Introducing resident doctors to complexity in ambulatory medicine

David Allan Cook, Thomas J. Beckman, Kris G. Thomas, Warren G. Thompson

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)838-848
Number of pages11
JournalMedical Education
Volume42
Issue number8
DOIs
StatePublished - Aug 2008

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Medicine
medicine
resident
Learning
Internal Medicine
Medical Education
Cross-Over Studies
Economics
Confidence Intervals
management
trainee
learning
continuity
confidence
expert
lack
knowledge
economics
education

Keywords

  • *ambulatory care
  • *internship and residency
  • Clinical competence/*standards
  • Internal medicine/*education
  • Minnesota
  • Randomized controlled trial [publication type]
  • Teaching/*methods

ASJC Scopus subject areas

  • Nursing(all)
  • Education
  • Public Health, Environmental and Occupational Health

Cite this

Introducing resident doctors to complexity in ambulatory medicine. / Cook, David Allan; Beckman, Thomas J.; Thomas, Kris G.; Thompson, Warren G.

In: Medical Education, Vol. 42, No. 8, 08.2008, p. 838-848.

Research output: Contribution to journalArticle

Cook, David Allan ; Beckman, Thomas J. ; Thomas, Kris G. ; Thompson, Warren G. / Introducing resident doctors to complexity in ambulatory medicine. In: Medical Education. 2008 ; Vol. 42, No. 8. pp. 838-848.
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abstract = "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.",
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