Robert S. Greenberg,Northwestern University Feinberg School of Medicine,Chicago,IL,Alanna . Higgins,Northwestern University Feinberg School of Medicine,Chicago,IL,Julie K. Stamos,Northwestern University Feinberg School of Medicine,Chicago,IL
In 1999, Louis Pangaro proposed the RIME Framework (Reporter, Interpreter, Manager, and Educator) to characterize the clinical progress of medical professionals. It is a goal of core clerkships to help students transition from reporting to interpreting clinical data through teaching accurate and concise patient assessments. Students frequently use character-limited formats to convey information on social media.
1) Develop an activity to facilitate and monitor students’ progress from reporter to interpreter utilizing a Twitter®-like platform
2) Qualitatively evaluate student feedback on the modality
We used text-pager messaging limited to 200 characters, similar to Twitter®, to challenge students to summarize and interpret the high-priority details of patient presentations. Two virtual patient histories and physical examinations (H&Ps) were developed. Within 36 hours of posting a case on the clerkship webpage, students sent a succinct text-page with their clinical assessment to a clerkship director. Feedback was provided in the form of a reply text-page and general feedback was posted after the group completed each case.
Anonymous post-clerkship survey feedback was collected using a 5-point Likert scale question about confidence (strongly disagree =1 to strongly agree =5) and a free-text response on lessons learned. Three reviewers scored and analyzed free-text feedback for themes. Group discussion and word-frequency analysis was used to achieve consensus on themes and subthemes.
Students reported improved confidence in summarizing patients (3.7/5, SD =1). Three themes and subthemes emerged from their feedback:
Prioritization – pertinence, succinctness, and extraneous information distracts
Interpretation – synthesizing, committing to a diagnosis, value of interpreting
Skill-building/Feedback – practicing towards a goal, high-stakes word game, high-value feedback
Our method utilizes a novel format for students to demonstrate their prioritization and interpretation skills in a succinct patient assessment. Reviewing learners' distilled thoughts on each case allowed the clerkship directors to identify students struggling to transition from reporter to interpreter and to provide appropriate feedback. Additionally, our tool may be valuable for use in teaching hand-off communication skills that require accurate and succinct clinical assessments.