Abstract
BackgroundThe Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus.MethodsA retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological, vascular, and skin) from the charts of patients followed by their physician peers. No formal feedback or education was provided.ResultsSignificant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological, vascular, and skin exams increased by 20% (from 13% to 33%) (p = 0.001), 26% (from 45% to 71%) (p < 0.001), and 18% (51%–72%) (p = 0.005), respectively. Similarly, the proportion of patients receiving a well-documented exam which includes all three components – neurological, vascular and skin foot exam – increased over time (6% to 24%, p < 0.001).ConclusionPeer chart audits performed by residents in the absence of formal feedback were associated with improved documentation of the foot exam in patients with diabetes mellitus. Although this study suggests that peer chart audits may be an effective tool to improve practice-based learning and documentation of foot care in diabetic patients, evaluating the actual performance of clinical care was beyond the scope of this study and would be better addressed by a randomized controlled trial.
Highlights
The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement
We developed the audit form based on the Diabetes Quality Improvement Project (DQIP) guidelines [12] and discussions among general medicine faculty
The analyses reported here assessed improvements in resident performance related to documentation of the foot examination
Summary
The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. The Accreditation Council on Graduate Medical Education (ACGME) mandates Practice-Based Learning and Improvement as a core competency area for residents in training. To fulfill this competency, residents are expected to : 1) analyze practice experience and perform PracticeBased Learning and Improvement activities using a systematic methodology, 2) locate appraise and assimilate evidence from scientific studies related to their patients' health problems, 3) obtain and use information about their own population of patients and the larger population from which their patients are drawn, 4) apply knowledge of study designs and statistical methods to appraisal of clinical studies and other information on diagnostics and 5) use information technology to manage information and access on-line information [1]. While improvements might be due to increased competence in the specific activity of practice-based learning, increased performance could be due to other forms of learning and behaviors as well
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