Effects of a deductive structure of oral case presentation on recipient listener’s comprehension

Oral patient presentations are often presented in a SOAP (subjective–objective-assessment-plan), or inductive structure, which provides a diagnostic anchor at the end of the presentation. Prior qualitative work in surgical education literature has suggested that a deductive structure contributes to an effective oral case presentation by providing the diagnostic anchor early to define the relevancy of subsequent information. This experimental study tests if a deductive structure of presentation improves the recipient’s comprehension.

Senior (n = 25) and junior (n = 32) general surgery residents at a single institution watched videos of two clinical case presentations. Videos differed in presentation structure (deductive or inductive) and anchor veracity (diagnosis given is true or misleading). After each video, participants provided an oral retelling of the case including only relevant details and their own diagnosis. Comprehension was measured by diagnostic accuracy and percentage of reported relevant elements.

Scenario A: 67% of residents diagnosed the case correctly. While presentation structure did not influence residents’ diagnostic accuracy, anchor veracity had a significant effect. All participants were more likely to report the correct diagnosis if given a true diagnosis in the presentation (p = .001). Junior residents were also more likely to report an incorrect diagnosis if given a misleading diagnosis (p = .009).

Scenario B: 32% of residents diagnosed the case correctly. Neither presentation structure nor anchor veracity independently influenced diagnostic accuracy. Those given a deductive structure with a true diagnosis reported fewer relevant elements specific to the correct diagnosis (p = .047) than those given an inductive structure with a true diagnosis. Those who reported an incorrect diagnosis were less likely to report elements specific to the correct diagnosis (p < .001).

Cognitive biases can affect comprehension of an oral case presentation. Comprehension is not improved in a deductive structure of oral presentation and may activate heuristics that exacerbate bias. Junior residents may be more susceptible to anchoring bias in certain conditions.