Ageism scale for dental students (ASDS): A focus group review of content validity.

PURPOSE/AIM: Improve content validity of the Ageism Scale for Dental Students (ASDS) and identify barriers to using the scale. METHODS: Thematic analysis of transcripts of three purposively sampled focus groups of 1) geriatric dentistry specialists, 2) older adult dental patients, and 3) dental students. RESULTS: Twenty-five participants engaged in focus groups. No new concepts to define ageism were identified. Experts found the scale acceptable and appropriate, yet they raised specific potential revisions to scale questions. Commonly reported themes already addressed by ASDS included the importance of tailoring decision-making to patient preference and not making assumptions about older adults' capacity or preferences for dental care. Barriers to identifying ageism or using the scale included experiential differences in interpreting scale items, cultural differences in attitudes towards older adults, and potential overlap with social determinants of health. Secondary findings include recommendations for older-adult focused training for dental students to provide positive, concrete guidance on caring for older adults. CONCLUSION: There are opportunities to refine the Ageism Scale for Dental Students and to allow tailoring of the scale for specific national or cultural contexts.

Anxiety and depression symptoms among patients with long COVID: a retrospective cohort study.

Patients suffering from post-acute sequelae of COVID-19 (PASC) have a higher prevalence of anxiety and depression than the general population. The long-term trajectory of these sequelae is still unfolding. To assess the burden of anxiety and depression among patients presenting to the University of Iowa Hospitals and Clinics (UIHC) post-COVID-19 clinic, we analyzed how patient factors influenced Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scores. In this retrospective cohort study, the GAD-7 and PHQ-9 questionnaire scores of patients presenting to the UIHC post-COVID clinic between March 2021-February 2022 (N = 455) were compared to the scores of a sample of patients presenting to the general internal medicine (GIM) clinic during the same period (N = 94). Our analysis showed that patients with an absent history of depression on their electronic medical record (EMR) problem list scored significantly higher on the GAD-7 (mean difference -1.62, 95% CI -3.12 to -0.12, p = 0.034) and PHQ-9 (mean difference -4.45, 95% CI -5.53 to -3.37, p < 0.001) questionnaires compared to their similar counterparts in the GIM clinic. On the other hand, patients with an absent history of anxiety on their EMR problem list scored significantly higher on the GAD-7 (mean difference -2.90, 95% CI -4.0 to -1.80, p < 0.001) but not on the PHQ-9 questionnaire (p = 0.196). Overall, patients with PASC may have experienced a heavier burden of newly manifest anxiety and depression symptoms compared to patients seen in the GIM clinic. This suggests that the mental health impacts of PASC may be more pronounced in patients with no prior history of anxiety or depression.

Research unit network (RUN) as a learning research system.

The clinical research units (CRUs) are one of the main spaces where both translational research and science take place. However, there is a lack of information about both best practices for CRU operations and, ultimately, benchmarks to evaluate CRU performance. The Research Unit Network (RUN) was created with the purpose to enable direct communication and collaboration among CRUs. An online survey was administered to further illustrate the functionality and impact of RUN. Thirty-one individual survey responses (39.2%) were included in the final analysis. The members value RUN monthly meetings (87.1%) as the most useful aspect of this network and CRU budgeting (67.7%) and staffing (61.3%) were the most relevant topics discussed. This is followed by EPIC - Research (58.1%), delegation of authority logs, unit signatures, and policies (51.6%), COVID-19 pandemic response (41.9%), the implementation of clinical trial management system (29.0%), and protocol deviations (19.4%). The intermediate goal of RUN is to identify best practices CRUs are establishing, implementing, and sharing these experiences with the goal to adopt them in different CRUs. The network's long-term goal is to establish standard benchmarks that can be used for evaluating the performance of CRUs across the nation.

Patient Experiences with a Tertiary Care Post-COVID-19 Clinic.

