Julie M. Noffsinger, MD, MD, University of Colorado Denver, Aurora, CO, Jennifer B. Soep, MD, University of Colorado Denver, Aurora, CO
Background:With increased use of electronic health records (EHR), there is a trend of decreased medical student documentation. In a survey of clerkship directors, only 2/3 of respondents who use EHRs allow students to write notes (Hammoud 2012). At our institution, students write notes, but they are placed in a special tab not used for billing. Student notes are not often read or used in patient care, and students rarely receive feedback on them.
Methods:In past years, medical students submitted a formal history and physical with a detailed discussion during the clerkship which was returned with written comments. This year, students were asked to print up 1-5 of their actual notes, ask for feedback from residents or faculty, and then self-reflect on their feedback. End-of-block evaluations and students self-reflection comments were reviewed.
Results:Receiving note feedback was rated favorably with a mean of 3.74 on a 5 point Likert scale where 1=not at all useful and 5=essential. When asked about note feedback frequency, the mean this year was expectedly higher at 4.39 compared to 3.19 last year on a 5=point Likert scale where 1=Never and 5=5 or more times (t=6.3618, p<.0001). Comments from evaluations before mandatory note feedback included, no one is reading them, so why are we writing them. Comments this year included, it was essential to have the attending provide feedback on my notes. Themes identified from self-reflected learning points were note organization, history, physical exam, and clinical reasoning.
Conclusions:If medical students do not get sufficient experience and/or feedback on their notes in medical school, they will not be prepared to do so when their notes are written as practicing physicians. When medical students perceive no value to their notes, they may lose out on a sense of responsibility for their patients. Requiring note feedback is a feasible way for students to receive real-time, practical suggestions on their actual notes. In the future, we will develop a standardized rubric for giving note feedback to see if it impacts students note writing skills.