1
|
Emekli E, Coşkun Ö, Budakoğlu Iİ. Medical record-keeping educational interventions for medical students and residents: a systematic review. HEALTH INF MANAG J 2024:18333583241269031. [PMID: 39138837 DOI: 10.1177/18333583241269031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
BACKGROUND Medical records, encompassing patient histories, progress notes, and more, play a crucial role in patient care and treatment, healthcare communication, medico-legal matters, and supporting financial documentation. OBJECTIVE Despite their significance, literature suggests inconsistencies in record quality and insufficient formal medical record-keeping education for medical students and residents. The study aimed to identify and evaluate the effectiveness of educational interventions by conducting a systematic review. METHOD A literature search covering 2003-2023 and review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. RESULTS The literature search identified 44 relevant studies for inclusion. Educational methods, including lectures, feedback, workshops and discussions, addressed different components of the clinical record. The review revealed positive impacts on participant satisfaction, skills and attitudes related to record-keeping. However, some studies reported no significant positive outcomes, emphasising the need for higher-level evidence. Most studies adopted a single-group pretest-posttest design, presenting challenges in control group implementation. The Kirkpatrick evaluation levels were primarily at level 2, with few studies reaching level 3. The absence of studies at level 4 suggested the need for more robust evidence. Studies targeted medical residents more frequently than medical students, with a lack of interventions during the first year of medical education. CONCLUSION Despite limitations including language bias and methodological variations, the review revealed diverse educational strategies and highlighted the necessity for more randomised controlled trials and studies providing higher-level evidence to enhance clinical record-keeping skills among medical students and residents. IMPLICATIONS Medical record-keeping educational interventions can significantly improve the documentation skills of medical students and residents, thereby enhancing patient care, communication and medico-legal compliance.
Collapse
Affiliation(s)
- Emre Emekli
- Eskişehir Osmangazi University, Turkey
- Gazi University, Turkey
| | | | | |
Collapse
|
2
|
Hansen A, Klute RM, Yadav M, Bansal S, Bond WF. How Do Learners Receive Feedback on Note Writing? A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:683-690. [PMID: 38306581 DOI: 10.1097/acm.0000000000005653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
PURPOSE The literature assessing the process of note-writing based on gathered information is scant. This scoping review investigates methods of providing feedback on learners' note-writing abilities. METHOD Scopus and Web of Science were searched for studies that investigated feedback on student notes or reviewed notes written on an information or data-gathering activity in health care and other fields in August 2022. Of 426 articles screened, 23 met the inclusion criteria. Data were extracted on the article title, publication year, study location, study aim, study design, number of participants, participant demographics, level of education, type of note written, field of study, form of feedback given, source of the feedback, and student or participant rating of feedback method from the included articles. Then possible themes were identified and a final consensus-based thematic analysis was performed. RESULTS Themes identified in the 23 included articles were as follows: (1) learners found faculty and peer feedback beneficial; (2) direct written comments and evaluation tools, such as rubrics or checklists, were the most common feedback methods; (3) reports on notes in real clinical settings were limited (simulated clinical scenarios in preclinical curriculum were the most studied); (4) feedback providers and recipients benefit from having prior training on providing and receiving feedback; (5) sequential or iterative feedback was beneficial for learners but can be time intensive for faculty and confounded by maturation effects; and (6) use of technology and validated assessment tools facilitate the feedback process through ease of communication and improved organization. CONCLUSIONS The various factors influencing impact and perception of feedback include the source, structure, setting, use of technology, and amount of feedback provided. As the utility of note-writing in health care expands, studies are needed to clarify the value of note feedback in learning and the role of innovative technologies in facilitating note feedback.
Collapse
|
3
|
Fraidlin A, Van Stratton JE, McElroy A, Aljadeff E. Peer Feedback: Recommendations for Behavior Analysts' Training and Supervision. Behav Anal Pract 2023; 16:696-708. [PMID: 37680336 PMCID: PMC10480097 DOI: 10.1007/s40617-022-00761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/04/2022] Open
Abstract
The increase in demand for behavior analysts in recent years has also increased the importance of effective supervision practices in the field of behavior analysis. A critical supervisory skill is performance feedback, which entails proficiency with two distinct, yet inseparable repertoires of technical and nontechnical skills. Supervisors report never receiving explicit training in feedback (Sellers et al., 2019) and graduate training programs provide little to no training in nontechnical skills (LeBlanc, Taylor et al., 2020b; Pastrana et al., 2018). As with any skill, to develop proficiency with feedback delivery and reception, trainees may require ample practice opportunities. One mechanism to provide trainees routine practice opportunities is to use peers as behavior change agents and peer feedback as an instructional method. The utility of peer feedback has been recognized in the organizational behavior management (OBM) literature (e.g., behavior-based safety interventions; Lebbon et al., 2012; Wirth & Sigurdsson, 2008), and has been used successfully in medical student training and evaluation for several decades. In the context of behavior analytic training and supervision peer feedback has yet to be established as a training method. Similarities in the behavioral and medical fields (e.g., significance of professional and interpersonal skills for successful therapeutic relationships) make the medical field a good model from which behavior analysts can learn. Using peer feedback in training and supervision for behavior analysts may provide trainees with similar benefits to those reported in medical student training literature. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-022-00761-1.
