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Acad Med. 2018 Sep 11. doi: 10.1097/ACM.0000000000002451. [Epub ahead of print]

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

Author information

1
L. Melvin is assistant professor, Department of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada. J. Rassos is a fifth-year resident, General Internal Medicine subspecialty training program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. D. Panisko is professor, Department of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada. E. Driessen is professor of medical education and chair, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. K.M. Kulasegaram is scientist and assistant professor, Department of Family and Community Medicine, Wilson Centre, University Health Network and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. A. Kuper is associate professor, Department of Medicine, scientist and associate director, Wilson Centre for Research in Education, University Health Network, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Abstract

PURPOSE:

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.

METHOD:

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.

RESULTS:

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, due to 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.

CONCLUSIONS:

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.

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