Oral Case Presentation Research Articles

Efficiency, Effectiveness, and Preference for Use of Traditional versus Assessment-oriented Oral Case Presentations in an Academic Emergency Department

Efficiency, Effectiveness, and Preference for Use of Traditional versus Assessment-oriented Oral Case Presentations in an Academic Emergency Department

Reflective teaching: the value of e-mail student journaling

Context and setting Early clinical encounters during the first 2 years of medical school place students with limited knowledge and skill in contact with sick patients, often without the support of the team that traditionally accompanies inpatient clinical clerkships. Why the idea was necessary Course chairs struggle to keep in touch with students' experiences, an essential component of developing and maintaining a student-centred curriculum. Students, in turn, need support and guidance as they start their clinical encounters. Existing pre-clinical curricula lack the social support system that comes with the inpatient care team. Timely insights into students' experiences and struggles during their first exposure to sick, hospitalised patients may provide opportunities for course chairs to connect with and counsel students. What was done At Mayo Clinic College of Medicine, all Year 2 medical students, in groups of 12–14, are required to take an 8-week, on-campus internal medicine course (Med2), a pre-clinical course following the Year 1 Introduction to Clinical Medicine. During Med2, students complete 8 comprehensive histories and physical examinations on hospitalised patients, followed by written and oral case presentations, and participate in weekly physical examination rounds. Beginning in 2001, the students were required to write weekly e-mails to the course director. The students were given 5 questions to promote self-reflection, but were told that they might write freely. The course chair responded to the e-mails, allowing for sharing of experiences and reflections. The journals were not graded. In 2003, the students' attitudes towards the required e-mails were assessed by an anonymous survey at the end of the course. Evaluation of results and impact All students participated and wrote an average of 6 e-mails over 8 weeks. The course chair spent 1 hour per week reading and responding to 10–11 e-mails, each between half and 1 page in length. While the quality varied, the majority of the e-mails provided insight into the students' struggles with detecting abnormal physical examination findings, encountering issues of death and dying, and dealing with patient−learner relationships. There were also remarks of affirmation, teacher effectiveness and insights into the learning process. In 2003, all 39 students (of that year's class) completed the anonymous survey. Twenty-six (66%) considered the e-mails helpful, 3 (7%) found them somewhat helpful and 10 (25%) found them unhelpful. The majority (66%) indicated that the e-mail system was a good forum for expressing their struggles and concerns. Twenty-eight (72%) of the students thought they benefited from the course chair's responses to the e-mails. While candour was encouraged and the course was assessed on a pass/fail basis, an obstacle for honesty and disclosure in the e-mails for some students may have been the lack of anonymity. The benefits of individualised e-mail responses versus complete anonymity should be evaluated. Consideration should also be given to the frequency of e-mails as some students felt it became tedious. While our experience is that e-mailing has been beneficial, adaptations (such as e-mail facilitators) will need to be made to implement this at larger medical schools.

Tensions in the Field: Teaching Standards of Practice in Optometry Case Presentations

Professional identity formation and its relationship to case presentations were studied in an optometry school's onsite clinic. Eight optometry students and six faculty optometrists were audio-recorded during 31 oral case presentations and the teaching exchanges related to them. Using convenience sampling, interviews were audio-recorded of four of the students and four of the optometrists from the field observations. After transcribing these audio-recordings, the research team members applied a grounded theory method to identify, test, and revise emergent themes. The theme reported herein pertains to communicating standards of practice. Faculty optometrists demonstrated three ways of communicating standards of practice to optometry students during case presentations: Official Way, Our Way, and My Way. Although there were differences between these standards, the rationale for the disparities was rarely explicitly articulated by the instructors to the students. Without this information, the incongruity among the standards was left to the students to interpret on their own. The risk created by faculty not articulating the rationale underlying standards of practice was that students misinterpreted the optometrists' ways as idiosyncratic. Thus, opportunities were missed in the educational setting to assist students in making responsible decisions, locating their position in practice, and shaping their professional identity. Competing responsibilities of patient care and student education left instructors with little time to articulate rationale for standards of practice. Therefore, educators must reflect on innovative ways to bring into relief the logic behind their actions when working with novices.

The role of progress notes in the professional socialization of medical residents

This paper examines the role of physicians’ progress notes in the professional socialization of medical residents. As a component of their specialty training, residents are principally responsible for making the physician entries in the medical charts of the patients who are under the joint care of the residents and the hospital’s medical staff. This includes the initial physician chart entry, the comprehensive ‘admit note’ which records the initial assessment of the patient upon presentation for medical care. Admit notes, which complement the oral case presentations that they reproduce, constitute a key training tool by means of which residents experience and internalize the cognitive processes which constitute medical reasoning and analysis. However, although a number of researchers have examined residents’ oral case presentations, their written communications have seldom been studied. This paper examines the generic conventions that structure residents’ admit notes, including abbreviations, telegraphic syntax, the ‘SOAP’ format, and reliance on background knowledge. Through the analysis of an admit note written by a first-year obstetrical resident, this paper demonstrates how the ability to operate these conventions evidences both the resident’s professional socialization and the growth of his or her clinical judgment.

