Number
255
Name
Patient Presents with Hypotension and Bradycardia: A Novel Approach to Triplet Oral Boards
Date & Time
Monday, June 8, 2026, 6:00 PM - 7:30 PM
Location Name
Oglethorpe Ballroom
Speakers
Authors
Esha Mittal, B.S., Virginia Commonwealth University School of Medicine
Michelle Troendle, MD, FACEP, Virginia Commonwealth University School of Medicine
Fahad Chaudhry, B.S., Virginia Commonwealth University School of Medicine
Hailey Feinzig, B.S., Virginia Commonwealth University School of Medicine
Lillian Nelson, B.S., Virginia Commonwealth University School of Medicine
Sejal Murthy, B.A., Virginia Commonwealth University School of Medicine
Zainab Siddiqui, B.S., Virginia Commonwealth University School of Medicine
Presentation Topic(s)
Curriculum
Description
PURPOSE
Mock oral examinations remain underutilized in undergraduate medical
education despite their potential to strengthen clinical reasoning.
Traditional formats typically present unrelated cases, which can predispose
learners to diagnostic tunnel vision. This project’s purpose was to evaluate
whether presenting medical students with three near-identical oral board
cases involving hypotension with bradycardia could improve their ability to
generate a differential diagnosis, distinguish overlapping clinical
presentations, interpret diagnostics, and initiate appropriate management.
METHODS
Fourth-year medical students on a clinical toxicology rotation completed a
quasi-experimental pretest-posttest study. After a baseline pretest assessing
knowledge of hypotension with bradycardia, students completed three similar
oral board cases featuring a 42-year-old patient presenting with altered
mental status, hypotension, and bradycardia secondary to third-degree heart
block, hypothermia, or beta-blocker/calcium-channel-blocker overdose.
Learners then participated in a structured debrief emphasizing diagnostic
reasoning and critical actions. Posttest assessments and case-specific
critical-action checklists were used to measure improvement.
RESULTS
Twelve students participated. Mean pretest and posttest scores were 62% and
97%, respectively. A Wilcoxon signed-rank test demonstrated a statistically
significant increase in scores (W = 0.0, p = 0.0005, two-tailed). Students
demonstrated marked improvement in identifying key differentiating features
and initiating appropriate interventions across the three scenarios.
CONCLUSION
Presenting multiple, subtly varied versions of the same clinical scenario
is a feasible and effective strategy to strengthen diagnostic reasoning in
medical students. This triplet-case approach has been incorporated into our
medical curriculum and expanded to additional presentations, including
postpartum headache, galactorrhea, facial droop, and paralysis. Although
time-intensive and best suited for small-group instruction, the model is
practical to implement and generalizable across disciplines such as
toxicology, emergency medicine, and internal medicine. This innovation
highlights the educational value of structured, comparative oral board cases
in fostering clinical reasoning skills.
Mock oral examinations remain underutilized in undergraduate medical
education despite their potential to strengthen clinical reasoning.
Traditional formats typically present unrelated cases, which can predispose
learners to diagnostic tunnel vision. This project’s purpose was to evaluate
whether presenting medical students with three near-identical oral board
cases involving hypotension with bradycardia could improve their ability to
generate a differential diagnosis, distinguish overlapping clinical
presentations, interpret diagnostics, and initiate appropriate management.
METHODS
Fourth-year medical students on a clinical toxicology rotation completed a
quasi-experimental pretest-posttest study. After a baseline pretest assessing
knowledge of hypotension with bradycardia, students completed three similar
oral board cases featuring a 42-year-old patient presenting with altered
mental status, hypotension, and bradycardia secondary to third-degree heart
block, hypothermia, or beta-blocker/calcium-channel-blocker overdose.
Learners then participated in a structured debrief emphasizing diagnostic
reasoning and critical actions. Posttest assessments and case-specific
critical-action checklists were used to measure improvement.
RESULTS
Twelve students participated. Mean pretest and posttest scores were 62% and
97%, respectively. A Wilcoxon signed-rank test demonstrated a statistically
significant increase in scores (W = 0.0, p = 0.0005, two-tailed). Students
demonstrated marked improvement in identifying key differentiating features
and initiating appropriate interventions across the three scenarios.
CONCLUSION
Presenting multiple, subtly varied versions of the same clinical scenario
is a feasible and effective strategy to strengthen diagnostic reasoning in
medical students. This triplet-case approach has been incorporated into our
medical curriculum and expanded to additional presentations, including
postpartum headache, galactorrhea, facial droop, and paralysis. Although
time-intensive and best suited for small-group instruction, the model is
practical to implement and generalizable across disciplines such as
toxicology, emergency medicine, and internal medicine. This innovation
highlights the educational value of structured, comparative oral board cases
in fostering clinical reasoning skills.
Presentation Tag(s)
Student Presentation