Accepted Type
Dedicated Poster
Code
LP12 - 8
Was this work accepted for CCME 2020?
no
Category
General Call (Workshop, Oral Presentation, Poster Presentation)
Type
Poster
Sub Type
Education Research
Will the presenter be a:
Fellow
Affiliation
Title
In Support of Meaningful Assessment and Feedback: A Study of Reasoning Tasks Used During Clinical Case Review in the Ambulatory Internal Medicine Clinic
Length of Presentation
Background/Purpose
Most clinical teaching focuses on completing clinical tasks, such as history taking and physical exams. Less focus is placed on what we reason about (reasoning tasks) and how that helps us learn to be more effective clinicians. The purpose of this study is to explore how clinical reasoning tasks are used by learners versus attending physicians during case review in general internal medicine (GIM) clinics.
Methods
Data consists of 29 audio-recorded case review discussions, 21 new and 8 follow-up cases, between 7 attending internists and 13 trainees (medical students, residents, and fellows). A framework of 27 clinical reasoning tasks was previously developed and validated in the setting of clinical teaching unit admissions. Transcripts were analyzed using constant comparison and template analysis.
Results
Expertise effects were evident in the use of clinical reasoning tasks. Junior learners focussed on listing presenting complaints, whereas fellows and attending physicians would reprioritize complaints to identify the most salient issues for the encounter. Attending physicians and fellows were more likely to address how risk factors and comorbid conditions impact the presenting complaint, and reason around educational strategies for patients. Only attending physicians considered documentation and follow-up strategies. Interestingly, goals of care and patient decision-making capacity were only addressed in 2/29 and 0/29 cases, respectively.
Conclusion
Clinical reasoning tasks provide a standardized vocabulary to communicate case-based reasoning during case review discussions. This can be a valuable way of understanding seniority-dependent differences in clinical reasoning and identify opportunities for quality improvement and competency-based education.
Level of Training
Post Graduate
Abstract Themes
Teaching and learning
Teaching and Learning
- Clinical Context
- Competency-Based Education
Additional Theme (First choice)
Additional Theme (Second Choice)
Additional Theme (Third Choice)
Authors
Presenter
Christina Valiaveettil
Term 1
Yes
Term 2
Yes
Term 3
Yes
Term 4
Yes
Term 5
Yes
