Combining bimodal presentation schemes and buzz groups improves - PDF document

Medical Teacher ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20 Combining bimodal presentation schemes and buzz groups improves clinical reasoning and learning at morning report Thomas Balslev, Astrid Bruun Rasmussen, Torjus Skajaa, Jens Peter Nielsen, Arno Muijtjens, Willem De Grave & Jeroen Van Merriënboer To cite this article: Thomas Balslev, Astrid Bruun Rasmussen, Torjus Skajaa, Jens Peter Nielsen, Arno Muijtjens, Willem De Grave & Jeroen Van Merriënboer (2015) Combining bimodal presentation schemes and buzz groups improves clinical reasoning and learning at morning report, Medical Teacher, 37:8, 759-766, DOI: 10.3109/0142159X.2014.986445 To link to this article: http://dx.doi.org/10.3109/0142159X.2014.986445 Published online: 11 Dec 2014. Submit your article to this journal Article views: 260 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [Statsbiblioteket Tidsskriftafdeling] Date: 07 June 2016, At: 01:57

2015, 37: 759–766 Combining bimodal presentation schemes and buzz groups improves clinical reasoning and learning at morning report THOMAS BALSLEV 1,2 , ASTRID BRUUN RASMUSSEN 1 , TORJUS SKAJAA 1 , JENS PETER NIELSEN 1 , ARNO MUIJTJENS 3 , WILLEM DE GRAVE 3 & JEROEN VAN MERRIE ¨ NBOER 3 1 Viborg Regional Hospital, Denmark, 2 Aarhus University, Denmark, 3 Maastricht University, The Netherlands Abstract Morning reports offer opportunities for intensive work-based learning. In this controlled study, we measured learning processes and outcomes with the report of paediatric emergency room patients. Twelve specialists and 12 residents were randomised into Downloaded by [Statsbiblioteket Tidsskriftafdeling] at 01:57 07 June 2016 four groups and discussed the same two paediatric cases. The groups differed in their presentation modality (verbal only vs. verbal þ text) and the use of buzz groups (with vs. without). The verbal interactions were analysed for clinical reasoning processes. Perceptions of learning and judgment of learning were reported in a questionnaire. Diagnostic accuracy was assessed by a 20-item multiple-choice test. Combined bimodal presentation and buzz groups increased the odds ratio of clinical reasoning to occur in the discussion of cases by a factor of 1.90 ( p ¼ 0.013), indicating superior reasoning for buzz groups working with bimodal materials. For specialists, a positive effect of bimodal presentation was found on perceptions of learning ( p 5 0.05), and for residents, a positive effect of buzz groups was found on judgment of learning ( p 5 0.005). A positive effect of bimodal presentation on diagnostic accuracy was noted in the specialists ( p 5 0.05). Combined bimodal presentation and buzz group discussion of emergency cases improves clinicians’ clinical reasoning and learning. Background Practice points Admissions to clinical departments are often reported at Structure of morning report is important for the quality � morning report, a major educational and patient care-related of clinical reasoning and learning. activity in teaching hospitals (Gross et al. 1999; Amin et al. 2000; Bimodal presentation of selected cases combined with � Hougtalen et al. 2002; Klaber & Macdougall 2009; Walton & activation of all the participants in buzz groups Steinert 2010; McNeill et al. 2013). Morning report is a decision- increases the quality of clinical reasoning at morning dense, work-based learning environment, diagnostic uncer- report. tainty is common, and opportunities to practice and compare Continued focus on residents’ self-directed learning, � clinical reasoning are frequent. As an educational tool, how- coaching and modelling by specialists is required. ever, morning report is challenging to define, and its outcomes are difficult to measure (McNeill et al. 2013). Learning needs among the participating clinicians are diverse, as they range in experience from novices (medical students) to intermediates partly because little empiric research has been done on the (residents) and experts (specialists). When defining a learning teaching and learning involved at morning report (Walton & theory framework for teaching and learning at morning report, Steinert 2010; McNeill et al. 2013). the concept of cognitive apprenticeship is relevant (Collins 2006; Schumacher 2013). Cognitive apprenticeship emphasises a number of teaching and learning methods, including Morning report and elaboration and guidance modelling, coaching and scaffolding. Inherently, interaction of clinical reasoning between learners and teachers is important and has the greatest impact when learners have adequate time and the curriculum According to the cognitive apprenticeship learning theory, permits continuity and sequenced challenges. Although morn- such research should include a focus not only on learning ing report may indeed offer opportunities for intensive, outcomes but also on the processes of learning (Collins interactive, work-based and sequenced learning from authentic 2006). Therefore, an emphasis on development of medical cases, these learning opportunities are often neglected or expertise is highly relevant. We know that medical expertise unused (Walton & Steinert 2010). We suggest that this is at least develops by integration of knowledge into illness scripts, i.e. Correspondence : Thomas Balslev, Department of Paediatrics, Regional Hospital Viborg, 8800 Viborg, Denmark. Tel: +45 2173 6904; Fax: +45 7844 5434; E-mail: bafl@dadlnet.dk 759 ISSN 0142-159X print/ISSN 1466-187X online/15/80759–8 � 2015 Informa UK Ltd. DOI: 10.3109/0142159X.2014.986445