Do you remember when you were a medical student and had to present patient cases to the ED attending? How often did they interrupt your presentation, and did this affect your learning experience?These were the questions that the following article by Dr. Rachel Chin (a super-mom colleague of mine at SF General) and Dr. Glen Yang answered in her 2007 publication in the Academic Emergency Medicine journal. Pubmed citation
Briefly, in this prospective study at SF General, one medical student observed 196 oral case presentations (OCP) in a convenience sampling of all ED shifts. The mean duration of an OCP was 3.30 minutes (± 1.85 min) for a range of trainees including students through PGY-3 residents. The medical student OCPs averaged a little over 4 minutes, while PGY-3 OCPs averaged about 1 minute. The average frequency of interruptions, however, was fairly stable at around 0.75 interruptions per minute, or 1 interruption every 80 seconds.
Other findings included:
1. Assessment and plans for the patient were prematurely provided to the trainee in 57% of medical student OCPs versus only 10% of PGY-3 resident OCPs.
2. In instances when OCPs were interrupted by the attending, 8.3% of the trainees felt that the interruptions were "disruptive" to the presentation. It's a small percentage, but I think we can do better -- by just saying less during the initial presentation. Less is more.
3. Despite some trainees finding the interruptions disruptive, the learning experience of the OCP was rated as 3.4 (± 1.0) on a scale of 1-5 (with 5 being the most effective) amongst all the trainees.
How has this changed my practice?
1. I make an active effort to minimize interruptions unless I just can't help myself, or the presentation is going on WAAAAY too long.2. I refrain from providing an initial assessment and plan, especially for the medical students. Having the trainees propose an assessment and plan actually has provided me with much more insight about their knowledge base and their sense of sick vs not sick. Plus I'm often pleasantly surprised that they've thought of things that I haven't! Shh, don't tell them.