Combining bimodal presentation schemes and buzz groups improves clinical reasoning and learning at morning report

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 four groups and discussed the same two paediatric cases. The groups differed in their presentation modality (verbal only vs. verbal + 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 = 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 < 0.05), and for residents, a positive effect of buzz groups was found on judgment of learning (p < 0.005). A positive effect of bimodal presentation on diagnostic accuracy was noted in the specialists (p < 0.05). Combined bimodal presentation and buzz group discussion of emergency cases improves clinicians’ clinical reasoning and learning.

Acknowledgments

We thank the participating residents and specialists in paediatrics department. We also thank Edwin Stanton Spencer for linguistic assistance.

Declaration of interest: The authors report no declarations of interest.

Practice points

• Structure of morning report is important for the quality of clinical reasoning and learning.

• Bimodal presentation of selected cases combined with activation of all the participants in buzz groups increases the quality of clinical reasoning at morning report.

• Continued focus on residents’ self-directed learning, coaching and modelling by specialists is required.