Exploring medical students' use of principles of self-explanation and structured reflection during clerkship.

Background: While educators observe gaps in clerkship students' clinical reasoning (CR) skills, students report few opportunities to develop them. This study aims at exploring how students who used self-explanation (SE) and structured reflection (SR) for CR learning during preclinical training, applied these learning strategies during clerkship. Methods: We conducted an explanatory sequential mixed-methods study involving medical students. With a questionnaire, we asked students how frequently they adopted behaviours related to SE and SR during clerkship. Next, we conducted a focus group with students to explore why they adopted these behaviours. Results: Fifty-two of 198 students answered the questionnaire and five participated in a focus group. Specific behaviours adopted varied from 50% to 98%. We identified three themes about why students used these strategies: as "just in time" learning strategies; to deepen their understanding and identify gaps in knowledge; to develop a practical approach to diagnosis. A fourth theme related to the balance between learning and assessment and its consequence on adopting SE behaviours. Conclusions: Students having experienced SE and SR regularly in preclinical training tend to transpose these strategies into the clerkship providing them with a practical way to reflect deliberately and capture learning opportunities of the unpredictable clinical context.

Contexte: Alors que les éducateurs observent des lacunes dans les compétences de raisonnement clinique (RC) des étudiants en externat, ces derniers font état de peu d'occasions de les développer. Cette étude vise à explorer comment les étudiants qui ont utilisé l'auto-explication (AE) et la réflexion structurée (RS) pour l'apprentissage du raisonnement clinique pendant la formation préclinique, ont appliqué ces stratégies d'apprentissage pendant l'externat. Méthodes: Nous avons mené une étude séquentielle explicative à méthodes mixtes auprès d'étudiants en médecine. À l'aide d'un questionnaire, nous avons demandé aux étudiants à quelle fréquence ils adoptaient des comportements liés à la AE et à la RS pendant l'externat. Ensuite, nous avons organisé un groupe de discussion avec les étudiants afin d'explorer les raisons pour lesquelles ils ont adopté ces comportements. Résultats: Cinquante-deux étudiants sur 198 ont répondu au questionnaire et cinq ont participé à un groupe de discussion. Les comportements spécifiques adoptés variaient de 50 % à 98 %. Nous avons identifié trois thèmes concernant les raisons pour lesquelles les étudiants ont utilisé ces stratégies : comme stratégies d'apprentissage "juste à temps"; pour approfondir leur compréhension et identifier les lacunes dans les connaissances ; pour développer une approche pratique du diagnostic. Un quatrième thème concernait l'équilibre entre l'apprentissage et l'évaluation et ses conséquences sur l'adoption de comportements liés à l'AE. Conclusions: Les étudiants qui ont fait l'expérience de l'AE et de la RS régulièrement au cours de leur formation préclinique ont tendance à transposer ces stratégies dans l'externat, ce qui leur fournit un moyen pratique de réfléchir délibérément et de saisir les opportunités d'apprentissage dans un contexte clinique imprévisible.

Considering the Structured Oral Examinations Beyond Its Psychometrics Properties.

Decisions to set aside Structured Oral Examinations (SOE) are, almost invariably, based on their poor psychometric properties. However, considering the perspectives of the stakeholders might help us to understand its potential contribution. To explore this, we conducted focus groups and individual interviews with stakeholders: students, assessors, and administrators. Students and assessors perceived the SOE as a window on students' clinical reasoning, as an authentic assessment, but as a subjective and stressful method. Administrators emphasized the organizational consequences such as logistical challenges. Consequences must be considered when making decisions about SOE and our results support important positive consequences.

Advanced hepatocellular carcinoma with subtotal occlusion of the inferior vena cava and a right atrial mass.

Hepatocellular carcinoma usually metastasizes to regional lymph nodes, lung, and bones but can rarely invade the inferior vena cava with intravascular extension to the right atrium. We present the case of a 75-year-old man who was admitted for generalized oedema and was found to have advanced HCC with invasion of the inferior vena cava and endovascular extension to the right atrium. In contrast to the great majority of hepatocellular carcinoma, which usually develops on the basis of liver cirrhosis due to identifiable risk factors, none of those factors were present in our patient.