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Teaching from Review of the Progress Note

Teaching from Review of the Progress Note. Tayloe Loftus, MD SUNY Syracuse Updated 2010 by Heather Harrell, MD, FACP University of Florida, Gainesville. Why Read a Student’s Note?. “Scut”  Teaching! Identify student learning needs “Case-based” teaching better than lecture

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Teaching from Review of the Progress Note

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  1. Teaching from Review of the Progress Note Tayloe Loftus, MD SUNY Syracuse Updated 2010 by Heather Harrell, MD, FACP University of Florida, Gainesville

  2. Why Read a Student’s Note? • “Scut”  Teaching! • Identify student learning needs • “Case-based” teaching better than lecture • Ensures accuracy of the medical record

  3. What are some of your “pet peeves” with students’ progress notes? • Too long • Too detailed • Not detailed enough • Not accurate • Lack plans • On the chart too late

  4. How have you set expectations with students? • Practical suggestions • Heading • How should they label their note? • “Date, time, stamp, sign” • Hospitalization context (e.g. day # of antibiotics) • Length • ≤ 1 page, telegraphic language (don’t need complete sentence) • Organization (SOAP) • Timing (when should it be on the chart/EMR) • Billing/compliance issues

  5. Setting Expectations: Data Reporting • Subjective • Patient’s input on major problems (minor concerns don’t need to go in the note) • Objective • Vital signs are vital, don’t forget them • Report pertinent exam (problem focused, exam changes, findings that change management) • Clarify how you want meds listed and how often

  6. Setting Expectations: Avoiding the “SOP” Note • Assessment/Plan- Diagnosis-based, not systems-based • Commit to a working diagnosis and plan for each problem before discussing the case with you • Prioritize problems/diagnoses • Brief assessments reflecting the most current thinking (not summaries of the whole hospitalization) • Plans should include therapeutic endpoints for discharge/care transition planning • Addenda • Clarify when should notes be addended

  7. Sample Notes • What can you learn about the student from this note

  8. What can you learn about a student from the note? • Communication skills • Organizational skills • Professionalism (timeliness, plagiarism) • Physical examination skills • Components – HEENT, lymph nodes, neuro • Meaning – “no tactile fremitus” • Knowledge physical manifestations of disease e.g. omitting JVD or S3 assessment in patient with CHF

  9. What MORE can you learn about a student from the note? • Clinical reasoning • Pertinent +/-’s • Appropriate prioritization of problems • Accurate representation of team’s reasoning • “Icing on the Cake” (Manager-level behavior) • Interesting additions to care? • Evidence of reading? • Attention to “finer points” (PT/OT, d/c plans)

  10. 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

  11. Author Contact Information Tayloe Loftus, MD Loftust@upstate.edu Heather Harrell harrehe@medicine.ufl.edu (Provided progress note examples and has many more)

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