Document Detail

Introducing resident doctors to complexity in ambulatory medicine.
MedLine Citation:
PMID:  18573168     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Medical education instructional methods typically imply one 'best' management approach. Our objectives were to develop and evaluate an intervention to enhance residents' appreciation for the diversity of acceptable approaches when managing complex patients. METHODS: A total of 124 internal medicine residents enrolled in a randomised, crossover trial. Residents completed four web-based modules in ambulatory medicine during continuity clinic. For each module we developed three 'complex cases'. Cases were intended to be complex (numerous variables, including psychosocial and economic barriers) and to suggest multiple acceptable management strategies. Several experienced faculty members described how they would manage each case. Residents reviewed each case, answered the same questions, and compared their responses with expert responses. Participants were randomly assigned to complete two modules with, and two modules without complex cases. RESULTS: A total of 76 residents completed 279 complex cases. Residents agreed that complex cases enhanced their appreciation for the diversity of 'correct' options (mean +/- standard error of the mean 4.6 +/- 0.2 [1 = strongly disagree, 6 = strongly agree]; P < 0.001). Mean preference score was neutral (3.4 +/- 0.2 [1 = strongly favour no cases, 6 = strongly favour cases]; P = 0.72). Knowledge post-test scores were similar between modules with (76.0 +/- 0.9) and without (77.8 +/- 0.9) complex cases (95% confidence interval for difference - 4.0 to 0.3; P = 0.09). Resident comments suggested that lack of time and cognitive overload impeded learning. CONCLUSIONS: Residents felt complex cases made a valuable contribution to their learning, although preference was neutral and knowledge scores were not affected. Methods to facilitate trainee comfort in managing medically complex patients should be further explored.
David A Cook; Thomas J Beckman; Kris G Thomas; Warren G Thompson
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Medical education     Volume:  42     ISSN:  1365-2923     ISO Abbreviation:  Med Educ     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-21     Completed Date:  2008-09-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7605655     Medline TA:  Med Educ     Country:  England    
Other Details:
Languages:  eng     Pagination:  838-48     Citation Subset:  IM    
Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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MeSH Terms
Ambulatory Care*
Clinical Competence / standards*
Cross-Sectional Studies
Internal Medicine / education*
Internship and Residency*
Teaching / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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