Stephanie . Royer,University of Michigan,Ann Arbor,MI,Jason Fischer,University of Michigan,Ann Arbor,MI,Chi-Chi Agbakwuru,University of Michigan,Ann Arbor,MI,Samual Wilson,University of Michigan,Ann Arbor,MI,Wendi Wendt,University of Michigan,Ann Arbor,MI,Heather Burrows,University of Michigan,Ann Arbor,MI,Kenneth Pituch,University of Michigan,Ann Arbor,MI,Jocelyn Schiller,University of Michigan,Ann Arbor,MI
Background: Due to medico-legal limitations, medical students (MS) are often restricted from contributing to the official record, reducing timely feedback, yet note writing is an essential skill for physicians. Furthermore, the National Board of Medical Examiners has identified note writing as an important clinical competency assessed in Step 2 Clinical Skills, further necessitating strong MS writing skills.
Objective: To improve and standardize education by residents for MS on writing inpatient daily progress notes.
Methods: At the beginning of each inpatient pediatric rotation, third year MS were introduced to a feedback rubric during an interactive workshop which consisted of a presentation with case based examples and self assessment. The rubric contained 15 discrete items grouped by these five categories: Clinical Data, Assessment, Medical Decision Making, Hospital Course Progress / Disposition, and Style. Each item was scored as 0 (not present), 1 (needs improvement), or 2 (present), with total scores ranging from 0-30. Progress notes from each student were collected prior to the workshop (pre-intervention) and at the completion of the rotation (post-intervention). This rubric was then used by blinded residents and faculty to assess the progress notes. The reviewers were blinded to authorship and time of collection to minimize bias.
Results: 40 pre-intervention and 43 post-intervention progress notes were collected, with scores ranging from 7-30. The scores were compared using independent variable t-test assuming equal variance. Mean scores of the pre- and post-intervention group was 17.43 and 22.14, respectively. Mean difference between the two groups were 4.52 (95% CI [2.63, 6.75], p < 0.001), with equal variance (p = 0.3).
Discussion: MS who attended a workshop utilizing case-based examples and self-assessment with a novel rubric demonstrated a significant improvement in daily progress notes writing. This strategy has potential to provide consistent education and feedback for writing daily progress notes. Future plans include analysis of progress notes written by MS on the internal medicine rotation (without workshop or feedback rubric) as a control group and validation of the rubric among authors; preliminary results will be available by the spring COMSEP meeting.