Collapse
Affiliation(s)
- Avner Fraidlin
- Psychology Department, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008-5439 USA
| | - Jessica E. Van Stratton
- Psychology Department, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008-5439 USA
| | - Alyssa McElroy
- Psychology Department, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008-5439 USA
| | - Elian Aljadeff
- Department of Behavioural Studies, Kinneret College, Sea of Galilee, Israel
| |
Collapse
|
4
|
Kusnoor AV, Balchandani R, Pillow MT, Sherman S, Ismail N. Near-peers effectively teach clinical documentation skills to early medical students. BMC MEDICAL EDUCATION 2022; 22:712. [PMID: 36209076 PMCID: PMC9548193 DOI: 10.1186/s12909-022-03790-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Composing the History of Present Illness (HPI), a key component of medical communication, requires critical thinking. Small group learning strategies have demonstrated superior effectiveness at developing critical thinking skills. Finding sufficient faculty facilitators for small groups remains a major gap in implementing these sessions. We hypothesized that "near-peer" teachers could effectively teach HPI documentation skills and fill the gap of small group facilitators. Here, we present a head-to-head comparison of near-peer and faculty teaching outcomes. METHODS Second-year medical students in a single institution participated in an HPI Workshop as a clinical skills course requirement. Students were randomly assigned a near-peer or faculty facilitator for the workshop. We compared mean facilitator evaluation scores and performance assessments of students assigned to either type of facilitator. RESULTS Three hundred sixty-five students, 29 residents (near-peers) and 16 faculty participated. On post-session evaluations (5-point Likert scale), students ranked near-peer facilitators higher than faculty facilitators on encouraging participation and achieving the goals of the session (residents 4.9, faculty 4.8), demonstrating small, statistically significant differences between groups. Mean scores on written assessments after the workshop did not differ between the groups (29.3/30 for a written H&P and 9/10 for an HPI exam question). CONCLUSIONS Near-peer facilitators were as effective as faculty facilitators for the HPI Workshop. Utilizing near-peers to teach HPI documentation skills provided teaching experiences for residents and increased the pool of available facilitators.
Collapse
|
5
|
Huang K, Mak D, Hafferty FW, Eva KW. The Advice Given During Near-Peer Interactions Before and After Curriculum Change. TEACHING AND LEARNING IN MEDICINE 2022; 34:351-359. [PMID: 34524067 DOI: 10.1080/10401334.2021.1957685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
PhenomenonNear-peer interactions (NPIs) provide formal and informal mentorship that can allow medical students to share strategies for successful training. Such capacity to convey valuable advice, however, may depend on the similitude of experiences. Given that many factors can disrupt homogeneity, including curriculum renewal, we must better understand whether junior trainees feel disadvantaged when they do not have more senior peers with similar experiences. This study was, therefore, conducted to examine the focus of, and engagement with, advice available through NPIs during curriculum renewal. Approach: We used a generic exploratory qualitative research approach. Twenty MD undergraduate students, seven from the Class of 2019 (the first cohort post-curriculum change), and thirteen from the Class of 2020 (the first cohort with access to more senior students in the new curriculum), participated in semi-structured interviews. Anonymized transcriptions were analyzed with open, axial, and selective coding to generate themes until saturation was attained. Findings: Participants from the Class of 2019 reported having particularly few reasons to seek advice; because curriculum renewal disrupted their near peers' capacity to provide critical insights, students exerted little effort to learn from them. That said, this vacuum was not generally cause for concern. Deeper probing illustrated why: advice given during NPIs in both classes more commonly focused on nonacademic (e.g., work-life balance issues) than academic advice; academic advice, when sought or offered, tended not to be aimed at improving understanding of curriculum dependent content; and, while students in both classes welcomed advice, both were wary of accepting it at face value, precluding a sense of dependence on senior peers. Insights: Students' skepticism about the overall utility of academic advice raises a number of important issues for medical education and training. Positively, it shielded students from feeling loss when advice from similarly trained students was not available, reducing concerns about disadvantage that could arise during periods of curriculum revision. On the other hand, knowing that what students perceive and what educators claim to be important aspects of training can be at odds and knowing that self-assessment is flawed makes it surprising and unsettling, respectively, that participants so readily treated the lessons learned by those who came before them as irrelevant.
