BEST Module 7: Teaching Charting
Bringing Education & Service Together (BEST) is an interdisciplinary service learning project for resident physicians.
- Faculty Guide - Module 7 - Teaching Charting
- Handouts - Module 7 - Teaching Charting
- Lesson Plan - Module 7 - Teaching Charting
- Slides - Module 7 - Teaching Charting
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:
- 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?