Thomas V Chacko

Abstract

The new competency based medical education represents a paradigm shift from a teacher centered to a student centered learning of outcome competencies paradigm and so both the students and the teachers are unfamiliar with it. Giving and receiving feedback is central to the competency development framework. Only through frequent, timely and appropriate feedback there will be effective development of cognitive competence in its lead up to performance of competence. These concepts are illustrated to convey the importance of giving feedback to students. As the teachers are expected to practice giving feedback to students, they were opportunistically asked prior to a faculty development workshop what their priority learning needs about giving feedback are. Based on this a focused review of literature was done to collect the information on the various models of giving feedback, the principles for giving feedback, the possible situations in curriculum delivery where teachers can and should give feedback to students.The literature revealed some good practice models for giving feedback to the naïve as well as the mature students in ambulatory and clinical teaching settings as well as on their performance as revealed by their test results. Models of counseling which has strong element of feedback on the learner’s performance and helping them choose the way forward after identifying the problem is also shared. Keywords: Feedback principles, Feedback models, Mentoring, Competency progression.

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Abstract

Patient care documentation is an important component of health care service delivery and continuity of care within the health system. Case documentation audit is a good tool to improve the quality of service and to help train budding doctors about the expected standard of care. This study was done as part of a Competent Interns training program for primary care as well as a quality improvement program to improve patient care documentation in an Urban health training center. The specific objectives were to identify the gaps in practice and serve as the baseline quality of Out-patient case records and using the gaps in practice to conduct an educational intervention among Interns. The effectiveness of this intervention was then measured by noting the changes seen upon re-audit. Materials and Methods: <!--[if !supportLists]-->1.    Study design: Intervention study (Educational) following a process audit 2.    Study sample: All new Out-patient case records from November 2014 to January 2015 for baseline study and new Out-patient case records from April to June 2015 for re-audit after setting targets <!--[if !supportLists]-->3.    Setting: Primary health care training center catering to an urban area. 4.  Analysis: Results are expressed in percentage of records with adequate documentation for each items in the checklist. Overall mean score ± standard deviation for records were calculated (pre and post audit separately) and t test was done to detect for statistically significance (1% level of significance) following the educational intervention. Results: Baseline audit (n=110) showed 100%, 97% and 95% records had documented patients details, patient complaints and physical examination on case sheets respectively. There was poor documentation of drug allergies (1%), review date (36%) and name of the examining doctor or intern (3%).Following the educational intervention during the re-audit (n=75) there was overall improvement in case sheet recording practice (t=15.34; p<0.001) among the health care staff. Conclusions: Identification of gaps in documentation practice using a validated standard of care audit tool helps. Training Interns got to learn this useful managerial skill so that they are trained for quality improvement at Primary Care level. Keywords: Case sheets audit, Competent Interns, Gap identification.  

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