Free game to facilitate faculty development on feedback

As an educator one is often asked to help other faculty and house staff learn about some key education principles when working with medical students. Some of these principles apply to any education setting.

1. Understanding the audience - their education level

2. Setting expectations

3. Giving formative feedback or useful feedback

• Timely
• Non judgmental
• Based on observed interactions
• Include what was done well, what could be done better.

I created a brief interactive game to help facilitators discuss these topics. The game uses an example of a student at a flying school. Facilitators should use this with faculty and house staff by discussing what a student might feel or think at each point before clicking on any option.

Let me know what you think.

Click here to try out the game.

The Logical Flow of a Physical Exam

The other day I was observing a 2nd year medical student examining a patient in my outpatient clinic. The student did a very good job- doing a very thorough examination of each organ system.

The only problem was the flow of the exam or the lack of one. He would start at the head and examine the mouth and then move down to the neck. Later he would come back to the mouth to check for the midline tongue and the gag reflex.

The patient would have to lie down for the abdominal exam, and then sit up to have the lumbar spine examined; lie down for the Straight Leg Raise test and sit up for the knee and ankle jerk; you get the idea.

It seemed an example of a logical flow of a physical exam that combined the elements of:

1. Going down from head to toe
2. Patient comfort and convenience
3. Efficiency

might be helpful. Of course everyone will have a slightly different protocol for doing this.

As I was wondering how to present this information, I came across Bubbl.us a cool mindmapping tool. So I created the following schema of the Logical Flow of a Physical Exam using Bubbl.us

The problem is that the site is transitioning to beta and is very very slow! Also if you use the beta it does not let you share the mind map or embed the code. So here it is in its slow but still glorious 1.0 form (Click the - sign in upper left to zoom out. Click and drag to see different elements, to see the full size, click the read only link at the bottom):

If you want to check it out on Bubbl.us, here is the read only link

What EMRs can learn from Twitter

One day I got a message in the EMR from a consultant cardiologist. This was a patient I had sent to the cardiologist after a positive stress test. The message said, click to review the consultant's note in the EMR.

I opened the note and saw an incredibly long note with results of every stress test, lipid, echo and cath done on the patient in the last 10 years pasted into the note. In addition there was even the informed consent statement prior to the cath included in the note. There was a note by the PA and then a note by the consultant buried in this morass of digital ink. It took me 10 minutes to find the consultant's assessment and plan which said to continue medical management. Apparently there was one small vessel that was stenosed and was not worth the risk of intervention.

Got me to start wondering if EHRs have caused us to lose our way; we have forgotten that the primary purpose of the medical record is communication. It seems that E/M coding and medico-legal issues are all that EHRs are being used for.

Can we save the EHR? What if we have a field at the top of each EMR note that allows only 140 characters like a Twitter update and each doctor has to populate this with a summary of assessment and plan before the note can be closed? E.g. "80% 1st diag, stable angina, not worth risk of intervention, recc aggressive medical Mx" This would still leave 53 characters to reach the 140 character limit! Could use this to provide a link to the actual chart note!

We could even make the poor Infectious Disease consultant happy. Every time someone copies and pastes their note into their own, there would be automatic attribution like a RT @IDdoc!

We could have a twitter like list of our patients that we follow and we can see tweets about them by all docs!

So what do you think? Any takers?