Presenting cases in front of patients: implications for a key medical education genre

Enk, A. van; Nimmon, Laura; Buckley, Heather; Cuncic, Cary; Canfield, Carolyn; Veerapen, Kiran; Holmes, Cheryl L.

doi:10.1007/s10459-022-10105-x

Cited by 3 publications

(5 citation statements)

References 69 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Still, there is some data suggesting that patients find value and comfort when their doctors openly discuss uncertainty with them. 26 Yet, a sensitivity analysis excluding uncertainty from the definition of sensitive topics showed similar results.…”

Section: Open Accessmentioning

confidence: 66%

“…Finally, there is no well accepted definition of sensitive topics and we thus defined it based on the clinical experience of the physician–researcher team. Still, there is some data suggesting that patients find value and comfort when their doctors openly discuss uncertainty with them 26. Yet, a sensitivity analysis excluding uncertainty from the definition of sensitive topics showed similar results.…”

Section: Discussionmentioning

confidence: 84%

See 1 more Smart Citation

Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial

Gross,

Becker,

Beck

et al. 2023

BMJ Open

View full text Add to dashboard Cite

ObjectiveDiscussing sensitive topics (eg, medical uncertainty, social issues, non-adherence) during ward rounds is challenging and may negatively impact patient satisfaction with the healthcare they are receiving. In the previous multicentre randomised BEDSIDE-OUTSIDE trial focusing on communication during ward rounds, we investigated the interplay between sensitive topics and low reported satisfaction with care.DesignPre-planned secondary analysis of a randomised controlled trial. For this analysis data of the original trial was pooled across intervention groups.SettingThree Swiss teaching hospitals.ParticipantsAdult patients hospitalised for medical care.InterventionsWe analysed predefined sensitive health topics and specific elements of communication from audiotapes recorded during ward rounds, for both patients dealing with and without sensitive topics.Primary and secondary outcome measuresThe primary endpoint was overall patient satisfaction with care; measured on a Visual Analogue Scale from 0 to 100. Secondary endpoints included duration of ward rounds and further satisfaction outcomes.ResultsOf the 919 included patients, 474 had at least one sensitive topic including medical uncertainty (n=251), psychiatric comorbidities (n=161), tumour diagnosis (n=137) and social issues (n=125). Compared with patients without sensitive topics, patients with sensitive topics reported lower satisfaction with care (mean (SD), 87.7 (±14.6) vs 90.2 (±12.1), adjusted difference −2.5 (95% CI −4.28 to −0.72), p=0.006. Among patients with sensitive topics, risk factors for low satisfaction included several parameters concerning patient–physician interaction such as disagreements during ward rounds (mean (SD), 14/212 (6.6%) vs 41/254 (16.1%), adjusted OR 2.78 (95% CI 1.47 to 5.27), p=0.002).ConclusionsA large proportion of medical inpatients must deal with sensitive health topics. This is associated with lower satisfaction with care, particularly if the patient perceives the interaction with doctors during ward rounds as unsatisfactory. Educating physicians on specific communication techniques may help improve care for these patients.Trial registration numberNCT03210987.

show abstract

Section: Open Accessmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 84%

Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial

Gross,

Becker,

Beck

et al. 2023

BMJ Open

View full text Add to dashboard Cite

show abstract

“…31,32 Genre theory has been used in previous medical education studies to demonstrate how unwritten rules and inaccessible practices can present challenges for new or peripheral members of a community to learn and effectively engage in these genres. 33,34 Given the connection between language and practices, research that draws on genre theory focuses on analysing language and practices within their specific contexts of use. 35 Therefore, our research will focus on the unwritten rules and language practices of LORs in one Canadian academic medical community.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Reading between the lines: exploring the unwritten rules of letters of recommendation in the Canadian resident selection process

Rachul,

Collins,

Porhownik

et al. 2024

Can. Med. Ed. J

View full text Add to dashboard Cite

Background: Efforts to better understand and improve letters of recommendation (LORs) in the resident selection process have identified unwritten rules and hidden practices that may limit their effectiveness. The objective of our study is to explore these unwritten rules and hidden practices more fully in one Canadian academic medical community. Methods: We conducted semi-structured, discourse-based interviews with 18 faculty members from the departments of Internal Medicine and Psychiatry at the University of Manitoba, Canada. Interviews were guided by sample LORs and were focused on experiences with either writing or reading LORs. We analyzed interviews using key concepts from genre theory and Aristotle’s appeals to ethos, logos, and pathos. Results: Participants described how the practices surrounding LORs are guided by unwritten rules. These practices contributed to writers’ use of visible strategies and textual silence to establish credibility, build a strong case, and appeal to readers. Readers rely on similar strategies, but not always as intended by the writers. Conclusions: The unwritten rules of one academic community can impede a nationally-facilitated resident selection process. Our findings highlight how critiques and potential improvements to LORs could benefit from considering the use of visible and invisible rhetorical strategies in specific contexts.

show abstract

“…Patients crave physicians who are humble and willing to admit their limitations, and who seek input and knowledge from other clinicians 16 . They value and better trust in the healthcare team when they observe explicit acknowledgments of uncertainty and, when necessary, the supervising physician teaches their trainees or proposes alternative care plans in collaborative and encouraging ways 17 . Open communication, including sensitive issues, during bedside rounds rather than behind patients' backs builds patient trust 7,18 .…”

Section: Trainees Need a “Safe Place” To Learnmentioning

confidence: 99%

“…16 They value and better trust in the healthcare team when they observe explicit acknowledgments of uncertainty and, when necessary, the supervising physician teaches their trainees or proposes alternative care plans in collaborative and encouraging ways. 17 Open communication, including sensitive issues, during bedside rounds rather than behind patients' backs builds patient trust. 7,18 Bedside rounds are the perfect training grounds for trainees and supervisors to hone the skills of humility, honesty, respect, and compassion that patients expect from them.…”

Section: Trainees Need a " Safe Place" To Learnmentioning

confidence: 99%

Point/Counterpoint: Should patients be presented before entering the room during ward rounds?

Centor

Goldszmidt

Heudebert

et al. 2022

Journal of Hospital Medicine

View full text Add to dashboard Cite

As for the right way, the correct way, and the only way, it does not exist." -Friedrich Wilhelm Nietzsche Ward attending rounds have dual purposes: teaching and developing trainees for a variety of clinical skills while providing quality patient care. While rounds occupy a central position in the training of Internal Medicine physicians (dating from Osler), attending rounds currently face increasing challenges due to the complexities of our demanding healthcare environment.The modern residency experience has maintained ward attending rounds to a position of prominence. In a world of competing demands from documentation and billing, this time on the inpatient service has become increasingly sacrosanct for teaching. Recently, many have espoused a style of rounds that includes presenting exclusively at the bedside. We believe that presenting (and discussing) the patient prior to entering the room has major patient care and educational advantages. This approach can serve the myriad, often competing, demands of ward attending.

show abstract

Presenting cases in front of patients: implications for a key medical education genre

Cited by 3 publications

References 69 publications

Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial

Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial

Reading between the lines: exploring the unwritten rules of letters of recommendation in the Canadian resident selection process

Point/Counterpoint: Should patients be presented before entering the room during ward rounds?

Contact Info

Product

Resources

About