Purpose: Improve feedback on student notes in the electronic health
record (EHR)
Background: Clinical documentation is a core entrustable
professional activity. Feedback on written notes is necessary for skill
development. Rapid spread of EHR technology and regulations limits use of
student documentation, creating impediments to regular review of student notes.
Methods: As part of a multi-phase quality improvement project,
medical students were surveyed at the conclusion of the obstetrics and
gynecology clerkship regarding their experience writing notes in the EHR. The
proportion of students who received feedback on inpatient and outpatient notes
and rated the feedback as meaningful was determined at baseline and after
implementation of a required formative feedback card. Following student and
faculty feedback, we randomized students to utilize a simplified version versus
the original detailed formative card and compared outcome measures.
Results: The response rate was 99%. Baseline data revealed 23%
and 38% of clerkship students received no feedback on written notes in the
inpatient and outpatient settings, respectively, while 44% of students reported
that feedback did not improve documentation skills. Use of the formative card
increased feedback (p<0.0001); 98% and 92% of students received feedback in
the inpatient and outpatient settings, respectively, and 88% rated it as
meaningful. There was no difference (p=0.3) in outcomes between the simplified
or detailed cards.
Discussions: Implementation of a formative card increased the quantity and
quality of written note feedback clerkship students received in all settings. A
less detailed card achieved comparable outcomes and increased faculty
satisfaction.
Topics: CREOG & APGO Annual Meeting, 2019, Student, Faculty, Clerkship Director, Clerkship Coordinator, Patient Care, Practice-Based Learning & Improvement, Assessment,
