AI in the ER: Using ChatGPT to Create Teaching Cases

As emergency physicians tasked with training the next generation of residents, it’s imperative to explore new tools and methods to enhance the learning experience. Enter ChatGPT, the powerful AI language model developed by OpenAI. In this blog post, we’ll delve into how emergency physicians can leverage ChatGPT to craft compelling and instructive teaching cases. This can save significant time and effort—and produce accurate and helpful learning material for EM residents. We’ll use the following example of a woman with severe abdominal pain.

Emergency Room Teaching Case: Abdominal Pain Evaluation in a Female Patient

Step 1: Write up the scenario overview as you typically would:

A 30-year-old female presents to the emergency department with severe abdominal pain localized to the right lower quadrant. She describes the pain as sharp and constant, worsening with movement. She reports nausea, vomiting, and anorexia. On examination, there is tenderness and guarding in the right lower quadrant, with rebound tenderness elicited. The patient has a history of recurrent abdominal pain but no previous surgical interventions.

Step 2: Input the following information into ChatGPT (this information is known as a “prompt”):

Please create an Emergency Department Teaching Case for medical residents for a 30-year-old female presenting with abdominal pain in the emergency room including:

1. List of differential diagnoses for abdominal pain in a female patient, focusing on the right lower quadrant.
2. Description of the approach to physical examination in a patient with suspected acute appendicitis.
3. Explanation of the interpretation of laboratory studies and imaging modalities in the evaluation of abdominal pain.
4. Discussion of the management algorithm for a patient with confirmed acute appendicitis.

Teaching Case Output from ChatGPT:

1) Differential Diagnoses for Abdominal Pain in a Female Patient, Focusing on the Right Lower Quadrant:

When evaluating a female patient with abdominal pain, especially focusing on the right lower quadrant, several differential diagnoses should be considered, including:

• Acute Appendicitis
• Ovarian cyst rupture or torsion
• Ectopic pregnancy
• Pelvic inflammatory disease (PID)
• Renal colic
• Diverticulitis
• Meckel’s diverticulitis
• Crohn’s disease
• Gastroenteritis
• Urinary tract infection (UTI)

2) Approach to Physical Examination in Suspected Acute Appendicitis:

A thorough physical examination is crucial in assessing a patient with suspected acute appendicitis. The following steps should be taken:

• General Inspection: Assess the patient’s general appearance, noting signs of distress or discomfort.
• Vital Signs: Measure temperature, heart rate, blood pressure, and respiratory rate.
• Abdominal Examination: Palpate the abdomen gently, starting away from the site of tenderness and moving towards it. Assess for rebound tenderness, guarding, and rigidity, which are indicative of peritoneal irritation. Pay attention to McBurney’s point tenderness, located one-third of the distance from the anterior superior iliac spine to the umbilicus.
• Pelvic Examination: Perform a pelvic exam to evaluate for signs of gynecological pathology, such as cervical motion tenderness or adnexal masses.

3) Interpretation of Laboratory Studies and Imaging Modalities:

Required Laboratory Studies:

• Complete blood count (CBC): Look for leukocytosis, which can indicate an inflammatory process.
• Urinalysis: Rule out urinary tract infection or other urinary pathology.
• Serum electrolytes: Assess for dehydration or electrolyte imbalances.
• Pregnancy test: Exclude ectopic pregnancy in reproductive-age females with abdominal pain.

Imaging Modalities:

• Ultrasound: Useful in evaluating ovarian pathology, such as ovarian cysts or torsion. It can also identify an inflamed appendix.
• CT scan: Highly sensitive and specific for diagnosing acute appendicitis. Look for findings such as an enlarged appendix, peri-appendiceal inflammation, and appendicolith.

4) Management Algorithm for Confirmed Acute Appendicitis:

Once acute appendicitis is confirmed, management typically involves:

• Fluid Resuscitation: Administer intravenous fluids to correct dehydration and electrolyte imbalances.
• Antibiotic Therapy: Initiate broad-spectrum antibiotics to cover enteric flora, such as a combination of a third-generation cephalosporin with metronidazole.
• Surgical Consultation: Consult a surgeon for consideration of appendectomy, either laparoscopic or open, depending on the patient’s clinical status and surgical expertise available.
• Analgesia: Provide adequate pain control with intravenous opioids or nonsteroidal anti-inflammatory drugs (NSAIDs).

Case Summary:

In summary, when encountering a female patient with abdominal pain, particularly in the right lower quadrant, it is essential to consider a broad range of differential diagnoses. A systematic approach to history-taking, physical examination, and interpretation of laboratory and imaging studies is crucial in reaching an accurate diagnosis. Once acute appendicitis is confirmed, prompt management with fluid resuscitation, antibiotic therapy, surgical consultation, and analgesia is paramount to ensure favorable outcomes.

FINAL STEP BEFORE CASE COMPLETION:

Carefully examine the case writeup for accuracy and completeness, editing as needed. Once you are satisfied with the writeup, you can add the patient scenario to the top after which you are ready to share with residents and others.

Conclusion:

Incorporating ChatGPT into emergency medicine residency training enables physicians to more easily and quickly generate teaching cases for their residents. By leveraging its capabilities to generate realistic scenarios and facilitate interactive case discussions, emergency department doctors can enhance the quality of education and empower residents to excel in the dynamic and challenging field of emergency medicine.