Role of Case-Based Discussion as Workplace-Based Assessment Tool in Urology and General Surgery

Article Information

Title: Role of Case-Based Discussion as Workplace-Based Assessment Tool in Urology and General Surgery

Authors: Shimee Shahzadi, Muhammad Shah, Liaqat Ali, Humera Adeeb, Brekhna Jamil

Journal: Journal of Gandhara Medical and Dental Sciences (JGMDS)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2022-07-01	2023-06-30
Y	2020-07-01	2021-06-30

Publisher: Gandhara University, Peshawar

Country: Pakistan

Year: 2024

Volume: 11

Issue: 2

Language: English

DOI: 10.37762/jgmds.11-2.584

Keywords: SurgeryPatient satisfactionClinicalUrologyKidney\

Abstract

OBJECTIVES
To determine the effectiveness of case-based discussion in terms of medical record-keeping, clinical reasoning, clinical judgment, and self-reflection in the management of patients.
METHODOLOGY
A multidisciplinary descriptive study was conducted in the Department of Urology Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar, and Department of General Surgery, Hayatabad Medical Complex Peshawar, Pakistan, from January to December 2023. A total number of 20 postgraduate residents, ten from Urology and General Surgery, participated in the study with equal male and female participants. Case-based discussion (CBD) assessments focused on medical record-keeping, clinical Decision-making, clinical judgment, management, follow-up, and reflective writing. The data was collected on structured proforma and was analyzed on SPSS-25.
RESULTSThe total number of study participants was 20, and 410 Case-Based Discussion sessions were conducted. This constitutes an average of 4.8 assessments per week. Most encounters were related to medical clinical decisions and management. The case-based discussion showed significant improvement on the Likert scale of the supervisor’s rating, which extended over four quarters on all major parameters of formative assessment (p 0.001). The multimodal regression test showed significant enhancement in learning parameters on case-based discussions. R2=0.172 F ration=25.141 n=410 (p=0.001). There was no significant difference in the gender of residents as well as training specialty of residents of urology and general surgery (p &gt;0.05).
CONCLUSION
A case-based discussion is an effective tool for formative assessment of Urology and General Surgery postgraduate residents.

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Research Objective

To determine the effectiveness of case-based discussion (CBD) in terms of medical record-keeping, clinical reasoning, clinical judgment, and self-reflection in patient management.

Methodology

A multidisciplinary descriptive study was conducted in the Department of Urology and Department of General Surgery at Hayatabad Medical Complex Peshawar, Pakistan, from January to December 2023. Twenty postgraduate residents (ten from Urology and ten from General Surgery) participated. Case-based discussions assessed medical record-keeping, clinical decision-making, clinical judgment, management, follow-up, and reflective writing. Data were collected on a structured proforma and analyzed using SPSS-25.

Methodology Flowchart

                        graph TD;
    A["Study Design: Multidisciplinary Descriptive Study"] --> B["Setting: Urology & General Surgery Depts, Hayatabad Medical Complex"];
    B --> C["Participants: 20 Postgraduate Residents"];
    C --> D["Data Collection: CBD Sessions assessing specific parameters"];
    D --> E["Data Analysis: SPSS-25"];
    E --> F["Results: Significant improvement in assessment parameters"];
    F --> G["Conclusion: CBD is an effective formative assessment tool"];

Discussion

Case-based discussion is an effective tool for formative assessment in postgraduate surgical training, addressing limitations of other workplace-based assessment tools like Mini-CEX and DOPS by potentially mitigating the Hawthorne effect. It significantly improves various assessment parameters and fosters critical thinking and self-reflection. The study's findings are comparable to existing literature, highlighting the importance of CBD in assessing residents at the "Does" level of Miller's Pyramid.

Key Findings

A total of 410 Case-Based Discussion sessions were conducted. CBD showed significant improvement (p < 0.001) in five parameters (medical record-keeping, clinical reasoning, judgment, management and follow-ups, reflective writing, and professionalism) on the Likert scale with each passing quarter. Multimodal regression analysis indicated significant enhancement in learning parameters (R²=0.172, F=25.141, p=0.001). No significant difference was found based on gender or training specialty (p > 0.05).

Conclusion

Case-based discussion is an effective tool for the formative assessment of postgraduate residents in Urology and General Surgery.

Fact Check

1. Study Period: The study was conducted from January 2023 to December 2023. (Confirmed)
2. Number of Participants: Twenty postgraduate residents participated in the study. (Confirmed)
3. Statistical Significance: A p-value of 0.001 was reported for significant improvement in assessment parameters. (Confirmed)

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