Teaching from Review of the Progress Note

1
Teaching from Review of the Progress Note

• Tayloe Loftus, MD
• Residents as Teachers Task Force
• October, 2004

2
Why Read a Students Note?

• Scut ? Teaching!
• Identify student learning needs
• Case-based teaching better than lecture
• Ensures accuracy of the medical record

3
Set Expectations (See handout for template)

• Practical suggestions (heading, telegraphic
  style, when to write)
• S/O pts input, vital signs are vital,
  significance of general appearance, pertinent (
  will change your management) findings and changes
  from last note, ?meds
• A/P organize by problems not systems,
  prioritize problem list, commit and confirm with
  team

4
What can you learn about a student from the note?

• Communication/organizational skills
• Professionalism
• Physical examination skills
• Components HEENT, lymph nodes, neuro
• Meaning no tactile fremitus
• Knowledge of diseases and physical manifestations
  funduscopic in pt with htn no microaneursyms
  no JVD or S3 assessment in CHF pt

5
What MORE can you learn about a student from the
note?

• Clinical reasoning
• Pertinent /-s
• Appropriate prioritization of problems
• Accurate representation of teams reasoning
• Icing on the Cake (Manager-level behavior)
• Interesting additions to care?
• Evidence of reading?
• Attention to finer points (PT/OT, d/c plans)

6
Giving Feedback on Notes

• Scut ? Teaching!
• Timing (end of day, interval options)
• Multiple notes (read all/review one, cull
  comments)
• Plan to address identified student issues
• If no/little progress, demo note