Council on Medical Student Education in Pediatrics

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COMSEP Meeting in Ottawa, ON

Platform Presentation:


Establishing Validity of PBEAR: An Oral Case Presentation Tool to Promote Clinical Reasoning

Authors:
Christina Tuluca,Childrens National,Washington,DC,Nicole Akar-Ghabril,Childrens National,Washington,DC,Jeff Sestokas,Childrens National,Washington,DC,Wilhelmina C. Bradford,Childrens National,Washington,DC,Gabrina Dixon,Childrens National,Washington,DC,Mary C. Ottolini,Childrens National,Washington,DC

BACKGROUND: Providing effective feedback on diagnostic reasoning to medical trainees during oral case presentations (OCP) is an important component of clinical clerkships. Few tools are available for faculty to provide structured feedback. OBJECTIVES: 1) To design a new feedback tool assessing diagnostic reasoning and communication skills of medical trainees during OCP 2) To assess the tool’s content and response validity, and internal structure METHODS: Our framework for OCP, “PBEAR,” differs from traditional presentations. Learners start with a “Problem Representation” to share their mental model from the outset. In “Background Evidence” learners filter relevant data from the history. “Analysis” encourages comparing and contrasting patient’s findings with known illness scripts. “Recommendation” is a problem-based plan. Students are also evaluated on communication skills. To assess content evidence for the tool, we requested feedback from > 100 hospitalists at pediatric national meetings. To assess response validity for the tool, 10 hospitalist educators rated an oral case presentation video and discussed their scoring rationale. Internal structure was analyzed from ratings of 53 audiorecorded case presentations. Three items were excluded (appropriately defers parts of the plan, uses notes minimally, makes appropriate eye contact) because they could not be assessed by audio recording. Sub-scales of the tool were also analyzed with Crohnbach’s alpha. RESULTS: Content evidence: After recommended changes to scoring rubric, the tool was piloted with 10 medical students, who endorsed the tool’s usefulness. Response validity: Tool was further modified, based on hospitalist educators’ feedback. Internal validity: Cornbach’s alpha for overall scale was excellent (alpha=0.89). Internal reliability of the subscales was good: Problem Representation Statement (0.88), Background Evidence – Objective (0.62), Analysis (0.87), Recommendation (0.89), and Communication Skills (0.79). Internal reliability of Background Evidence – Subjective (0.57) was weaker. CONCLUSION: The PBEAR OCP Tool is a valid rating scale for measuring students ability to effectively present a synthesized case while promoting clinical reasoning.