Oral Case Presentation Research Articles

Effects of a deductive structure of oral case presentation on recipient listener’s comprehension

Effects of a deductive structure of oral case presentation on recipient listener’s comprehension

Barriers and future improvements of workplace-based learning in Korean medicine clinical clerkship: perspectives of graduates

BackgroundWorkplace-based learning (WPBL) has emerged as an essential practice in healthcare education. However, WPBL is rarely implemented in Korean medicine (KM) due to the passive attitude of teachers and possible violation of medical laws that limit the participation of trainees in medical treatment. In this study, we implemented WPBL in the clinical clerkship of Acupuncture and Moxibustion Medicine at a single College of KM and explored the barriers and future improvements of WPBL.MethodsThe WPBL was implemented from January to July 2019. During the clerkship, each senior student was assigned an inpatient at the university hospital. WPBL was conducted as follows: patient presentation by the supervisor, interaction with the patient at the bedside, preparation of medical records, oral case presentation, and discussion with feedback. The student performed a physical examination and review of systems as a clinical task. In addition, six doctors of KM who are currently practicing after three years of WPBL were interviewed in September 2022 to investigate the real-world effects and unmet needs of WPBL in their workplaces.ResultsTwo major themes identified from the interview were: “the experience of novice doctors of KM with KM practice” and “Current state of KM clinical education.” The five subcategories were: “Clinical competency priorities vary according to the KM workplace,” “Difficulties faced by doctors of KM immediately after graduation,” “WPBL experience of the interviewees,” “Necessary but difficult to implement real patient learning,” and “Unmet needs for clinical clerkship in KM.”ConclusionIt is essential to consider the unique characteristics of KM practice and the duties required in various workplaces for successful WPBL. We anticipate our study to be a starting point for improving the WPBL and addressing the unmet needs in KM clinical education.

Development and Testing of Mobile Assisted Language Learning Application to Improve Oral Clinical Case Presentation of Student Nurses

Background: Nurses’ oral case presentation is a core clinical communication skill with distinctivelinguistic qualities that require specific language training. The present paper is auser feedback analysis of a start-up Mobile Assisted Language Learning application (MALLapp) developed and implemented to provide English language training to improve OralCase Presentation (OCP) of student nurses pursuing baccalaureate degrees from a nursingcollege in South India. Objective: The aim was to develop and test an Android based OCPMALLapplication for user acceptability and effectiveness in improving OCP performanceand decreasing the perceived language difficulty. Methodology: Sixty-two student nursesfrom a reputed nursing college in Chennai, South India, using Android mobile phonesparticipated in the study. All the participants were given access and instructions on theuse of OCP-MALL app. A comparison of pre and post-test of perceived level of languagedifficulty and OCP pre and post score along with users’ acceptance were collected. Results:The users’ acceptability showed that all participants rated the clarity in reading the textwith highest mean score of 8.29 and std of 1.276, simplicity in navigation – moving to nextpage with next highest mean score of 8.19 and std of 1.526, clarity in text application layoutwith a mean score of 8.14 and std of 1.497 and user friendliness of the application witha mean score of 8.13 and std of 1.393. Conclusion: This startup OCP-MALL app user satisfactionfeedback proves that

Comparing oral case presentation formats on internal medicine inpatient rounds: a survey study

BackgroundOral case presentations – structured verbal reports of clinical cases – are fundamental to patient care and learner education. Despite their continued importance in a modernized medical landscape, their structure has remained largely unchanged since the 1960s, based on the traditional Subjective, Objective, Assessment, Plan (SOAP) format developed for medical records. We developed a problem-based alternative known as Events, Assessment, Plan (EAP) to understand the perceived efficacy of EAP compared to SOAP among learners.MethodsWe surveyed (Qualtrics, via email) all third- and fourth-year medical students and internal medicine residents at a large, academic, tertiary care hospital and associated Veterans Affairs medical center. The primary outcome was trainee preference in oral case presentation format. The secondary outcome was comparing EAP and SOAP on 10 functionality domains assessed via a 5-point Likert scale. We used descriptive statistics (proportion and mean) to describe the results.ResultsThe response rate was 21% (118/563). Of the 59 respondents with exposure to both the EAP and SOAP formats, 69% (n = 41) preferred the EAP format as compared to 19% (n = 11) who preferred SOAP (p < 0.001). EAP outperformed SOAP in 8 out of 10 of the domains assessed, including advancing patient care, learning from patients, and time efficiency.ConclusionsOur findings suggest that trainees prefer the EAP format over SOAP and that EAP may facilitate clearer and more efficient communication on rounds, which in turn may enhance patient care and learner education. A broader, multi-center study of the EAP oral case presentation will help to better understand preferences, outcomes, and barriers to implementation.

