Assessing the Impact of a Note-Writing Session and Standardized Note Template on Medical Student Note Length and Quality.

Abstract

To determine whether a formal note-writing session and note template for medical students (MS) during the Core Clerkship in Pediatrics (CCP) increases note quality, shortens note length, and decreases time of documentation. In this single site, prospective study, MS participating in an 8-week CCP received a didactic session on note-writing in the electronic health record (EHR) and utilized EHR template developed for the study. We assessed note quality [measured by Physician Documentation Quality Instrument-9 (PDQI-9)], note length and note documentation time in this group compared to MS notes on the CCP in the prior academic year. We used descriptive statistics and Kruskal-Wallis tests for analysis. We analyzed 121 notes written by 40 students in the control group and 92 notes writing by 41 students in the intervention group. Notes from the intervention group were more "up to date," "accurate," "organized," and "comprehensible" compared to the control group (p=0.02, p=0.04, p=0.01, and p=0.02, respectively). Intervention group notes received higher cumulative PDQI-9 scores compared to the control group (median score 38 (IQR 34-42) vs 36 (IQR 32-40) out of 45 total, p=0.04). Intervention group notes were approximately 35% shorter than the control group notes (median 68.5 lines vs 105 lines, p <0.0001) and were signed earlier than control group notes (median file time 316 minutes vs 352 minutes, p=0.02). The intervention successfully decreased note length, improved note quality based on standardized metrics, and reduced time to completion of note documentation. An innovative note writing curriculum and accompanying standardized note template improved the outcomes of medical student progress notes in multiple domains, including timeliness, accuracy, organization, and overall quality." The intervention also significantly decreased note length and time to note completion.