A qualitative study of pediatric residents’ developmental oral case presentations

Objectives: To explore how pediatric residents apply their knowledge of relevance in their oral case presentations to the unfamiliar context of a chronic care setting, that of developmental pediatrics. Methods: Pediatric resident oral case presentations were observed and semi-structured interviews were conducted with residents and staff developmental pediatricians. A total of 13 residents and 5 developmental pediatricians were observed and 13/18 participants were interviewed and audiorecorded. Qualitative transcript data were analyzed for emergent themes using an inductive thematic analysis approach. Results: Pediatric residents identified challenges with determining relevance in their oral case presentations in this context. They had difficulty generating succinct case presentations and integrating patient information into an overall clinical impression. Residents conflated the strict organization of information with relevance, and demonstrated presentation formats akin to those used by more novice medical trainees. Staff members viewed the oral case presentation as a flexible vehicle to integrate patient information; however, this perspective was not always explicitly shared during teaching exchanges. Conclusions: Results of this study draw attention to the possible contextual nature of residents’ understanding and use of relevance principles in their oral case presentations. Clinicians responsible for teaching in outpatient chronic care settings need to be aware of the possible challenges residents may have with their case presentation, so that teaching strategies can be implemented to ensure residents’ acquisition and appropriate adaptation of this essential communication skill.