Linda Orkin Lewin

What’s the Story? Expectations for Oral Case Presentations

This article focuses on teaching and evaluating oral presentation skills as part of the ongoing Council on Medical Student Education in Pediatrics (COMSEP) series on skills and strategies used by superb clinical teachers. While oral presentations by students can be used to enhance diagnostic reasoning,1 we will focus this article on the characteristics of high-quality oral presentations by medical students, highlight several common pitfalls, and reinforce the connection between effective oral presentations and clinical reasoning. A model for evaluating student clinical performance, the RIME model, will be reviewed. Students often struggle with what is expected of them when asked to give an oral presentation of a patient encounter. Many preceptors have asked a student to present a case, only to be answered with the question, “What would you like to hear?” Students frequently perceive the oral presentation as “a rule-based, data-storage activity governed by order and structure.”2 Clinicians, however, view the oral presentation as a flexible form of communication, with content determined by the clinical context and audience. The first step in bridging this gap is to set explicit expectations. Students should be told early in the clinical experience the commonly accepted and expected style for oral presentations and the rationale for the organization. The ultimate goal of the presentation is to provide the justification for diagnostic and therapeutic decisions. Table 1 summarizes the elements of an effective oral presentation.3 View this table: TABLE 1 Oral Presentation Expectations Checklist3 ### Chief Complaint: Who Are We Talking About? Presenting information in an expected order makes it easier for listeners to process information. This begins with the chief complaint. Either a direct quote (eg, “My tummy hurts”) or an identifying statement (“A 6-year-old girl with fever and abdominal pain”) sets the context for this patient’s story from the first line (a different context than that … Address correspondence to Michael Dell, MD, Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children’s Hospital, 11100 Euclid Ave, Cleveland, OH 44122. E-mail: michael.dell{at}uhhospitals.org

Interrater Reliability of an Oral Case Presentation Rating Tool in a Pediatric Clerkship

Background: Composing and delivering effective oral case presentations is an important skill for medical students to learn, but the large variety of patients and presenting problems makes teaching and evaluating this skill complex. Few published tools are available for educators to use, and those that are described are not well studied. Purpose: The authors describe the development of the Patient Presentation Rating tool and the study to establish its interrater reliability. Methods: Three raters reviewed 15 recorded new patient presentations delivered by 3rd-year medical students on their pediatrics clerkship. Intraclass correlation coefficients were used to determine the interrater reliability of the tool as a whole, its subsections, and each individual item. Results: The tool was found to reliably rate the technical aspects of presenting patients as well as several aspects of clinical reasoning embedded in that process. Conclusions: The Patient Presentation Rating tool is a reliable instrument for evaluating medical students’ oral patient presentations.

Let's Start at the Very Beginning: Addressing the Goal of Service to the Community

All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2013.12.005 A cademic medical centers often are located in urban areas, and a proportion of their patients may live in the shadow of these institutions. Unfortunately, the children in those cities often are, paradoxically, medically underserved, as well as challenged by poor schools, unsafe neighborhoods, and a variety of other threats to their health and well-being. As one of those cities, Baltimore can be a challenging urban environment for children, and West Baltimore, the location of the University of Maryland Medical Center, is no exception. In Baltimore, many indicators of child health are concerning, including the teen birth rate (64.4/100 000 in 2011 vs 31.3/100 000 nationally) and the infant mortality rate (13.4/100 000 in 2009 vs 6.39/100 000 nationally). Caring for the local children should be a priority of the institutions that dominate the landscape, but, for many historical reasons, that has not always been the case. Many academic pediatric departments have successfully become integral parts of their local communities, and looking to their examples is instructive. One of the best examples of true community-based pediatrics emanating from an academic department comes from the University of Rochester. The department, led by Robert Haggerty, MD, stated as its mission to address the health of children in a defined area, and then conducted a needs assessment to determine the major health concerns among its citizens with regard to their children. They took advantage of opportunities that were presented in real time, paid close attention to measurable outcomes, such as hospitalization rates in children served by their inner-city community health center, andworked across disciplines to address the children’s needs. They incorporated all of this into their training program so that their residency graduates would be more likely to continue such efforts in their own careers. These steps mirror the four pillars of “the bridge from bedside to neighborhood” described by Sanders et al: (1) collaboration with the community in defining a specific short-term goal; (2) identification of best practices in achieving that goal; (3) collaboration with the community to adapt the best practices to their local needs; and (4) evaluation of the intervention using appropriate measures. Although efforts such as those at Rochester are inspiring, they are also daunting. For a department of pediatrics that has not historically had a large presence in its local community, how does one even begin? The Department of Pediatrics at the University of Maryland decided to take the challenge, and has begun several efforts that might provide ideas for other departments or institutions with similar dilemmas.