Post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC) is a complex condition with multisystem involvement. We assessed patients' experience with a PASC clinic established at University of Iowa in June 2020. A survey was electronically mailed in June 2021 asking about (1) symptoms and their impact on functional domains using the Patient-Reported Outcomes Measurement Information System (PROMIS) measures (Global Health and Cognitive Function Abilities) (2) satisfaction with clinic services, referrals, barriers to care, and recommended support resources. Survey completion rate was 35% (97/277). Majority were women (67%), Caucasian (93%), and were not hospitalized (76%) during acute COVID-19. As many as 50% reported wait time between 1 and 3 months, 40% traveled >1 h for an appointment and referred to various subspecialities. Participants reported high symptom burden-fatigue (77%), "brain fog" (73%), exercise intolerance (73%), anxiety (63%), sleep difficulties (56%) and depression (44%). On PROMIS measures, some patients scored significantly low (≥1.5 SD below mean) in physical (22.7%), mental (15.9%), and cognitive (17.6%) domains. Approximately 61% to 93% of participants were satisfied with clinical services. Qualitative analysis added insight to their experience with healthcare. Participants suggested potential strategies for optimizing recovery, including continuity of care, a co-located multispecialty clinic, and receiving timely information from emerging research. Participants appreciated that physicians validated their symptoms and provided continuity of care and access to specialists.

Translation and preliminary validation of a French version of an ageism scale for dental students.

BACKGROUND AND AIM: The World Health Organization considers ageism an important barrier to age-appropriate care for older adults. A new ageism scale for dental students (ASDS) has been validated in the United States, Brazil, Greece and Romania. The aim of this study was to validate a French version (ASDS-Fr). METHOD AND MATERIALS: The 27-item ageism scale was translated from English into French, and its content validity was investigated using the content validity index. The translated version was completed by 180 dental students in the Dental School of Clermont-Ferrand in France. Principal component analysis (PCA) was performed and internal consistency reliability was calculated. RESULTS: The final PCA model resulted in 10 items and three components that together accounted for 57.2% of the overall variance. The first component contained four items that point to a negative view of older adults; the second contained three items that appeared to reflect an absolving of responsibility for providing care to older adults; and the third contained three items that deal with gerodontology education. CONCLUSIONS: This preliminary validation of the ASDS-Fr produced a new 10-item scale with three components with acceptable validity and reliability.

Medical Education and the Ethics of Self-Care: A Survey of Medical Students Regarding Professional Challenges and Expectations for Living Healthy Lifestyles.

OBJECTIVES: Little is known about medical students' attitudes regarding the healthy lifestyle habits they are taught to recommend to patients and whether they believe they have a professional responsibility to live a healthy lifestyle. Understanding students' attitudes and practices regarding healthy lifestyles may provide insights into the personal and professional challenges that students face as they navigate the ethical tension between obligations to care for others (altruism) and for themselves (self-care). METHODS: The authors conducted a cross-sectional, anonymous, online survey of all medical students at the University of Iowa Carver College of Medicine in fall 2019, using descriptive statistics for analysis. RESULTS: A total of 351 students participated (response rate, 52.0%). Most agreed that physicians (85.5%) and medical students (77.8%) have a responsibility to try to live a healthy lifestyle; that physicians who practice healthy behaviors are more confident in counseling patients (94.0%), more likely to counsel patients (88.3%), and more likely to have their advice followed (86.9%); that as students they are more likely to counsel patients if they practice the healthy behavior (90.0%); and that their medical school workload resulted in exercise (69.7%), sleeping (69.4%), and eating (60.2%) practices that were less healthy than they should be. CONCLUSIONS: Most medical students support the professional responsibility to live a healthy lifestyle and believe doing so increases their effectiveness in counseling patients about healthy lifestyle habits. The medical school workload may limit some students' ability to live healthy lifestyles, however. Medical students need educational opportunities in ethics and professionalism to discuss challenges and expectations for living healthy lifestyles, with an eye toward practical approaches to living the life of a medical student that are professionally responsible and personally realistic.

Impact of COVID-19 on Clinical Research Units (CRUs).

Few studies have explored the challenges that the COVID-19 pandemic has presented for Clinical Research Units (CRUs), the solutions that have been implemented, and the changes that have been made in the operational guidelines for these entities. This study sought to identify and document common practices implemented by CRUs around the United States of America (USA) when addressing the unique challenges posed by the COVID-19 pandemic. This descriptive study utilized a non-experimental mixed-methods approach and gathered data from representatives of 43 CRUs across the USA. An online survey was followed by in-depth interviews. The findings show that challenges faced from the COVID-19 pandemic, changes made to daily operations, and lessons learned are very similar across CRUs. Although most CRUs never stopped performing essential clinical research, many adapted to the pandemic by engaging in virtual visits, and many played key roles in administering and supporting both COVID-19 therapeutic and vaccine trials. Follow-up interviews showed that processes for formal approval and reopening were similar across CRUs. In addition to highlighting the significance of the role played by CRUs during the COVID-19 pandemic, this study addresses the relevance of CRUs and lays the groundwork for future conversations on the importance of these units.

