiratory related complaints.This card game is a cognitive artifact designed to stimulate small group discussion that will enhance the clinical reasoning skills of the medical students and resident physicians who play the game. The clinical content of thoracic-respiratory conditions has been gamified through the strategy of play modeled after the popular card game, Cards Against Humanity. Discussion of key educational points during and after the game provides clarification of learner knowledge to solidify concepts.

The game was implemented in a weekly resident educational conference session where 19 resident physicians and several faculty physicians participated in gameplay and immediately following the game, evaluated the educational experience by survey using a Likert scale. They assessed their overall experience with the game, engagement with the game, the game's ability to reinforce existing medical knowledge, and if game content was relevant to their clinical practice.

The results were overwhelmingly positive with an average of strongly agreed on every Likert scale in every category and a request for the creation of other similar games covering more topics. Resident physicians stated they appreciated being able to laugh and learn, and that the inclusion of case discussion after a case concluded really emphasized the educational points regarding the medical care of patients with respiratory complaints. They encouraged increased discussion of the medicine after each round.

Overall, this game was very effective in stimulating conversation regarding the care of patients with thoracic-respiratory related complaints. All medical students, residents, and attending physicians were very engaged and remained excited throughout gameplay. Implementation of the game showed the appropriate small group size is about five to six players to allow for robust discussion and engagement. It is also important for the facilitators to discuss expected outcomes for the patient at the conclusion of a set of case cards to encourage educational value alongside humorous game play.

Pulmonology, thoracic-respiratory system, shortness of breath, cough, viral respiratory infection, bronchiolitis, asthma, COPD, pulmonary edema, pediatric respiratory conditions.