An online evidence based medicine exercise prompts reflection in third year medical students

BackgroundReflective practice is a desirable trait in physicians, yet there is little information about how it is taught to or learned by medical students. The purpose of this study was to determine whether an online Evidence Based Medicine (EBM) exercise with a face-to-face debriefing session would prompt third year medical students to reflect on their current skills and lead them to further reflection on clinical decision making in the future.MethodsAll third year medical students at the University Of Maryland School Of Medicine who completed their pediatrics clerkship between 7/1/09 and 2/11/11 were required to complete the EBM exercise. Following completion each student received a personal report (Learning Profile) of their responses and attended a one hour large group debriefing session. Student responses to a survey following the debriefing sessions were analyzed using a post-test survey design with a single experimental cohort.ResultsNinety-five percent of students completing the debriefing survey indicated that the debriefing session helped them better understand their learning profiles; 68% stated that their profiles allowed them to evaluate themselves and their decisions. Sixty-three percent noted that participating in the exercise and the debrief would lead them to either learn more about EBM and use EBM more in the future or reflect more on their own decision making.ConclusionsThe EBM exercise was a successful way to introduce the concept of reflective practice to third year medical students, and the graphic Learning Profiles were effective instigators of discussion and reflection.

Self-Directed Rater Training for Pediatric History and Physical Exam Evaluation (P-HAPEE) Rubric, a Validated Written H&P Assessment Tool

Introduction We developed, revised, and implemented self-directed rater training materials in the course of a validity study for a written Pediatric History and Physical Exam Evaluation (P-HAPEE) rubric. Methods Core training materials consist of a single-page instruction sheet, sample written history and physical (H&P), and detailed answer key. We iteratively revised the materials based on reviewer comments and pilot testing. Eighteen attending physicians and five senior residents underwent self-directed training, scored 10 H&Ps, and completed a rubric utility survey in the course of the validity study. We have since implemented the P-HAPEE rubric and self-directed rater training in a pediatric clerkship. Based on input from reviewers, study raters, faculty members, and medical student users, we have also developed and implemented additional optional supplemental training materials. Results Pilot testing indicated that training takes approximately 1 hour. While reviewers endorsed the training format, several suggested having optional supplemental materials available. Nineteen out of 23 volunteer study raters completed the rubric utility survey. All described the rubric as good or very good and indicated strong to very strong interest in continued use. Discussion The P-HAPEE rubric offers a novel, practical, reliable, and valid method for supervising physicians to assess pediatric written H&Ps and can be implemented using brief, self-directed rater training.

Small Steps in Impacting Clinical Auscultation of Medical Students

The objective of this study was to determine if a training module improves the auscultation skills of medical students at the University of Maryland School of Medicine. Second-year medical students completed pretests on 12 heart sounds followed by a 45-minute training module on clinical auscultation, with retesting immediately after the intervention and during their third-year pediatrics clerkship. The control group consisted of third-year medical students who did not have the intervention. There was a 23% improvement in the identification of heart sounds postintervention (P < .001). Diastolic and valvular murmurs were poorly identified pre- and post intervention. There was a 6% decline in accuracy of the intervention group in the following academic year. The intervention group was superior to the control group at identifying the tested heart sounds (49% vs 43%, P = .04). The accuracy of second-year medical students in identifying heart sounds improved after a brief training module.