ContextIn teaching hospitals, junior trainees (first‐year residents and third‐year medical students) are responsible for patient follow‐up and documentation under the supervision of senior team members. In order to support trainees in their role, supervisors need to understand how trainees approach these tasks and how they can be coached to develop best practices.ObjectivesThe purpose of our study was to explore the range of practices used by junior trainees in clinical settings.MethodsConstructivist grounded theory was used to guide the collection and analysis of data on follow‐up and documentation during 34 observation periods with 17 junior trainees. Data sources included field notes, field interviews and de‐identified copies of patient charts. We also held two focus groups with four attending physicians in each.ResultsWe were able to describe three interrelated characteristics that influenced a trainee's approach to and ability to perform the tasks of patient follow‐up and documentation: (i) diligence; (ii) relationship to the team (dependent, independent, collaborative), and (iii) level of performance (Data Gatherer, Sensemaker, Manager). Diligence and relationship to the team appeared to influence the quality and focus of a trainee's approach at all levels of performance. Level of performance was felt, by focus group attending physicians, to reflect a developmental progression of knowledge and skills.ConclusionsOur findings contribute to the existing literature in three ways. Firstly, they extend our understanding of how junior trainees approach the task of in‐patient follow‐up and clinical documentation and the value of those activities. Secondly, they provide new insights to support formative and summative assessment. Finally, they contribute to a growing body of literature exploring the factors that impact trainees' roles and interactions with the team. Future research should focus on validating our findings and exploring their utility in the development of novel assessment strategies.

Leadership curriculum in Undergraduate Medical Education should be grounded in a healthcare context relevant to the student's stage of training. Student engagement may be better supported if leadership is framed as a competency throughout their career. Schools considering such innovations could draw lessons from other professional schools and utilize material and faculty that resonate with students.

We report a case of a 44-year-old man who presented with a left medial canthal mass and epiphora. Imaging was suggestive of a mass continuous with the nasolacrimal sac. Subsequent surgical exploration revealed a mass adherent to bone with invasion of the lacrimal system. Histological examination revealed a squamous/transitional cell papilloma overlying a low-grade mucoepidermoid carcinoma (MEC). Complete surgical resection was completed and pathology confirmed the diagnosis. This is the first case in which a MEC has been reported concurrently with an overlying papilloma, providing support for the hypothesis that MECs arise from papillomas in the lacrimal sac. Additionally, the tissue stained positive for p63, which is congruent with MEC immunoreactivity in the salivary gland. The description of these unique histopathological findings may assist in definitive diagnosis and improve our understanding of the pathophysiology underlying lacrimal sac MEC tumors.