Heidemann LA, McTaggart S, Monrad SU, Hartley S. Can Incoming Interns Be Entrusted to Recognize Medical Emergencies? Implementation of a Vignette-Based Cross-Cover Assessment.
J Grad Med Educ 2022;
14:488-492. [PMID:
35991107 PMCID:
PMC9380638 DOI:
10.4300/jgme-d-21-01193.1]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/26/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND
Interns must recognize urgent clinical situations and know when to seek assistance. However, assessing this skill is challenging.
OBJECTIVE
We explored whether graduating medical students could determine urgency of medical cross-cover scenarios and what factors were associated with this ability.
METHODS
Sixty senior medical students enrolled in an internal medicine residency preparation course, and 28 experts were invited to take an assessment using 4 clinical vignette handoffs, each with 5 to 6 cross-cover scenarios. Respondents were asked whether they would evaluate the patient at bedside and notify their supervising resident. They were asked to rate their comfort managing the scenario, rate the urgency (1=low, 2=moderate, 3=high), and take a medical knowledge quiz. Student performance was categorized based on stratification of clinical urgency-those who underestimated (fourth quartile), accurately estimated (second and third quartile), and overestimated (first quartile) urgency. We examined differences between groups in medical knowledge, action, and confidence using analysis of variance and post-hoc Tukey Honestly Significant Difference test.
RESULTS
Fifty-eight students (96.7%) and 22 experts (78.6%) participated. Clear differentiation emerged between students' ability to estimate urgency on the 3-point urgency scale (lowest quartile: 2.15±0.11; mid-quartiles: 2.38±0.07; upper quartile: 2.61±0.10, respectively). Students who underestimated urgency were less likely to notify their supervising resident (P=.001) and less likely to evaluate a patient at bedside (P=.01). There was no difference in quiz score or comfort level.
CONCLUSIONS
Incoming interns vary in their abilities to recognize urgent scenarios, independent of medical knowledge and confidence.
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