Temporal changes in medical student perceptions of their clinical skills and needs using a repeated self-assessment instrument.

BACKGROUND: Medical student needs in clinical skill training may change over time, but data on this topic are limited. This study uses repeated self-assessments on clinical rotations during medical school to evaluate students' perceptions of their clinical skill growth. METHODS: A self-assessment rating was completed by students during each clinical rotation as they progressed through their core clinical rotation year. The instrument consisted of questions on 5 clinical skill categories where students rated their performance as "below", "at" or "above" expected, and open-ended questions on strengths and challenges. We evaluated changes in self-ratings between the first (n=136) and third (n=118) quarters by matched-pair analysis of the shift in responses between time points using a Sign Test. We also identified the main themes from the students' responses to open-ended questions. RESULTS: We found 22.4 % and 13.3 % of students increased their self-assessment ratings on "Oral Presentation Skills" and on "Differential Diagnosis", respectively. In contrast, perceived ability to communicate with patients saw the largest negative shifts. "Patient Interaction" was the most commonly identified area of strength and "Knowledge and Organization" was most frequently cited as a barrier. CONCLUSIONS: Students demonstrated a positive shift in perceived competence in some core clinical skills that are not strongly emphasized in the preclinical curriculum, likely reflecting increased exposure over time. However, their perceived competence in communication skills declined. This may reflect initial over-estimation or true decline due to competing needs/interests. These patterns of change can inform the design of longitudinal curricula that anticipate and address students' needs during clinical rotations, such as placing increased emphasis on presentation skills and differential diagnosis earlier in the curriculum, and adding more emphasis to communication skills in later phases.

Developing a self-assessment tool for dental faculty to map professional growth.

Although self-assessment is a lifelong skill practiced in predoctoral training, the utility of this mechanism is seldom linked to competencies that encompass the broad range of skill sets and roles of an academic dentist. Literature defining faculty competencies and/or roles in medical and dental education is limited in scope focusing primarily on teaching and research. Identifying the broad spectrum of dental faculty skill sets and connecting them to self-assessment and professional development needs to be explored. Furthermore, a mechanism that can serve as a professional roadmap with identified areas to develop and catapult faculty into a self-reflection growth process is lacking in dental academia. The purpose of this study was to define the broad spectrum of competencies, or skill sets of an academic dentist and develop a faculty self-assessment tool grounded in self-regulation theory to help faculty track and plan professional growth. A mixed-methods approach including a faculty focus group was used to refine and verify the relevance of pre-defined faculty roles and skill sets. A self-assessment instrument was then developed with 31 broad skills and two scales that ascertained faculty interest in developing and development stage for each skill set. The intended utility of the self-assessment tool is to provide an introspective mechanism to obtain specific information about a wide range of faculty professional growth areas beyond teaching and research. The instrument can also be used to facilitate mentoring and may have implications for determining faculty development programming.

Assessing factors for choosing a primary care specialty in medical students; A longitudinal study.

A shortage of primary care physicians exists in the US, and medical schools are investigating factors that influence specialty choice. To better understand the factors associated with medical students choosing primary care specialties, a longitudinal annual survey from 2013 to 2019 was administered to students at the University of Iowa Carver College of Medicine, starting pre-matriculation. A logistic regression model examined factors of interest. Matching into a primary care specialty (family medicine, internal medicine, pediatrics) for residency was the primary outcome. Our study compared factors students reported in annual surveys: demographics, mentorship, debt, and lifestyle. Factors significantly associated with primary care specialty included pre-medical and medical school research, a family member in primary care, student age and gender. 28% of men chose primary care, and 47% of women. Although there was no gender difference in rates of medical education debt (N = 286,χ2(1) = 0.28, p = 0.60), men were more likely to report being influenced by debt (N = 278, χ2(1) = 10.88, p = 0.001), and students who reported debt-influenced specialty choice were one-third as likely to enter primary care (N = 189, 95% CI [0.11-1.06], p = 0.06). For men, potential salary was negatively associated with entering primary care (p = 0.03). Women were more likely to have a mentor in primary care (N = 374, χ2(1) = 13.87, p < 0.001), but this was not associated with an increased likelihood of entering primary care for men or women. Having a family member who practices primary care was associated with a 2.87 times likelihood of entering primary care (N = 303, 95% CI [1.14-7.19], p = 0.03). The decision to enter primary care is influenced by many factors; a key gender differentiator is that men's specialty choice is more negatively influenced by financial concerns.

