BEST Module 7: Teaching Charting

Bringing Education & Service Together (BEST) is an interdisciplinary service learning project for resident physicians.

Learning Outcomes

By the end of this module, participating residents will be able to:

  • Identify the benefits of teaching charting.
  • Define the CHART approach.
  • Practice teaching charting to a medical student.

Benefits of Teaching Charting

Learners must go through three phases of psychomotor skills development:

  • Many medical students may prefer to learn “hands on” clinical skills (history-taking, physical examination, charting, procedures) from resident physicians rather than from faculty.
  • Medical school provides numerous teachable moments for students to learn writing skills.
  • Once students become residents, they may be offered less feedback about charting, or they may be less inclined to use feedback that they are offered.
  • Published tools now exist for assessing the quality of electronic notes, including the Physician Documentation Quality Instrument (PDQI-9).

The “CHART” Approach

A tool for giving feedback on learners’ written work, the acronym "CHART" stands for:

  • Comments
  • Help
  • Assessment
  • Resources
  • Timing of Follow-Up

Learners first need to understand the “why” components of the procedure:

  • Take as much time as you need to read the learner’s note and write comments on it.
  • Include an adequate (but not overwhelming) level of detail.
  • Writing down your comments will help you organize your feedback and will later help the learner recall what you’ve said.

Since learners prefer active learning, teach through questioning:

  • Establish mutual goals for this feedback session (first the learner’s, then yours).
  • Clarify that you will focus on learning about charting rather than clinical issues.
  • Which writing skills does the learner think may require extra help.

Now you can discuss your mutual assessment of the written work:

  • Start with the learner’s self-assessment.
  • Then give your assessment, balancing positive and negative attributes.
  • Organize your feedback into logical sections to make it easier to follow.
  • Involve the learner actively: can s/he learn from rewriting some text with you?

Finally, learners begin achieving proficiency and are ready for independent performance.

  • Discuss learning resources the student can use to improve charting skills (online texts and other resources, other teachers).
  • Which resources does the learner think would be best for his/her learning style?
Timing of Follow-Up

When would the learner like to meet again to go over more written work?