Submission ID 77906

Code OC-3-5
At the end of this workshop, participants will be able to:
Category Medical Education
Type Oral
Will the presenter be a: Early Career Faculty - (Less than 7 years of practice)
Title New Insights and Challenges for One of the Most Classic Teaching Scenarios: Admission Case Review
Background/Purpose One of the most important aspects of collaborative thinking and learning for on-call junior trainees (medical students and first year residents) is the creation of a problem list at the time of hospital admission. Although prior research has identified problematic variability in its documentation little is known about how it is developed and negotiated prior to junior trainee documentation - the focus of this study.
Methods Our methodology was constructivist grounded theory and involved iterative data collection and analysis, constant comparison and purposive sampling. Data was generated through direct observation of admission case review between senior medical residents (SMRs) and junior trainees on-call and included field notes, field interviews, and copies of de-identified admission notes.
Results Across the 8 observation periods, 11 SMRs were observed interacting with junior trainees, admitting 19 patients. Contrary to classic teaching, the development of the problem list did not take place at a single moment. Rather, its evolution began at ER physician handover and continued past the point of review. Multiple competing demands on the SMR and changing patient status that the SMR but not the junior trainee, was privy to both contributed to this phenomena. Considerable variability was also observed in SMR problem list construction.
Discussion Given that it is the junior trainee who documents and presents cases in the morning to the team, our findings flag a major gap in overnight collaboration and learning. Programs should explore the extent this is true in their context and develop strategies for supporting more effective practice.
Keyword 1 Clinical Teaching Unit (CTU)
Keyword 2 Collaborative Care
Keyword 3 Clinical Learning
Abstract content most relevant to: (check all that apply) Residency Education
Undergraduate Medical Education
Abstract Track - First Choice Teaching and learning
Teaching and Learning Clinical Skills
Authors Nicole Hugel
Nicole Hugel
Mitchell Cooper
Kristen Bishop
Mark Goldszmidt

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