Mayo Clinic
Rochester, MA
Craig Daniels, MD
In 1904 William Osler wrote, “No teaching should be done without a patient for a text”.
Affectionately referred to as “Wednesday morning conference”, our Pulmonary and Critical Care Division’s Case Conference is a superb example of a “best educational practice”. The basic structure of presentation of a brief “unknown” clinical case to a single physician who must demonstrate diagnostic reasoning while under the eye, and occasionally the ire, of the whole division has endured – unchanged – through the tests of time, technologic innovation, new medical knowledge, and educational theory. It is a point of pride for our division that our Case Conference is the longest running clinical conference in Mayo’s history.
Applying knowledge through a problem solving strategy to reach a diagnosis is the most valuable skill a physician must learn. This skill, termed clinical reasoning, endures the changes in medical knowledge throughout one’s career. But how is it taught? Historically, students present a single patient’s case to a medical educator who guides them through the process of relating isolated facts (symptoms, signs, and test results) into a coherent understanding their patient’s diagnostic possibilities. The opportunity to observe and assess the clinical reasoning by physicians at various levels of training up to master clinicians is the basis of our Division’s Case Conference.
While many institutions have conferences in which they present cases, the culture of our case conference is unique, memorable, and entertaining. A staff physician presents a case and questions a tremulous trainee with the knowledge that a trainee has an equal opportunity to challenge a staff member with a difficult case. The modest anxiety which accompanies this interchange means one may be assured those involved in the interchange will recall the details of missed cases years later. In addition, the opportunity to repetitively rethink one’s own diagnostic skills from a comfortable chair in the audience provides the format from which one quickly recognizes holes in reasoning and fund of knowledge with painful clarity. How many times has each of us stated, “I’m glad I wasn’t called to discuss that case, I would have missed it.” Typically, presenters select cases for presentation because they have learned and been challenged. In preparing and sharing a difficult case over 15 minutes, one is forced to distill essential elements and therein analyze the success and failure in their own diagnostic reasoning. The spectrum of diseases and presentations never ceases to amaze.
We asked our fellows for feedback of our Case Conference:
“This spirit of sharing our best and most interesting patients with one another solidifies the Division and allows fellows to feel on par with the experienced and learned.”
“Interdisciplinary participation by our colleagues from pathology and radiology make it exceptionally comprehensive and educationally robust. It is undoubtedly the best educational conference I have ever attended.”
“All faculty from the department participate which allows for the fellows to learn from the strengths of each staff.”
“When new fellows ask why they should attend our Case Conference, I tell them that every time I have ever attended the conference I learn something which impacts patient care. There is nothing else like it.”
