“The adrenals need your help! There’s been a crime!” — Detective Le, PILLARS Session Leader
The Setup: PILLARS and Play
PILLARS is a collaborative clinical case discussion format at Dell Medical School that I initially approached with dread (mostly because of the 8 AM start time, if we’re being honest 😴). But something magical happened when I connected the clinical reasoning process to something I genuinely loved—detective games!
For this particular session on adrenal disorders, I transformed a standard case discussion into an actual game of CLUE, complete with suspects, rooms, and evidence cards. The result? A memorable learning experience that had students genuinely excited about distinguishing pheochromocytoma from paraganglioma (no small feat at 8 AM).
🎲 The Game Setup
The Mystery: There’s been a disturbance in the adrenal system! Six suspects (adrenal disorders) are under investigation, but only one is behind our patient’s symptoms of episodic hypertension, headaches, and palpitations.
The Suspects:
- Professor Pheochromocytoma in the Medulla
- Colonel Conn’s in the Cortex
- Dr. Paraganglioma in the Sympathetic Chain
- Lady Adenoma of the Adrenal Estate
- Major Myelolipoma from the Fatty Forces
- Captain Carcinoma of the Cortical Corps
🏰 The Game Board
Just as CLUE has different rooms where evidence can be found, our medical mystery takes place across different diagnostic spaces:
Investigation Rooms:
- The Laboratory - Where biochemical secrets are revealed (elevated plasma metanephrines, anyone?)
- The Radiology Chamber - Home of imaging clues (those CT scans showing a 3.2 cm right adrenal mass)
- The Patient Encounter Room - Where symptoms tell their tales (episodic symptoms including headache, palpitations, and diaphoresis)
- The Research Facility - Repository of epidemiology and etiology (genetic associations like MEN2 and VHL syndromes)
- The Pathology Department - Where microscopic evidence lies (chromaffin cells with “zellballen” pattern)
📋 The Case Breakdown
Our Patient: Sylvia Reyes
- 37-year-old woman
- Chief complaint: “Headache and high blood pressure”
- HPI: Episodic symptoms including headaches, palpitations, feeling “on edge,” diaphoresis
- Episodes lasting 15-30 minutes, 1-2x weekly for 3 months; recent episode more intense and prolonged
- BP during episode measured at 190/110
- Previous BP readings normal (110-130/60-70)
Key Physical Findings
- BP 178/104, HR 122 (in office)
- No papilledema, retinal hemorrhages, or other signs of end-organ damage
Critical Lab Values
- Basic metabolic panel normal
- Metanephrine (free), plasma: 5.2 nmol/L (ref: <0.50)
- Normetanephrine (free), plasma: 9.8 nmol/L (ref: <0.90)
- Normal cortisol, TSH, renin, and aldosterone levels
The Management Twist
Just when students thought they’d solved the case by diagnosing pheochromocytoma, we threw in the management challenge:
“If you give beta-blockers before alpha-blockers to a patient with pheochromocytoma, what happens?”
This critical clinical pearl became a dramatic plot point—making the wrong choice could lead to a hypertensive crisis!
🕵️♀️ The Educational Magic
Turning this case into a game accomplished several things:
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Transformed passive learning into active problem-solving Students became investigators rather than note-takers
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Created emotional investment in the outcome Teams competed to gather evidence and make the diagnosis first
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Made clinical pearls memorable through narrative “Remember when giving beta-blockers first nearly killed our suspect?” is more memorable than “Alpha blockade must precede beta blockade”
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Demonstrated clinical reasoning as a process Students could visualize how evidence collection leads to diagnostic refinement
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Built confidence through guided discovery Teams felt the thrill of solving the case themselves, with faculty as guides rather than lecturers
🎮 From Tabletop to Terminal: The Digital Evolution
This experience inspired YOG1TRON to create a terminal-based game version of the case, where players navigate the clinical reasoning process while avoiding the wrath of a demanding attending physician. The digital implementation adds:
- Anxiety meters to simulate the stress of clinical decision-making
- Clinical pearl collection as achievement mechanics
- Branching narrative that reflects real clinical consequences
- Diagnostic reputation tracking to simulate professional development
Want to play?
Check out the ddxCROOK terminal game to test your own diagnostic abilities!
Lessons for Clinical Educators
This experience taught me several valuable lessons about medical education:
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Play is a powerful teacher Game mechanics tap into intrinsic motivation in ways traditional methods can’t
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Narratives stick better than facts Students remember stories and characters long after they forget bullet points
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Visualization matters for abstract concepts Creating physical or digital representations of reasoning processes makes them more accessible
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Emotional engagement enhances retention The excitement, competition, and satisfaction of game-based learning creates stronger memory formation
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Student agency improves outcomes Giving learners active roles in the diagnostic process builds both confidence and competence
From Detective to Designer
This experience represents a perfect integration point between my medical knowledge and emerging technical interests. By transforming clinical reasoning from an abstract process into an interactive experience, I found a way to make medical education more engaging while developing new skills in game design and narrative development.
It’s this kind of integration—finding creative ways to make medical expertise more accessible and engaging through technology—that excites me about the path ahead.
After all, in both medicine and technology, the most valuable innovations often come from asking: “What if we approached this differently?”