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Example 3
Scenario: Using questions to foster Practice-based Learning and Improvement and Medical Knowledge through a departmental case conference.
You are an Associate Residency Director at a community-based residency program, and have been asked by the Residency Director to address the issue of patient non-compliance in the Outpatient Clinic. You consider developing a lecture, but decide to use a set of questions to structure a resident chart review.
The illustration below describes how you may use questions to achieve Practice-Based Learning and Improvement and Medical Knowledge learning objectives through a chart review activity and case conference discussion. The objectives are that residents will be able to: (a) use a systematic methodology involving chart review, literature review, and reflection to analyze and improve practice (Practice-Based Learning and Improvement); and (b) obtain, analyze, and synthesize knowledge, including psycho-social knowledge, to solve patient care problems (Medical Knowledge).
Illustration:
By using carefully-crafted questions to guide residents’ reflection on their clinical experiences, you can facilitate their ability to discern practice patterns that may have gone unnoticed. In this illustration, an existing departmental case conference is adapted to include a question-guided chart review. To prepare for these conferences, your residents are required to pull the charts on five patients seen over the last three months and consider a group of guided questions. Examples of questions that you could use to guide the chart review include:
- Is there evidence in the chart that the patient’s problem has been resolved?
- Is there evidence in the chart that the patient followed the diagnostic/therapeutic plan?
- For any of the five patients by whom you suspect therapeutic non-compliance, develop a hypothesis concerning the patients’ reasons for non-compliance, using the literature, personal knowledge of the patients and patient information in the chart.
- Is there a relationship between patient compliance and the patient’s socio-economic status, personal preferences, and lifestyle?
The data and hypotheses are discussed at the conference along with plans for improvement.
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