Initial Development of an Automated Platform for Assessing Trainee Performance on Case Presentations.

Oral case presentation is a crucial skill of physicians and a key component of team-based care. However, consistent and objective assessment and feedback on presentations during training are infrequent. To determine the potential value of applying natural language processing, computer software that extracts meaning from text, to transcripts of oral case presentations as a strategy to assess their quality automatically and objectively. We transcribed a collection of simulated oral case presentations. The presentations were from eight critical care fellows and one critical care attending. They were instructed to review the medical charts of 11 real intensive care unit patient cases and to audio record themselves, presenting each case as if they were doing so on morning rounds. We then used natural language processing to convert the transcripts from human-readable text into machine-readable numbers. These numbers represent details of the presentation style and content. The distance between the numeric representation of two different transcripts negatively correlates with the similarity of those two transcripts. We ranked fellows on the basis of how similar their presentations were to the attending's presentations. The 99 presentations included 260 minutes of audio (mean length: 2.6 ± 1.24 min per case). On average, 23.88 ± 2.65 sentences were spoken, and each sentence had 14.10 ± 0.67 words, 3.62 ± 0.15 medical concepts, and 0.75 ± 0.09 medical adjectives. When ranking fellows on the basis of how similar their presentations were to the attending's presentation, we found a gap between the five fellows with the most similar presentations and the three fellows with the least similar presentations (average group similarity scores of 0.62 ± 0.01 and 0.53 ± 0.01, respectively). Rankings were sensitive to whether presentation style or content information were weighted more heavily when calculating transcript similarity. Natural language processing enabled the ranking of case presentations on the basis of how similar they were to a reference presentation. Although additional work is needed to convert these rankings, and underlying similarity scores, into actionable feedback for trainees, these methods may support new tools for improving medical education.

Theme choice in oral case presentations: Differences between medical novices and experts

The clinical case presentation is an important mode of professional communication as well as an academic genre in medical education. Examining both students' and experienced doctors' linguistic practices can reveal how students differ in their underlying knowledge, interpretation and execution of the case presentation that mark their novice status. In this paper, we describe differences in the use of theme in initiating sentences in case presentations produced by doctors and medical students. Theme analysis, an analysis of the linguistic elements that are used to begin a clause, was used. The data comprised 50 audio-recorded oral case presentations elicited from 20 doctors and 30 students in two medical schools. Choice of theme in doctors' and students' presentations was compared. The findings show that doctors and students differ significantly in their use of specific theme types indicating their different understanding and use of the oral case presentation as well as their social position in the professional field. Indexing students' novice status are differences in the use of conjunctive adjuncts, interpersonal, existential and pronoun themes, and marked themes as overt signalling of the presentation structure. These findings contribute to provide some insight on students’ learning trajectory and can inform appropriate educational interventions.

TCU and UNTHSC School of Medicine.

TCU and UNTHSC School of Medicine.

The Parallel Encounter: An Alternative to the Traditional Serial Trainee-Attending Patient Evaluation Model.

The emergency department environment requires the clinician-educator to use adaptive teaching strategies to balance education with efficiency and patient care. Recently, alternative approaches to the traditional serial trainee-attending patient evaluation model have emerged in the literature. The parallel encounter involves the attending physician and resident seeing the patient independently. Instead of the trainee delivering a traditional oral case presentation, the trainee does not present the history and examination to the attending physician. Rather, the attending and trainee come together following their independent evaluations to jointly discuss and formulate the assessment and plan. The parallel encounter has the potential to enhance the teaching encounter by emphasizing clinical reasoning, reduce cognitive bias by integrating two independent assessments of the same patient, increase attending workflow flexibility and efficiency, and improve patient satisfaction and outcomes by reducing time to initial provider contact. The attending must be mindful of protecting resident autonomy. This model tends to work better for more senior learners. The parallel encounter represents a novel approach to the traditional serial trainee-attending patient evaluation model that may enhance the teaching encounter and improve patient care.

