Role of case presentation for teaching and learning activities.

In most clinical teaching settings, case presentation is the most frequently used teaching and learning activity. From an educational viewpoint, the two important roles of case presentations are the presenter's reflective opportunity and the clinician educator's clues to diagnose the presenter. When a presenter prepares for a case presentation, he/she has to organize all the information collected from a patient. The presenter sometimes does not recall what to ask or to examine with relation to pertinent differential diagnoses while seeing a patient, and afterward he/she might note that more information should have been collected. He/she is able to note the processes by reflection-on-action and improve the processes the next time. Such a reflective process is the most important role of case conference for a presenter. When a clinician has a consultation with a patient, early problem representation determines the quality of differential diagnoses. Clinicians make a "big picture" while listening to the patient (sometimes only a glance is enough to diagnose a patient) as problem representation to narrow down clinical areas to ask questions. If the early problem representation is far from the optimal direction, the possibility of misdiagnosis will be higher. To correct the cognitive processes that lead to misdiagnosis, disclosure of uncertainty will be the key. If the teaching environment among residents or young clinicians is too competitive, some might feel reluctant to disclose incorrect reasoning processes to their peers. Or, if a clinician educator is too authoritative, students may hide key information from the educator. The educator should construct the best environment for students to be able to disclose such uncertainty. The main role of clinician educators is to facilitate and evaluate case presentations and to suggest points for improvement. Neher et al's "five microskills" are a typical example of these processes, after a short presentation of an outpatient case. Yet, for an inpatient or for formal discussion, a longer version presentation is used. To improve the clinical reasoning processes of the presenter, the short presentation has several advantages: (1) shortening the presentation requires abstraction of information, possibly leading to better problem representation; (2) it is time-efficient; and (3) it stimulates more informal interactions with the facilitator and the audience. In clinical settings, a presenter uses his/her time for the preparation of case presentations to reflect on the information he/she has collected. The facilitator should know how to improve case presentations to diagnose and improve the presenter. The advantages of the short presentation should be emphasized.