Efficient Communication: Assessment‐oriented Oral Case Presentation

Abstract Objective: To introduce and assess the time savings from and effectiveness of assessment‐oriented (AO) oral case presentation as a model of interphysician communication. Methods: This was a prospective, interventional study of all 10 on‐site faculty and 36 residents in a postgraduate year 1 to 3 format emergency medicine residency training program. Residents were requested to perform all oral case presentations in either the traditional or AO formats. Presentations were timed, and residents and faculty rated essential measures of oral case presentation effectiveness: data content, expression of decision making, organization, and overall satisfaction. Results: A total of 199 oral case presentations were sampled—112 traditional and 87 AO. Mean length of presentation for traditional presentations was 117 seconds versus 71 seconds for AO presentations (p < 0.001), a clinically significant difference, without significant differences in the essential measures of case presentation effectiveness. Conclusions: AO oral case presentation may provide a means for emergency medicine residents to “get to the point” and to communicate effectively and efficiently.

Learning Activities and High-Quality Teaching

To identify learning activities that students associate with high-quality teaching on a clinical rotation. From July to December 2001, data on patient encounters, learning activities, and teaching quality were collected via personal hand-held computers from 82 medical students during a required third-year internal medicine (IM) clerkship at the Medical College of Wisconsin, Milwaukee. Univariate (chi-square test) and multivariate analysis (stepwise multiple logistic regression) were performed to assess the association between learning activities and students' perceptions of teaching quality during this rotation. A total of 1,839 patient encounters were recorded: 62% of these occurred in the inpatient setting and 38% in outpatient clinics. In 80% of all encounters, students reported that they gave an oral case presentation and proposed a plan; they reported receiving high-quality feedback after 64% of these presentations. Univariate analysis demonstrated that the students' perception of high-quality teaching was associated with being on an inpatient rotation, formulating an assessment, proposing a plan, presenting to the attending physician with other members of the team present, giving an oral case presentation, and receiving high-quality feedback (p <.01). Multivariate analysis demonstrated that receiving high-quality feedback (odds ratio [OR] 4.5; 95% CI 3.57-6.25) and proposing a plan (OR 2.3; 95% CI 1.4-3.9) were the two strongest predictors of high, overall teaching quality. Receiving high-quality feedback from faculty and proposing a plan were the learning activities most strongly associated with students' perception of high-quality teaching on a required third-year IM clerkship.

'Talking the talk': school and workplace genre tension in clerkship case presentations

Socialisation into a community involves learning sanctioned ways of talking. This study investigates the case presentation genre as a site of socialisation into the clinical community of practice. Sixteen oral case presentations and the teaching exchanges surrounding them (involving 11 students and 10 faculty members) were observed by paired researchers during inpatient paediatric medicine rounds. A total of 21 in-depth interviews were conducted with 11 students and 10 faculty. Both data sets were audio-recorded, transcribed and analysed for emergent themes and rhetorical strategies. Students emphasised case presentation as a school genre and described the ideal presentation as free of interruptions. As a consequence, students' presentation strategies were directed towards getting through the presentation without questions. In contrast, faculty responses suggested an understanding of the genre as a way of constructing shared professional knowledge. Faculty feedback was often explicit about critical issues in constructing shared knowledge, such as handling uncertainty. However, student presentations rarely reflected this feedback. The school genre described and enacted by students conflicts in key ways with the workplace genre evident in faculty feedback, suggesting that school and workplace iterations of case presentation may be at cross-purposes. Such cross-purposes have implications, because when students and teachers perceive a genre differently, a 'gap' is created in their interactions. Even rich and contextually situated feedback may get lost or distorted as it crosses this gap. Explicit acknowledgement of the multiple and flexible iterations of case presentation will improve the learning that novices experience through acquiring this central form of professional 'talk'.

