Outpatient case presentations in the conference room versus examination room: results from two randomized controlled trials

Abstract

Purpose Ambulatory case presentations occur typically in conference rooms, and attending physicians often have little contact with patients. The purpose of this study was to examine the effects of two different ambulatory case presentation formats that involve attending physicians more directly. Subjects and methods We conducted two randomized controlled trials in a community-based ambulatory internal medicine clinic. Participants comprised 393 adult patients, 40 house officers, and 14 attending physicians. In the first trial, patient encounters were assigned randomly to either exclusive house officer–attending physician conference room discussion or to house officer–attending physician conference room discussion plus attending physician–patient interaction. In the second trial, patient encounters were assigned randomly to either exclusive house officer–attending physician conference room discussion or to exclusive house officer–attending physician discussion in the examining room with the patient present. Patient satisfaction; attending physician contributions to teaching, diagnosis, and therapy; and house officer comfort and autonomy were assessed. Results Patient visit satisfaction and house officer assessment of attending physician teaching, diagnosis, and therapy were similar in the control and intervention groups of both trials. Patients involved in examination room discussions thought they were more comfortable with the discussion (mean ± SD, 4.3 ± 0.9 vs. 3.4 ± 0.9 on a one- to five-point Likert scale, P <0.001) and more often indicated a preference to listen to the discussion in the future than did the control group (86% [71/83] vs. 63% [52/83], P <0.001). Some house officers (11% [9/83]) but no attending physicians (0/83, P <0.001) were made uncomfortable by examination room presentations, and some house officers (11% [9/83]) thought that examination room presentations diminished their autonomy. Conclusion Patients perceive that ambulatory examination room presentations are beneficial, whereas some house officers perceive that examination room presentations are associated with discomfort and diminished autonomy.