gms | German Medical Science

Introduction: During internships students frequently witness clinical situations in which routine medical algorithms are not sufficient to solve the problem. This forms a challenge for clinical teaching, since there is often no time, or awareness, to work up these situations. Furthermore, by overseeing these situations important teaching opportunities might be missed. Only little is known about the nature of respective situations and how they are related to CanMEDS roles. For our research we intentionally defined the term “difficult clinical case” in a broader fashion, including potential underlying causes outside the specific medical problem (e.g. communication within teams, resource shortages, ethical dilemmata). With better insight into the problems perceived by students, we might be able to design more adequate preparation for internships and provide information for clinical teachers in regard to CanMEDS roles.

Methods: The University of Zurich implemented a new learning format to reflect physicians’ roles within the 6th year of undergraduate training (total cohort: n=240). As a fundamental element of this course each student submits a “difficult clinical case” of 150-300 words from his own internship experience (to form the thematic basis of the course). We performed qualitative analysis of these case vignettes, relating to the seven CanMEDS roles.

Results: The preliminary analysis of 10% of the collected material showed a wide distribution of difficult clinical cases reaching from “access to health care” over “communication challenges” and “interprofessional communication” to “shared decision” and “palliation”. Leading CanMEDS roles addressed within the case vignettes were “professional” (approx. 35% of cases), “communicator” (25%), and “health advocate” (20%).

Discussion: “Difficult clinical case” vignettes from internships may serve as a rich resource to identify teaching gaps and opportunities, and to design preparation formats for students before their internships. More elaborate results will be available at the time of the RIME conference 2015.