Tools for Responding to Patient-Initiated Verbal Sexual Harassment: A Workshop for Trainees and Faculty.

Introduction: Patients are the most common source of gender-based harassment of resident physicians, yet residents receive little training on how to handle it. Few resources exist for residents wishing to address patient-initiated verbal sexual harassment themselves. Methods: We developed, taught, and evaluated a 50-minute workshop to prepare residents and faculty to respond to patient-initiated verbal sexual harassment toward themselves and others. The workshop used an interactive lecture and role-play scenarios to teach a tool kit of communication strategies for responding to harassment. Participants completed retrospective pre-post surveys on their ability to meet the learning objectives and their preparedness to respond. Results: Ninety-one participants (57 trainees, 34 faculty) completed surveys at one of five workshop sessions across multiple departments. Before the workshop, two-thirds (67%) had experienced patient-initiated sexual harassment, and only 28 out of 59 (48%) had ever addressed it. Seventy-five percent of participants had never received training on responding to patient-initiated sexual harassment. After the workshop, participants reported significant improvement in their preparedness to recognize and respond to all forms of patient-initiated verbal sexual harassment (p < .01), with the greatest improvements noted in responding to mild forms of verbal sexual harassment, such as comments on appearance or attractiveness or inappropriate jokes (p < .01). Discussion: This workshop fills a void by preparing residents and faculty to respond to verbal sexual harassment from patients that is not directly observed. Role-play and rehearsal of an individualized response script significantly improved participants' preparedness to respond to harassment toward themselves and others.

Preliminary validation of the Dental Clinical Learning Environment Instrument in a Brazilian dental school.

INTRODUCTION: This study aimed to perform a preliminary validation of the Dental Clinical Learning Environment Instrument (DECLEI) in a Brazilian dental school. MATERIAL AND METHODS: Dental Clinical Learning Environment Instrument was translated into Brazilian-Portuguese, and Brazilian DECLEI's items relevance and content validity were assessed using the content validity index (CVI). DECLEI was then distributed to 155 Brazilian undergraduate dental students attending the 7th and 8th semester of dental studies. Principal Component Analysis (PCA) was used as an initial exploration of the Brazilian DECLEI's internal structure. Item-total correlations for the remaining items were calculated to identify items with poor discrimination coefficients. The internal consistency reliability for the final set of 17 items was calculated using Cronbach's alpha coefficient. The sensitivity of the instrument to measure differences between groups regarding year in dental school, race and sex was also assessed. RESULTS: The CVI was ≥0.80 for all 24 items of the Brazilian DECLEI indicating that all items were relevant to the local culture. Principal Components Analysis (PCA) provided evidence of a single dominant component containing 17 items (Cronbach's α = .86), and all 17 items met the benchmark of acceptable item-total correlation. Significant differences were found only when comparing 7th- and 8th-semester students. CONCLUSIONS: Dental Clinical Learning Environment Instrument has the potential to be used as a reliable instrument to measure clinical learning environments for Brazilian dental students.

Translation and validation of the ageism scale for dental students in Romanian (ASDS-Rom).

AIMS: The aim of this paper was to validate the Romanian version of an ageism scale for dental students. MATERIALS AND METHODS: The initial 27-item ageism scale was translated into Romanian and administered to 210 dental students in Craiova. The data were analysed using principal components analysis (PCA) with an orthogonal, Varimax rotation. The answers were then compared across several demographic variables using a combination of independent samples t tests and one-way between-subjects analysis of variance (ANOVA). RESULTS: Adequate factorability was confirmed with a Kaiser-Meyer-Olkin (KMO) of 0.676 and a Bartlett's Test of Sphericity yielding P < 0.001. PCA revealed a 10-item scale distributed into three components that accounted for 58% of the overall variance. The first component contained 4 items related to the cost-benefit of providing care to older patients (α = 0.80). The second contained 3 items that revolved around the perceptions about older people and their value in the society (α = 0.59). The third contained 3 items related to gerodontology training (α = 0.46). Discriminant validity showed differences in the first component based on whether a student had an older family member. CONCLUSIONS: The 10-item, three components scale demonstrated acceptable validity and reliability.

Steps towards validation of the Dental Education Clinical Learning Instrument (DECLEI) in American dental schools (DECLEI-USA).