Collapse
Affiliation(s)
- Kelly Huang
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Mak
- Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Frederic W Hafferty
- Division of General Internal Medicine and Program in Professionalism and Values, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin W Eva
- Education Research and Scholarship, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
6
|
Peer Tutoring and Math Digital Tools: A Promising Combination in Middle School. MATHEMATICS 2022. [DOI: 10.3390/math10132360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Peer tutoring in combination with math digital tools was employed with middle school students learning mathematics. A total of 112 students in 9th grade (14 to 15 years old) participated in the study. A pretest–posttest with control group design was used. Students worked with systems of linear equations during the experience. The effects of the intervention of peer tutoring in combination with math digital tools on students’ mathematics achievement were examined using quantitative methods. The way students in the experimental group learned and their motivation towards using digital tools compared with students in the control group were analysed qualitatively. Statistically significant improvements and a large effect size were reported for students’ mathematics achievement in the experimental group. No statistically significant differences were reported between the pretest and the posttest for the control group. The qualitative analyses revealed that students in the experimental group achieved a higher level of autonomous learning, showed a greater association of mathematical concepts, helped their peers more, did more exercises and problems than students in the control group, and enjoyed the experience.
Collapse
|
7
|
Kim M, Chan N, Evans J, Min JK, Hayton AC. Improving Medical Student Inpatient Documentation Through Feedback Using a Note Assessment Tool. Cureus 2022; 14:e23369. [PMID: 35475068 PMCID: PMC9020806 DOI: 10.7759/cureus.23369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Documentation within the Electronic Health Record (EHR) is an essential skill for medical students to succeed in residency and post-residency training. The increased use of medical student progress notes for billable services raises the need for the education and assessment of quality note writing. We hypothesized that structured note feedback using a note assessment tool would improve the quality of medical student inpatient progress notes. Methods We conducted a retrospective study to review the quality of student inpatient progress notes written before and after structured feedback using the Responsible Electronic Documentation (RED) checklist throughout a third-year internal medicine clerkship. The first intervention group received feedback from clerkship directors in the 2017-2018 academic year and the second intervention group received feedback from ward residents/attendings in the 2018-2019 academic year. Within each intervention group, the total note scores from pre and post-intervention were compared. Results Feedback from clerkship directors yielded a greater increase in students’ total note score from pre to post-intervention compared to ward resident/attending feedback (F(1,255) = 12.84, p < 0.001). Cohen’s d effect size value was greater for the clerkship director feedback arm (d=0.71) compared to the ward resident/attending feedback arm (d=0.24). Post-hoc analyses using dependent sample t-tests revealed that there were significant increases in total note scores from pre to post-intervention for both the clerkship director arm (t(123) = 8.26, p < 0.001, d = 0.71) and the ward resident/attending arm (t(132) = 2.85, p = 0.005, d = 0.24). Conclusion Clerkship director feedback led to a greater increase in medical student documentation compared to ward attending/resident feedback. Nonetheless, structured feedback with a note assessment tool, whether from clerkship directors or ward attendings/residents, leads to a significant improvement in medical student documentation. Though there are various methods for providing feedback, educators can use the RED checklist to provide clear guidelines that will facilitate note-writing feedback.
Collapse
|
8
|
Taylor CFC, Kurn OR, Glautier SP, Anbu D, Dean O, Nagy E, Geoghan KR, Harrison CH, Payne DR, Hall S, Border S. The Efficacy of Interdisciplinary Near-Peer Teaching Within Neuroanatomical Education-Preliminary Observations. MEDICAL SCIENCE EDUCATOR 2021; 31:387-393. [PMID: 34457897 PMCID: PMC8368458 DOI: 10.1007/s40670-021-01238-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 06/13/2023]
Abstract
Near-Peer Teaching (NPT) is increasingly becoming an integral part of the medical curriculum. When considered alongside the increasing popularity of interdisciplinary education, it seems appropriate to explore NPT within an interdisciplinary context. In these observations, 3rd-year medical students taught 2nd-year psychology students neuroanatomy. The session was evaluated using three objective and subjective assays. A knowledge assessment test showed significant improvement after teaching, and there were significant improvements on self-perceived knowledge/attitudes towards neuroanatomy, as well as positive feedback on the use of NPT. These observations evidence the successful use of Interdisciplinary Near-Peer Teaching (INPT) within a neuroanatomical curriculum. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01238-6.