MP16: Oral case presentation: evaluation of a novel curriculum and development of a competency-based assessment tool in Emergency Medicine

Introduction: The oral case presentation is recognized as a core educational and patient care activity but has not been well studied in the emergency setting. The objectives of this study are: 1) to develop a competency-based assessment tool to formally evaluate the emergency medicine oral case presentation (EM-OCP) competency of medical students and ‘transition to discipline’ residents, and 2) to develop, implement and evaluate a curriculum to enhance oral case presentation (OCP) communication skills in the emergency medicine (EM) setting. Methods: Using data from a literature review, a Canadian Association of Emergency Physicians national survey, and local focus groups, the authors designed an OCP framework, blended learning curriculum, and EM-OCP assessment tool. Ninety-six clerkship students were randomly assigned to receive either the control, the standard clerkship curriculum, or intervention, the blended learning curriculum. At the beginning of their emergency medicine rotation, learners completed a pre-test using a standardized patient (SP) case to assess their baseline OCP skills. The intervention group then completed the EM-OCP curriculum. All students completed post-tests with a different SP at the end of the six-week EM rotation. Audio-recordings of pre and post-tests were evaluated using the assessment tool by two blinded evaluators. Results: Using the Kruskal-Wallis test, all students demonstrated improvement in EM-OCP skills between their pre-test and post-test, however, those who received the blended learning curriculum showed significantly greater improvement in synthesis of information (p = 0.044), management (p = 0.006) and overall entrustment decision score (p = 0.000). Conclusion: Implementation of a novel EM-OCP curriculum resulted in more effective communication and higher entrustment scores. This curriculum could improve OCP performance not only in emergency medicine settings but also across specialties where medical students and residents must manage critical patients.

Need and relevance for english language training in oral case presentation of student nurses

Oral case presentation (OCP) is an important clinical skill for nurses. Literature shows that, generally, less attention is paid to the development of OCP skills. Most of these studies being done by native English speakers have given importance only to content development rather than English language skills needed for OCP. This article explores the English language difficulty and its associated psychological barriers underneath the presentation of clinical cases of student nurses with limited English proficiency. This descriptive needs analysis study was done amongst the student nurses in South India. It has used a mixed method of exploratory interview and a standardised quantitative tool uniquely designed to bring out the hidden barriers in the effective use of English for OCP. The findings show that the most of the student nurses were not satisfied with their language ability to perform OCP. Amongst the language difficulty, the highest perceived difficulty was related to grammar usage and the inability to correct grammar mistakes, which had a mean value of 5.00 and 4.96, while explaining with good pronunciation had been their next concern with 4.96. The findings show that psychological aspects related to learning of second language influence their OCP skills. This language audit will furnish information on key linguistic skills that need to be focussed while developing English for specific purposes lessons for OCP training. The study will help to bridge the gap between classroom teaching and clinical communication requirement and significantly improve the performance of the English as a Second Language student nurses.

Emergency Medicine Oral Case Presentations: Evaluation of a Novel Curriculum.

Oral case presentation (OCP) is recognized as a central educational and patient care activity, yet has not been well studied in the emergency medicine (EM) setting. The purpose of this study was to evaluate the effect of a novel curriculum on medical students' EM-OCP skills. An EM-OCP assessment tool and novel blended curriculum were developed based on results from a Canadian survey of emergency physicians and focus groups with key stakeholders. We conducted a randomized controlled trial of 96 clerkship students between 2017 and 2018. Students were randomly assigned into an intervention group where they completed a novel EM-OCP curriculum or a control group without the curriculum. A pretest baseline assessment of students' OCP skills was performed using a standardized patient case at the beginning of their EM rotation. Similarly, all students completed a posttest assessment with a different standardized patient case at the end of their 6-week EM rotation. Audio recordings of pre- and posttests were assessed using the EM-OCP assessment tool by two blinded assessors. Using the Kruskal-Wallis test, all students demonstrated improvement in EM-OCP skills between their pretest and posttest; however, those who received the curriculum (intervention group) showed significantly greater improvement in "synthesis of information," "management," and "overall entrustment decision" scores. Implementation of a novel EM-OCP curriculum resulted in improved clinical reasoning and higher entrustment scores. This curriculum could improve OCP performance not only in EM settings but also across specialties where medical students and residents manage critically ill patients.

