Council on Medical Student Education in Pediatrics

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COMSEP Meeting in Ottawa, ON

Poster Presentation:


Characteristics of 3rd Year Medical Students' Patient Assessments

Authors:
Robert S. Greenberg,Northwestern University Feinberg School of Medicine,Chicago,IL,Alanna . Higgins,Northwestern University Feinberg School of Medicine,Chicago,IL,Julie K. Stamos,Northwestern University Feinberg School of Medicine,Chicago,IL

Background:
In 1999, Louis Pangaro proposed the RIME Framework (Reporter, Interpreter, Manager, and Educator) to characterize the clinical progress of medical professionals. It is a goal of core clerkships to help students transition from reporting to interpreting clinical data through teaching accurate and concise patient assessments. While curricula have been developed to improve students’ case presentations, little has been reported about the content of student presentations, particularly their assessment statements.

Objective:
1.  Characterize student prioritization patterns in short assessments using text-pager messaging
2.  Determine the relationship between students’ reporting and interpreting skills using virtual patient cases

Methods:
Two required virtual patient scenarios including detailed history and physical exams were posted online for students participating in the clerkship between July 2012 and October 2013. Students used text-pager messaging limited to 200 characters to share their patient assessments with clerkship faculty.

Using a rubric developed by the clerkship directors, cases were independently scored by two physician reviewers and discrepancies resolved by a third physician reviewer. Historical facts, physical exam findings, and problems/diagnoses were extracted from student text-pages. Historical facts were further classified as pertinent or non-pertinent. Physical exam or lab findings were classified as “reported” or “interpreted” data. An interpreter:reporter index was calculated for each student for each case.  Pearson coefficients were used to determine correlations between interpreted and reported data.

Results:
140 assessments were reviewed and scored. Historical facts were reported more than physical exam findings (Case 1: 5.2 Hx to 1.4 PEx; Case 2: 4.2 Hx to 1.6 PEx).  There was weak to no correlation between the number of reported details and the number of interpreted details in the students' assessments. 

Discussion:
We expected an inverse relationship between reported and interpreted data, which was not seen. Our finding suggests that prioritizing information for a succinct assessment may be a different skill than transitioning from reporting to interpreting data.  The two skills may develop at a different pace and education should be tailored accordingly.