Background: Chart stimulated recall (CSR) is a tool to delve into a learner’s clinical reasoning and knowledge, using a recent real-world case in which the learner participated. To date, its use in Emergency Medicine (EM) has been limited. We sought to use CSR to help new interns develop their medical decision making and documentation skills, and to identify interns who may require early intervention.
Methods: During a shift in their first month of residency, each intern underwent a CSR led by a senior resident using a case from a recent shift. The learner reviewed the case, then each element of the case including data gathering, medical decision making, and disposition were discussed. Probing questions were used to determine the learner’s depth of understanding. Finally, the learner’s note was reviewed, and feedback provided on its clarity, brevity and thoroughness. Learners’ performance was scored according to the Accreditation Committee for Graduate Medical Education’s EM Milestones rubric, and those who scored inadequately in a field were identified to be given additional support. At the end of the month, learners were surveyed on their perceptions of the CSR’s usefulness to their learning.
Results: Interns were scored on 6 sub-competencies (PC2, PC3, PC4, PC5, PC7 and SBP3). All performed adequately on the patient care (PC) milestones, while two performed inadequately on the Systems Based Practice milestone of “Uses technology to document safe healthcare delivery.” In both cases, the interns demonstrated appropriate thought process, but documentation of their medical decision making was inadequate. Of the 21 interns surveyed, 16 (76%) responded. 14 (88%) reported they had never before received formal feedback on their EM charting. When asked to respond using a Likert scale (1-5), they reported that the CSR improved their differential diagnosis (4.0±0.7) and helped them to better disposition patients (3.8±0.9). They also reported that the CSR made them more confident (4.4±0.5) and efficient (4.0±0.8) in their charting. All agreed the CSR activity should be continued in future years, but some requested more instruction on improving their efficiency on-shift.
Conclusion: CSR may be an effective tool to assess and improve interns’ medical reasoning and charting skills in EM.