PURPOSES/OBJECTIVES: Few tools assess the dental school clinical learning environment from students' perspectives. Considering previous efforts to validate the Dental Education Clinical Learning Instrument (DECLEI) in the United States, the goal of this study was to look for the fewest number of items that accounted for the most amount of variability in responses and/or had the highest correlation to the total DECLEI score using a larger, multi-center sample. METHODS: The DECLEI was distributed to 286 students in two dental schools (University of Iowa and University of Texas at Houston) during the 2017-2018 academic year. Two alternative methods were applied. In the first approach, all 24-items were regressed on the total composite score using a forward conditional method. In the second approach, the item-total correlation for the full scale was calculated and then items with relatively poor coefficients were eliminated. A cutoff of 0.30 or less was used. RESULTS: The first approach, Total R2 by Regression Model, produced a 9-item scale accounting for 90% of the variance in total score and a Cronbach's α coefficient of 0.79. The second approach, Item-Total Correlation, produced a larger scale (20 items), as well as a higher Cronbach's α coefficient of 0.89. The instrument also presented appropriate sensitivity to measure differences between race groups and school of origin. CONCLUSION: DECLEI may have the potential to be used as an instrument to measure clinical learning environments for U.S. dental students using either a smaller, concise scale (Mini DECLEI-USA) or a larger (DECLEI-USA), more thorough scale.

Translation and preliminary validation of an ageism scale for dental students in Brazil (ASDS-Braz).

BACKGROUND AND OBJECTIVE: Ageism is a major barrier for age-appropriate care. The aim of this study was to translate and perform a preliminary validation of an ageism scale for dental students (ASDS) in Brazil (ASDS-Braz). METHODS: The 27-item original ageism scale was translated from English into Brazilian Portuguese. A panel of five Brazilian dental educators revised the scale to establish content validity. The translated version was completed by 156 dental students in the Federal University of Pelotas in Brazil. Principal component analysis, internal consistency reliability and discriminant validity were estimated. RESULTS: All items in the Brazilian Portuguese version received a content validity index score ≥0.80 indicating that they were relevant to the topic. The principal component analysis produced a 12-item scale with three components that accounted for 51% of the overall variance. The first component contained six items associated with a negative view of older adults; the second component contained three items dealing with the complexity of providing care for older adults; and the third component contained three items associated with a positive view of older people. Discriminant validity did not show any differences related to demographic factors, the semester of studies and history of living with older people. CONCLUSIONS: The preliminary validation of the ASDS-Braz produced a 12-item scale with three components with acceptable validity and reliability. Future research in a larger, multi-institutional sample is now warranted.

Responding to Patient-Initiated Verbal Sexual Harassment: Outcomes of a Pilot Training for Ophthalmologists.

BACKGROUND: Sexual harassment of physicians by patients is highly prevalent and rarely reported. Little is known on how to prepare physicians to handle verbal sexual harassment that detracts from their ability to provide care but does not meet the threshold for reporting. PURPOSE: To assess the impact of a sexual harassment workshop and toolkit for ophthalmologists and ophthalmology trainees on responding to patient-initiated verbal sexual harassment. METHODS: A survey study of ophthalmology faculty, fellows, and residents who participated in workshops on responding to patient-initiated verbal sexual harassment was performed at an academic center. A toolkit of strategies for response was distributed. Volunteer participants completed a retrospective pretest-posttest evaluation at the conclusion of the workshop and follow-up survey 3 weeks after the workshops on whether they experienced harassment and intervened. The pretest-posttest surveys assessed the workshop's effect on ophthalmologists' perceptions of and preparedness to respond to sexual harassment in the moment using a 5-point Likert scale, including bystander intervention. Participants described their responses observing and/or experiencing patient-initiated sexual harassment in the 3 weeks following the workshop and whether they had intervened toward the harassment. RESULTS: Ophthalmologists (n=31) felt significantly more prepared to respond to patient-initiated sexual harassment directed towards themselves or a trainee in the moment after participating in the workshop (4.5 ± 1.63,) than before (3.0 ± 1.3) with a mean change of -1.6 (95% CI -2.2 to -.98, p<0.001). After the workshop 86.3% of participants felt mostly or completely prepared to respond to comments about their age, gender, marital status, appearance, attractiveness, a specific body part, and sexual or inappropriate jokes. Most participants (83.9%) said that they had not previously received training on techniques for responding to patient-initiated sexual harassment. Two-thirds (66.7%) of participants who experienced (n=8) or observed (n=13) harassment (n=15) following the workshop intervened. All participants who intervened toward patient-initiated harassment behavior after the workshop (n=10) found the Sexual Harassment Toolkit helpful in addressing harassment in the moment. CONCLUSION: Participation in a brief skills-based workshop significantly improved ophthalmologists' preparedness to respond to verbal sexual harassment by patients.

