Special article
Improving oral presentation skills with a clinical reasoning curriculum: a prospective controlled study

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Abstract

Purpose

The oral case presentation is an essential part of clinical medicine, but teaching medical students to present clinical data remains difficult. Presentation skills depend on the ability to obtain, process, and organize patient data. Clinical reasoning is fundamental to the development of these skills. We compared a clinical reasoning curriculum with standard ward instruction for improving presentation skills and clinical performance.

Subjects and methods

Between October 1998 and May 1999, 62 third-year medical students at three hospitals were assigned to a 4-week clinical reasoning curriculum (n = 27) or a control group (n = 35) that underwent routine instruction. The curriculum consisted of four 1-hour group sessions and 1 hour of individual videotaped instruction, and taught students to use the principles of clinical reasoning, such as generation and refinement of diagnostic hypothesis, interpretation of diagnostic tests, and causal reasoning, to determine data for inclusion in the oral presentation. We videotaped students presenting two standardized case histories; one at baseline and a second 4 weeks later. Two independent evaluators who were blinded to the group assignments reviewed the videotapes and scored them for presentation quality and efficiency, and general speaking ability.

Results

Mean (± SD) presentation times at baseline were similar in the two groups (intervention group: 8 ± 2 minutes; control group: 8 ± 2 minutes; P = 0.74). Presentation time in students who were taught clinical reasoning decreased by 3 ± 2 minutes, but increased by 2 ± 2 minutes in control students. The difference in the changes between the groups was statistically significant (mean difference = 4 minutes; 95% confidence interval [CI]: 3 to 5 minutes; P <0.001). Presentation quality scores at baseline were similar in both groups (intervention group: 17 ± 8 points; control group: 20 ± 7 points; P = 0.11). Students who were taught the clinical reasoning curriculum had an improvement of 9 ± 6 points in the quality of their presentations, while control students had an improvement of 2 ± 7 points (on a scale of 4–36). The difference in the changes between the groups was statistically significant (mean difference = 4 points; 95% CI: 1 to 7 points; P = 0.04).

Conclusion

A clinical reasoning curriculum, in combination with video-based individual instruction, improves the efficiency and quality of oral presentations, and may augment clinical performance.

Section snippets

Subjects and study design

Sixty-two consecutive medical students at the University of California at San Francisco (UCSF) School of Medicine who were entering their third year of medicine clerkship were evaluated between October 1998 and May 1999. UCSF uses three hospitals for the medicine clerkship: The San Francisco Veterans Hospital, the San Francisco General Hospital, and The Moffitt-Long University Hospital. Although students are allowed to express a preference, the medical school assigns them to their clinical site

Results

There were no differences in baseline characteristics of the students in the intervention and control groups (Table 1). Because UCSF does not assign grades or class rank during the first 2 years of instruction, indices of medical school performance were not available.

Discussion

Undoubtedly the student tries to learn too much, and we teachers try to teach too much. We can only instill principles, put the student in the right path, give him methods, teach him how to study, and early to discern between essentials and non-essentials.Sir William Osler (24)

Instruction in the oral case presentation has failed to realize its potential, and some have advocated dispensing with the spoken case presentation entirely (25). The spoken case presentation, however, remains an integral

Acknowledgements

The authors would like to thank William Plauth, MD, and Warren Browner, MD, for their contributions to this manuscript. They extend a special thanks to William Plauth, MD, who served as one of the two physicians who reviewed the videotapes.

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