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Overshadowed by Assessment

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

Melvin, Lindsay, MD, MHPE; Rassos, James, MD; Panisko, Daniel, MD, MPH; Driessen, Erik, PhD; Kulasegaram, Kulamakan M., PhD; Kuper, Ayelet, MD, DPhil

doi: 10.1097/ACM.0000000000002451
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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, 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.

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.

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.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Ethical approval was obtained from the Research Ethics Board at the University of Toronto, March 9, 2015; protocol no. 31387.

Previous presentations: Earlier versions of this work have been presented at the International Conference on Residency Education, October 20, 2017, in Quebec City, Quebec, Canada.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A599.

Correspondence should be addressed to Lindsay Melvin, Toronto Western Hospital, 399 Bathurst Street, 8E-425, Toronto, Ontario, Canada M5T 2S8; e-mail: lindsay.melvin@uhn.ca.

© 2019 by the Association of American Medical Colleges