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Jun 17, 2008
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We are considering changing our unknown conference format. So I'm looking for information on how other programs run theirs and what they like/dislike about it.
Presently, we have a weekly conference with 15 cases submitted by staff with usually a single H&E and either just site or a few words of history. We have a form on which we give our diagnosis/differential and additional studies we'd perform. This gets turned in prior to conference and graded. At conference, we take turns taking first crack at a case. It's usually just diagnosis-only. There will occassionally be a brief discussion of the case, but typically it's just "right" or "nope, anyone else?".
It's great that we get to see essentially every note-worthy case that comes through, but working through the 15 hardest cases from the previous week eats up a huge chunk of time and we really don't get instruction/feedback as to where we went wrong on the ones we miss. It just seems like the educational-value to time-spent ratio is really poor and it could be improved.


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Why do you get graded? Seems silly. Evaluations on your actual performance in rotations would be more effective. This seems like a way for attendings to pass the buck on having the "arduous" task of filling out evaluations - this way they can give it to an administrative assistant who can grade it and record it. Is it required?

We have a couple of different unknown conferences. One is a board-review type of thing where one attending (always the same one) gives us 10 cases which we look at in silence and think of our own answers, then at the end we go through them again and he tells us the answers. No pressure or anything. The other is weekly, attendings take turns, usually they put out cases a few days before and people can go over them. Then at the conference they go over them. Some of them ask people what they think or call on people, or ask for volunteers. Not any real pressure. It does sort of let residents off the hook in terms of not committing to an answer, but you're only hurting yourself if you don't take it seriously. It's more for education, not for evaluation.

I would suggest spending more time on education and less on evaluation. What is the point of the evaluation? To prove people get better as they go through training?

levels x3

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We have 3 different types.

Once a month there will be an organ/tissue type specific conference given by 1 attending. We'll get the slides 3-4 days in advance to look at and then we'll go over them together at our multi-headed scope. Purely educational, no pressure, quite effective.

Each friday morning on the other hand is our traditional unknown conference. 7-8 slides will be put out with minimal history near the beginning of the week. We get the week to look at them and develop a differential, plan for IHC's, etc. Then we'll go over them on Friday morning and the discussion can be quite long winded depending on the attending. Occasionally the pressure level seems too high and junior residents tend to see this as a stressful conference. Still, it's reasonably effective as we see a lot of unusual cases this way. 15 cases would be way too many for us to do here because our attendings like to talk...a lot. A few years ago (when I started and before) we handed in sheets like you describe, but it was so obviously pointless that we kind of just stopped. I don't think anybody made a decision to stop collecting them, we just did.

About a year ago we added an "on the spot" unknown session that precedes the usual friday conference. 5 supposedly postage stamp lesions will be shown with just a few seconds each and we have to make a diagnosis. This one is graded though I'm unsure of why or what it's used for. The problem with this session is that we occasionally get cases that are absolutely not "on the spot" diagnoses. I don't think many people find this session too stressful, but I also don't know how helpful it is. Generally we just end up complaining that the driver didn't show the diagnostic fields well enough, or arguing that it wasn't an obvious diagnosis anyway. I'm not really in favor of this conference as we do it here. It seems to be just added on for the sake of having a graded pop quiz. Ungraded, on the spot cases with adequate discussion would be fine though. Then junior residents can work through their descriptions and then ask the senior residents for help with the final diagnosis.


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We have had some graded pre-/post-tests related to some didactic series we've had - We were told its some requirement (AGCME?) that the program has to meet, regarding objectively quanitfying our performance/improvement on a regular basis, or something silly like that. We're told not to worry about it. It's never related to unknowns, tho.

Our unknown conference is weekly, Monday 8am. We typically get anywhere from 4 - 6 cases the previous Wed or Thur, with minimal history, sometimes immunos are provided. In conference, we're typically called on - usually first years are called on to describe the lesion (power point images) and offer a differential. If the cases are harder, sometimes they'll just start out with an upper level. The format is good because typically the differential and important diagnostic points are discussed. There is typically a "theme" organ/system, and the attending in charge rotates (many attend).

So that's our main "Unknown" conference. We also have a semi-weekly bone/soft tissue unknown, for a noon conference on Monday. We're often given the accompanying radiograph/CT. We have a "Frozens" conference every other week, where we take turns sitting down at the scope and looking over an unknown frozen case, making the call ("what would you tell the surgeon?") and then discussing it. We also have a biweekly neuropath and cytopath conference where we essentially go over unknown cases that are presented to us in conference (powerpoint, typically).

So I guess in a way, we have a lot of unknowns, but only 2 conferences which require advance preparation... the differential and key diagnostic points are discussed... I think they're good.

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