Unearthing Faculty and Trainee Perspectives of Feedback in Internal Medicine: the Oral Case Presentation as a Model.

The case presentation is a fundamental activity used in both patient care and trainee education, partly due to feedback from supervisor to trainee. Although feedback in medical education is well studied, prior studies have not focused on the perceptions of feedback by Internal Medicine supervisors and trainees as it relates to clinical activities like the case presentation. Semi-structured interviews were conducted with eight Internal Medicine physicians, and 18 Internal Medicine trainees (5 medical students, 13 residents) at the University of Toronto. Purposive sampling was used. Interviews were conducted and coded iteratively within a constructivist grounded theory approach until saturation was reached. Supervisors and trainees recognized feedback as an important part of the case presentation that can be (1) explicit, labeled feedback or (2) implicit, unlabeled feedback. Both trainees and supervisors perceived that not enough feedback occurs, likely stemming from a hesitancy by supervisors to label implicit feedback, calling it an interruption instead. Although trainees were keenly aware of non-verbal feedback from their supervisors as implicit feedback, they often interpreted explicit constructive feedback negatively. Interestingly, the same feedback from senior residents was regarded as highly educational, as it was uncoupled from assessment. Feedback occurs more frequently in case presentations than previously described, particularly in an implicit, unlabeled format. Even though under-recognized, trainees identify and utilize implicit feedback from supervisors, and coaching from senior residents, to develop learned behaviors. This is reassuring in the age of Competency-Based Medical Education, as feedback has an essential role in workplace-based assessment and promotion.

Clinical Reasoning Assessment Methods: A Scoping Review and Practical Guidance.

An evidence-based approach to assessment is critical for ensuring the development of clinical reasoning (CR) competence. The wide array of CR assessment methods creates challenges for selecting assessments fit for the purpose; thus, a synthesis of the current evidence is needed to guide practice. A scoping review was performed to explore the existing menu of CR assessments. Multiple databases were searched from their inception to 2016 following PRISMA guidelines. Articles of all study design types were included if they studied a CR assessment method. The articles were sorted by assessment methods and reviewed by pairs of authors. Extracted data were used to construct descriptive appendixes, summarizing each method, including common stimuli, response formats, scoring, typical uses, validity considerations, feasibility issues, advantages, and disadvantages. A total of 377 articles were included in the final synthesis. The articles broadly fell into three categories: non-workplace-based assessments (e.g., multiple-choice questions, extended matching questions, key feature examinations, script concordance tests); assessments in simulated clinical environments (objective structured clinical examinations and technology-enhanced simulation); and workplace-based assessments (e.g., direct observations, global assessments, oral case presentations, written notes). Validity considerations, feasibility issues, advantages, and disadvantages differed by method. There are numerous assessment methods that align with different components of the complex construct of CR. Ensuring competency requires the development of programs of assessment that address all components of CR. Such programs are ideally constructed of complementary assessment methods to account for each method's validity and feasibility issues, advantages, and disadvantages.

SITUPS: a new tool for oral case presentation in the paediatric emergency department.

We developed a new case presentation technique, SITUPS, and studied its impact on the patient presentations by medical students at a paediatric emergency department. The students' opinions about the usefulness of the technique were also assessed. The students saw patients both before and after introduction to SITUPS. Their presentations were analysed by the clinical instructor using a student assessment form. The students filled in a 15-item questionnaire about their opinion of SITUPS as a learning tool. Twenty-eight students were evaluated both without and with SITUPS in a total of 78 presentations. Using SITUPS, the students gave more complete case presentations without increasing the presentation time. The main areas of improvement were discussing differential diagnoses, proposing a management plan, and identifying where they lacked knowledge and needed to ask the instructor questions. The students found SITUPS particularly helpful in identifying family and social issues of significance, thinking of relevant questions to ask the patient and the family, and thinking through differential diagnoses. We propose a new case presentation technique, SITUPS, for use at the paediatric emergency department. With the help of SITUPS, the medical students gave more complete case presentations in a time-effective manner.