Improving oral presentation skills with a clinical reasoning curriculum: a prospective controlled study

Purpose The oral case presentation is an essential part of clinical medicine, but teaching medical students to present clinical data remains difficult. Presentation skills depend on the ability to obtain, process, and organize patient data. Clinical reasoning is fundamental to the development of these skills. We compared a clinical reasoning curriculum with standard ward instruction for improving presentation skills and clinical performance. Subjects and methods Between October 1998 and May 1999, 62 third-year medical students at three hospitals were assigned to a 4-week clinical reasoning curriculum (n = 27) or a control group (n = 35) that underwent routine instruction. The curriculum consisted of four 1-hour group sessions and 1 hour of individual videotaped instruction, and taught students to use the principles of clinical reasoning, such as generation and refinement of diagnostic hypothesis, interpretation of diagnostic tests, and causal reasoning, to determine data for inclusion in the oral presentation. We videotaped students presenting two standardized case histories; one at baseline and a second 4 weeks later. Two independent evaluators who were blinded to the group assignments reviewed the videotapes and scored them for presentation quality and efficiency, and general speaking ability. Results Mean (± SD) presentation times at baseline were similar in the two groups (intervention group: 8 ± 2 minutes; control group: 8 ± 2 minutes; P = 0.74). Presentation time in students who were taught clinical reasoning decreased by 3 ± 2 minutes, but increased by 2 ± 2 minutes in control students. The difference in the changes between the groups was statistically significant (mean difference = 4 minutes; 95% confidence interval [CI]: 3 to 5 minutes; P <0.001). Presentation quality scores at baseline were similar in both groups (intervention group: 17 ± 8 points; control group: 20 ± 7 points; P = 0.11). Students who were taught the clinical reasoning curriculum had an improvement of 9 ± 6 points in the quality of their presentations, while control students had an improvement of 2 ± 7 points (on a scale of 4–36). The difference in the changes between the groups was statistically significant (mean difference = 4 points; 95% CI: 1 to 7 points; P = 0.04). Conclusion A clinical reasoning curriculum, in combination with video-based individual instruction, improves the efficiency and quality of oral presentations, and may augment clinical performance.

South American Working Group in Interventional and Therapeutic Neuroradiology (SAWITN)

South American Working Group in Interventional and Therapeutic Neuroradiology (SAWITN)

Quantitative analysis of the outpatient oral case presentation

To measure the content of oral outpatient case presentations and to assess the correlation of objective assessments of this content with subjective ratings provided by the clinic attending physician. Blinded assessment via audiotape of 36 oral case presentations of new patient evaluations by 23 medical residents. Outpatient general medical clinic. Duke University Medical Center medical residents during their outpatient rotation. Important deficiencies were found in oral case presentation content. Specifically, psychosocial data were often missing (employment history) was mentioned in 28% of presentations; illicit drug use, in 17%; household social structure, in 11%; sexual history, in 6%). An assessment and a plan were mentioned only 56% and 69% of the time, respectively. No correlation was seen between an objective "content score" and the attending physician's subjective rating of the quality of the presentation (r = 0.09). 1) The outpatient care presentation can be quantitatively assessed in a simple, straightforward manner; 2) outpatient case presentations have important deficiencies in content; and 3) preceptors' evaluations of case presentations may be based upon factors other than content of the presentation.

Systematic evaluation and increased structure in a radiology elective.

Diagnostic radiology is expanding, playing an increasingly central role in patient care, which heightens the importance of radiology teaching in undergraduate medical education. This study examined the impact of increased structure and systematic evaluation on student performance in a radiology elective. The evaluation protocol included premultiple and postmultiple choice examinations (70 questions each), a film interpretation quiz (ten films, 20 questions), faculty assessment of a student oral case presentation, and student evaluations of the elective experience. The relationships among the evaluation techniques, as well as differences in class level and course ratings were also examined. Two different treatment groups were studied. Group 1 was given general objectives and information regarding availability of recommended resources, including self-learning materials for the elective, didactic seminars, and viewbox exposure. Group 2 was given specific written instructional objectives, a structured schedule for viewing the self-learning materials, and the same seminars and viewbox exposure. The statistically significant higher performance of the structured group suggests that medical students achieve the objectives of an elective better when learning activities are well defined, structured, and systematically evaluated. In addition, those students receiving the structured experience rated the radiology elective more favorably.

Objectively evaluating student case presentations.

Evaluation and documentation of student performance is of major importance to a radiology elective coordinator. To better assess a variety of aspects of competence and learning, an oral case presentation was included in the final elective evaluation. This article describes the 31-item checklist designed to assess the level of student achievement of the objectives for the oral presentation. In addition to developing this standard evaluation instrument, methodologies were used to increase the validity and reliability of the oral presentation; the examiners were briefed in advance, the checklist included cognitive and noncognitive measures, and a simple grading score was used for each item. Students who received the checklist and written course objectives at the beginning of the elective earned better grades than those students who did not receive the materials. Student evaluations reveal that the oral case presentation as presently organized is felt to be of value.