António Pais de Lacerda

Intensive care Department (Prof. Carlos França), Hospital de Santa Maria, Faculty of Medicine of Lisbon, Portugal

Transforming Healthcare through Excellence in Assessment and Evaluation
A conjoint conference with the 12th Canadian Conference on Medical Education

16th Ottawa Conference
(April 25-29, 2014) 

A new type of oral assessment at the end of a rotation in intensive care medicine: The “fictitious patient” set up by the resident

Background: Resident’s rotations in an ICU, is required in the postgraduate curriculum of several other areas of medicine. In addition to continuous assessment, their summative assessment at the end of the rotation validates a basic training with critically ill patients, capital in the growth of the future “hospitalist”. During the orals, it was asked to present the clinical history of an ICU patient and discuss his/her diagnosis, treatment and evolution/prognosis.

Summary of work: Currently a new format for orals was tried, in which each resident structures the clinical history of a fictitious patient, having necessarily to follow two or three clinical elements given at an initial statement (“seizures at hospital admission”, “5th day: fever 39ºC”, “continuous renal replacement therapy introduced at day 8th…). The resident should explain the admission to the ICU reason(s), the cause(s) for an extended length of stay, discuss laboratory values and imaging, mechanical ventilation modes (chosen parameters), haemodynamics monitoring/treatment, AKI evolution, feeding problems, any surgical interventions…

Summary of results: Some questions at the end were helpful to clarify the resident’s integrated knowledge and to evaluate other areas not highlighted in the “fictitious case”. Residents reported greater difficulties during the initial period, “thinking” what kind of condition would have triggered the whole patient’s process.

Conclusions: In the oral assessment of a rotation in critical care medicine, structuring “fictional clinical cases” by the resident can be a useful tool for assessing aspects of knowledge integration.

Take-home message: Structured “fictional clinical cases” are helpful in postgraduate ICU rotations assessment