Comparing resident-patient encounters and case presentations in a family medicine clinic.

Oral case presentations following resident-patient interactions provide the primary mechanism by which faculty supervisors assess resident competence. However, the extent to which these presentations capture the content and quality of resident-patient communication during the encounter remains unknown. We aimed to determine whether: (i) the resident-patient encounter content matched information conveyed in the case presentation; (ii) the quality of resident-patient communication was accurately conveyed, and (iii) supervisors addressed effective and ineffective communication processes. A total of 22 pairs of resident-patient encounters and family medicine resident case presentations were video- or audiorecorded, transcribed and compared for content. Resident-patient communication was assessed using adapted versions of the Calgary-Cambridge Guide to the Medical Interview and Explanation and Planning Scale. Interviews and presentations contained largely congruent content, but social history and the patient's perspective were consistently excluded from case presentations. Although six of 19 specific communication skills were used in over 80% of resident encounters, the effective use of communication skills was widely variable. In most presentations, the quality of resident-patient communication was not explicitly conveyed to the supervisor. Although resident presentations provided 'cues' about communication issues, supervisors rarely responded. This study lends support to direct observation in workplace-based learning of communication skills. When content areas such as the patient's perspective and education are excluded, supervisors cannot address them. In addition, presentations provided minimal insight about the quality of resident-patient encounters and limited the ability to address communication skills. These skills could be enhanced by attending to communication cues during case presentations, making increased use of direct observation and feedback, and promoting faculty development to address these missed teaching opportunities.

Entrustment Checkpoint: Clinical Supervisors’ Perceptions of the Emergency Department Oral Case Presentation

Phenomenon: The oral case presentation represents a unique method of communication and forms the foundation for trainee–supervisor interactions in the clinical setting. Recently, entrustment has been highlighted as an essential element of trainee–supervisor interactions. Despite the growing body of knowledge concerning entrustment in medical education, how supervisors conceptualize the oral case presentation as a contributor to entrustment decision making during clinical supervision remains unknown. Given their widespread use, oral case presentations may represent a potential tool for future frameworks of workplace-based assessment. This study sought to explore what factors influence supervisors’ expectations of oral case presentation content and how the oral case presentation may contribute to entrustment decision making. Approach: Using qualitative methodology, semistructured interviews were conducted from a purposive sample of attending emergency medicine physicians at an academic medical center from 2015 to 2016. Thematic analysis of the semistructured interview transcripts was conducted by 2 investigators using line-by-line coding and constant comparative analysis. Key themes were identified through consensus. Theoretical sampling occurred until thematic saturation was reached. Findings: Twenty-one attending physicians were interviewed. Four factors were found to influence supervisor expectations pertaining to oral case presentation content (trainee level, trainee familiarity, clinical context, and clinical task). Further, the oral case presentation was found to serve as a means of indirect observation and an entrustment check point informing future decisions relating to trainee supervision. Insights: The oral case presentation represents a core activity within the trainee–supervisor relationship in which entrustment plays a central role. Given the numerous factors influencing oral case presentation content, we caution supervisors against relying solely on the oral case presentation as an entrustment check point, as this may lead to inaccurate judgments of trainee competence. We recommend that the oral case presentation be used in conjunction with other means of direct and indirect observation to assist with entrustment decisions relating to trainee supervision.

Overshadowed by Assessment: Understanding Trainee and Supervisor Perspectives on the Oral Case Presentation in Internal Medicine Workplace-Based Assessment.