Efficacy-based Contraceptive Counseling for Women Experiencing Homelessness in Iowa City, Iowa.

This study evaluated homeless women's contraception knowledge and demonstrated improved knowledge following efficacy-based contraceptive counseling. Women were surveyed using a pre-test then post-test following standardized efficacy-based contraceptive counseling. 47 women participated. 13/19 (68.4%) of reproductive-aged women were not using contraception. After education there was significant increase in good-excellent self-rated knowledge (35, 75.5% vs 44, 93.6%; p < .001) and correct identification of most effective contraception OR 5.90 (95% CI = 2.31-15.02; p < .001). In conclusion, homeless women overestimated their understanding of contraception. Following education, there was significantly increased understanding of efficacy. While most did not desire pregnancy, few were using effective contraception and may benefit from education. Abbreviations: SH: Shelter House; LARC: Long-Acting Reversible Contraception; IUD: Intra-Uterine Device; ACOG: American College of Obstetricians and Gynecologists.

Translation and validation of the Greek version of an ageism scale for dental students (ASDS_Gr).

OBJECTIVES: To describe the validation of a new 27-item ageism scale for dental students in Greece. BACKGROUND: A new ageism scale for dental students has been developed by American and European Gerodontology educators and was preliminary validated in the United States. METHODS: The scale was translated into Greek and administered to 8th- and 10th-semester dental students in Athens. Principal components analysis was used to explore the internal structure of the measure; internal consistency reliability was assessed using Cronbach's α coefficient; corrected item-total correlations were calculated to decide which low contributing items should be removed from the scale; and discriminant validity was tested investigating variation in relation to demographic and educational factors. RESULTS: A total of 152 students responded to the questionnaire. The Principal component analysis offered a 15-item scale distributed into four factors that accounted for 56.4%, of the total variance, produced stronger factor loadings, a comparable amount of overall component variance and logical sets of components. The four factors produced were values/ethics about older people (four items, α = 0.71), patient compliance (four items, α = 0.72), barriers to dental care (four items, α = 0.57) and dentist-older patient interaction (three items, α = 0.64). Discriminant validity revealed statistically significant differences in factors and items related to semester of studies, gender and family's permanent residence. CONCLUSION: The preliminary validation of the Greek version of the ageing scale for dental students revealed a 15-item questionnaire that demonstrated acceptable validity and reliability and could be further tested in larger samples.

Comparing resident-patient encounters and case presentations in a family medicine clinic.

OBJECTIVES: Oral case presentations following resident-patient interactions provide the primary mechanism by which faculty supervisors assess resident competence. However, the extent to which these presentations capture the content and quality of resident-patient communication during the encounter remains unknown. We aimed to determine whether: (i) the resident-patient encounter content matched information conveyed in the case presentation; (ii) the quality of resident-patient communication was accurately conveyed, and (iii) supervisors addressed effective and ineffective communication processes. METHODS: A total of 22 pairs of resident-patient encounters and family medicine resident case presentations were video- or audiorecorded, transcribed and compared for content. Resident-patient communication was assessed using adapted versions of the Calgary-Cambridge Guide to the Medical Interview and Explanation and Planning Scale. RESULTS: Interviews and presentations contained largely congruent content, but social history and the patient's perspective were consistently excluded from case presentations. Although six of 19 specific communication skills were used in over 80% of resident encounters, the effective use of communication skills was widely variable. In most presentations, the quality of resident-patient communication was not explicitly conveyed to the supervisor. Although resident presentations provided 'cues' about communication issues, supervisors rarely responded. CONCLUSIONS: This study lends support to direct observation in workplace-based learning of communication skills. When content areas such as the patient's perspective and education are excluded, supervisors cannot address them. In addition, presentations provided minimal insight about the quality of resident-patient encounters and limited the ability to address communication skills. These skills could be enhanced by attending to communication cues during case presentations, making increased use of direct observation and feedback, and promoting faculty development to address these missed teaching opportunities.