Music to Their Ears: Improving Feedback Students Receive on Written Documentation

Abstract

PURPOSE: Improve feedback on student notes in the electronic health record (EHR). BACKGROUND: Clinical documentation is a core entrustable professional activity. Feedback on written notes is necessary for skill development. Rapid spread of EHR technology and regulations limits use of student documentation, creating impediments to regular review of student notes. METHODS: As part of a multi-phase quality improvement project, medical students were surveyed at the conclusion of the obstetrics and gynecology clerkship regarding their experience writing notes in the EHR. The proportion of students who received feedback on inpatient and outpatient notes and rated the feedback as meaningful was determined at baseline and after implementation of a required formative feedback card. Following student and faculty feedback, we randomized students to utilize a simplified version versus the original detailed formative card and compared outcome measures. RESULTS: The response rate was 99%. Baseline data revealed 23% and 38% of clerkship students received no feedback on written notes in the inpatient and outpatient settings, respectively, while 44% of students reported that feedback did not improve documentation skills. Use of the formative card increased feedback (p<0.0001); 98% and 92% of students received feedback in the inpatient and outpatient settings, respectively, and 88% rated it as meaningful. There was no difference (p=0.3) in outcomes between the simplified or detailed cards. DISCUSSION: Implementation of a formative card increased the quantity and quality of written note feedback clerkship students received in all settings. A less detailed card achieved comparable outcomes and increased faculty satisfaction.