The oral case presentation (OCP) is an essential part of daily clinical practice in internal medicine (IM) and a key competency in medical education. It is not known how supervisors and trainees perceive OCPs in workplace-based learning and assessment. Using a constructivist grounded theory approach, 26 semistructured interviews were held with trainees and supervisors (18 clinical clerks and first- through third-year postgraduate trainees, and 8 supervisors) on the IM clinical teaching unit at the University of Toronto, 2015-2016. Interviews focused on how the OCP was viewed by both trainees and supervisors in clinical practice as a tool for patient care, learning, and assessment. Iterative, constant comparative techniques were used to analyze the interviews and develop a framework to understand trainee and supervisor perspectives. Supervisors and trainees viewed the OCP as an important part of informal trainee assessment in IM. Supervisors used OCPs to understand the patient through trainee-demonstrated skills including the use of narratives, information synthesis, and management of uncertainty. However, because of awareness of assessment, trainees sought to control the OCP, viewing it as a performance demonstrating their competence, mediated by senior residents and tailored to supervisor preferences. Preoccupied with assessment around OCPs, trainees often lost sight of the valuable learning taking place. Use of OCPs in assessment necessitates optimization of the educational activity for trainees. Providing explicit direction to both trainees and supervisors, defining expectations, and clarifying the assessment activity of the OCP can optimize the encounter for best educational practice.

Student experiences of two small group learning-teaching formats: Seminar and fishbowl.

As teaching strategies, the seminar and fishbowl approaches promote active learning and shift the focus from the teacher to the learner. The aim of this study was to compare the self-reported perceptions of each student-centred teaching technique amongst a group of dental students as well as resultant quiz scores after each teaching technique. During the first semester of 2017, all year-3 (N=88) Semiology and year-5 (N=71) Oral Surgery students participated in weekly seminars in which teams of students from both cohorts were given an actual clinical case to study; a diagnosis and treatment plan would be rendered, and an oral case presentation would be presented to the rest of the class. In the second semester, the same students tried to solve similar clinical cases using the fishbowl training format. A course coordinator provided final feedback, and the session culminated with a quiz. Students were invited to provide quantitative and qualitative perceptions whilst quiz scores obtained during seminar and fishbowl teaching formats were compared. A total of 97 (61%) seminar and 92 (58%) fishbowl students provided insights regarding these teaching techniques. Both cohorts believed the fishbowl format allowed them to be actively involved. However, only year-3 students gave the fishbowl format a significantly higher score than the seminar format, considering it an attractive format that allowed them to learn. In contrast, year-5 students believed the seminars met their expectations better than the fishbowl format. Interesting clinical cases as well as the final round of feedback were qualitative themes reported by both cohorts. The mean seminar and fishbowl quiz scores were statistically significant different for year-3 students (P<0.0001), but not for year-5 students (P=0.09). These findings suggest that a more structured small-group learning-teaching format can be implemented for younger students whilst at the same time allowing more flexible organisation for senior students.

What Skills Do Clinical Evaluators Value Most In Oral Case Presentations?

Phenomenon: Trainees and practicing physicians are judged by the way that they present patients. We therefore invest heavily in teaching students how to do oral case presentations (OCPs), but the relative weights by which different aspects of these complex tasks contributes to an overall evaluation is poorly understood. Approach: We sought to contrast how clinical evaluators assess students’ OCPs and how medical students expect OCPs to be evaluated. Multiple linear regression and correlation matrices assessed how individual components of 3rd-year medical students’ OCPs affect overall faculty assessment of students’ performance using the previously validated Patient Presentation Rating tool. Preclinical medical students were surveyed to determine how they expect their OCPs to be evaluated. Findings: Faculty evaluations of students’ overall organization and descriptions of patients’ situations and vital signs were strongly associated with their overall OCP evaluation. Students believed that describing the patient’s situation, chief complaint, and history of present illness would be highly valued but not organization or vital signs descriptions. Insights: Students and faculty differ about what is important in OCPs. Aligning these perceptions through intentional redesign of curricula and feedback instruments may facilitate teaching clinical communication to students.

The Schematic Structure in Oral Case Presentation of ESL Medical Students

Due to the importance of oral case presentation in the pedagogical assessment of medical students and for their future career as medical officers, this study attempted to investigate the rhetorical pattern of oral case presentations of Clinical undergraduates of Year 3 and Year 5 at the International Islamic University Malaysia. Using content analysis, and proposed sampling, 32 case presentations were recorded during ward rounds and analysed. The researcher mapped all recordings against Dell, Lewin and Gigante’s Oral Presentation Expectations Checklist, and found that the subjects did not adhere to the schematic structure identified. Keywords: Case presentation, schematic structure