"What is the mechanism?": Cues, barriers, and opportunities to discuss foundational science during internal medicine rounds. (3rd July 2022)

• Record Type: Journal Article
• Authors: Pai, Jonathan S.; Kirsch, Heidi E.; O'Sullivan, Patricia S.; Cornett, Patricia A.
• Is Part Of: Medical teacher. Volume 44:Number 7(2022)
• Page Start: 765
• Page End: 771
• Publication Date: 2022-07-03
• Subjects: Clinical teaching -- foundational science -- qualitative methods -- thematic analysis; Medical education -- Periodicals; 610.711
• DOI: 10.1080/0142159X.2022.2033189
• Languages: English
• ISSNs: 0142-159X

Abstract

Abstract: Background: Repeated application of foundational science (FS) during medical reasoning results in encapsulation of knowledge needed to develop clinical expertise. Despite proven benefit of educating learners using a FS framework to anchor clinical decision making, how FS is integrated on clinical rotations has not been well characterized. This study examines how and when FS discussion occurs on internal medicine teaching rounds. Material and methods: We performed a convergent mixed method study. Six internal medicine teams at a quaternary hospital were observed during rounds and team members interviewed. Transcripts were analyzed using thematic analysis. Descriptive statistics provided a summary of the observations. Results: Our study revealed that rounds used a teacher-centered model where FS knowledge was transmitted as pearls external to the clinical context. FS content arose primarily when the patient was complex. Barriers preventing FS discussion were lack of time and perceived lack of personal FS knowledge. Conclusion: Our study describes scenarios that commonly elicit discussion of FS on inpatient medicine rounds highlighting a 'transmission' model of FS knowledge. We suggest a learner-centered model that engages students in the practice of integrating FS into clinical reasoning.