Collapse
Affiliation(s)
- Charles F. C. Taylor
- Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Octavia R. Kurn
- Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Steven P. Glautier
- Department of Psychology, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK
| | - Deepika Anbu
- Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Oliver Dean
- Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Eva Nagy
- Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kate R. Geoghan
- Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Charlie H. Harrison
- Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - December R. Payne
- Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sam Hall
- Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Scott Border
- Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
9
|
Komasawa N, Terasaki F, Nakano T, Kawata R. Correlation of student performance on clerkship with quality of medical chart documentation in a simulation setting. PLoS One 2021; 16:e0248569. [PMID: 33720982 PMCID: PMC7959337 DOI: 10.1371/journal.pone.0248569] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medical chart documentation is an essential skill acquired in a clinical clerkship (CC). However, the utility of medical chart writing simulations as a component of the objective structured clinical examination (OSCE) has not been sufficiently evaluated. In this study, medical chart documentation in several clinical simulation settings was performed as part of the OSCE, and its correlation with CC performance was evaluated. METHODS We created a clinical situation video and images involving the acquisition of informed consent, cardiopulmonary resuscitation, and diagnostic imaging in the emergency department, and assessed medical chart documentation performance by medical students as part of the OSCE. Evaluations were conducted utilizing original checklist (0-10 point). We also analyzed the correlation between medical chart documentation OSCE scores and CC performance of 120 medical students who performed their CC in 2019 as 5th year students and took the Post-CC OSCE in 2020 as 6th year students. RESULTS Of the OSCE components, scores for the acquisition of informed consent and resuscitation showed significant correlations with CC performance (P<0.001 for each). In contrast, scores for diagnostic imaging showed a slightly positive, but non-significant, correlation with CC performance (P = 0.107). Overall scores for OSCE showed a significant correlation with CC performance (P<0.001). CONCLUSION We conducted a correlation analysis of CC performance and the quality of medical chart documentation in a simulation setting. Our results suggest that medical chart documentation can be one possible alternative component in the OSCE.
Collapse
Affiliation(s)
- Nobuyasu Komasawa
- Medical Education Center, Osaka Medical College, Osaka, Japan
- * E-mail:
| | - Fumio Terasaki
- Medical Education Center, Osaka Medical College, Osaka, Japan
| | - Takashi Nakano
- Medical Education Center, Osaka Medical College, Osaka, Japan
| | - Ryo Kawata
- Medical Education Center, Osaka Medical College, Osaka, Japan
| |
Collapse
|
10
|
Ahmad SE, Farina GA, Fornari A, Pearlman RE, Friedman K, Olvet DM. Student Perception of Case-based Teaching by Near-Peers and Faculty during the Internal Medicine Clerkship: A Noninferiority Study. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211020762. [PMID: 34104794 PMCID: PMC8170334 DOI: 10.1177/23821205211020762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Third-year medical students traditionally receive their didactic or small group teaching sessions from clinical faculty during clerkship rotations. Near-peer teaching is increasingly recognized as an acceptable method for teaching, however most near-peer teaching takes place during the pre-clinical curriculum. We sought to determine if fourth year medical students were noninferior to faculty in facilitating small group discussions during clerkship rotations. METHODS Seventy-five third-year medical students participated in a small group session focused on rheumatologic diseases during their internal medicine clerkship rotation. Students were taught by fourth-year medical students who self-selected to participate as near-peer teachers at 1 clinical site (near-peers, N = 36) and by clinical faculty at another site (N = 39). At the end of the session, third-year medical students completed a survey evaluating teacher performance and effectiveness. RESULTS There was no significant difference between the 2 groups on each of the 17 survey items assessing teacher performance, the total teaching performance score, and the teaching effectiveness rating (all P-values >.05). A mean between-group difference of 2% in favor of the near-peers indicated noninferiority of the near-peer teachers compared with faculty teachers on the total teaching performance score. An absolute difference of 14% in favor of the near-peers indicated noninferiority of the near-peer teachers compared with faculty teachers on the teaching effectiveness score. Near-peer teachers reported several benefits, including improving their own medical knowledge and skills as a future educator. DISCUSSION Our data supports the noninferiority of the perceived performance and effectiveness of near-peer teachers compared to faculty teachers in the clerkship setting. Adding near-peer teachers to the clerkship setting is feasible and can be beneficial to all stakeholders.
Collapse
Affiliation(s)
- Syed E Ahmad
- Departments of Medicine, Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,
USA
| | - Gino A Farina
- Departments of Science Education,
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,
Hempstead, NY, USA
- Departments of Emergency
Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,
Hempstead, NY, USA
| | - Alice Fornari
- Departments of Science Education,
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,
Hempstead, NY, USA
| | - Ruth Ellen Pearlman
- Departments of Medicine, Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,
USA
- Departments of Science Education,
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,
Hempstead, NY, USA
| | - Karen Friedman
- Departments of Medicine, Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,
USA
| | - Doreen M Olvet
- Departments of Science Education,
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,
Hempstead, NY, USA
| |
Collapse
|