Article Review: Student documentation in the chart

MedicalRecord

Do you have medical students rotating in your Emergency Department? Are they allowed to document in the medical record?

Charting in the medical record is the cornerstone of clinical communication. You document your findings, your clinical reasoning, and management plan. The medical record allows communication amongst providers. Chart documentation is a crucial skill that every medical student should know, as stated by the Association of American Medical Colleges (AAMC).

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By |2016-11-11T19:00:30-08:00Sep 6, 2010|Education Articles, Medical Education|

Getting a subpoena: What is an expert witness?

Gavel

Well, it’s an inevitable part of working in an Emergency Department. I got a subpoena recently and now have to go in to testify on a trauma patient. I’ve gotten a few subpoenas before on trauma patients, but fortunately most cases were settled out of court.

First of all, I think it’s an ethical responsibility of emergency physicians to describe what we saw and did in the care of the injured patient in the legal system. However, I have found that the few lawyers I have interacted with slowly expand their scope of questions to cover things NOT in the medical chart. Has this happened to anyone else? They essentially start to ask me things which an “expert witness” should answer. Expert witnesses receive expert witness fees. (more…)

By |2019-02-19T18:53:03-08:00Aug 31, 2010|Medical Education|

Article Review: Rethinking the premed requirements

PremedThink back to your college years. Remember those premed courses that you had to take? Biology, chemistry, physics… oh my. How helpful were these in your preparation for medical school and clinical practice?

In 1981, the Association of American Medical Colleges assembled a group, the General Professional Education of the Physician and College Preparation for Medicine (GPEP) to relook at these premed requirements. In 1984, the published a report “Physicians for the Twenty-First Century”. They advocated that the intensive premed requirements overly skews students’ education towards a “narrow objective of medical school admission”. Education is not balanced to include broader liberal arts learning, which may teach students more about humanistic values and communication skills. 

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By |2016-11-11T19:00:31-08:00Aug 30, 2010|Education Articles, Medical Education|

Trick of the Trade: Increasing students responses to the differential diagnosis

DiagnosisAnyone who teaches medicine asks students to list their differential diagnosis when discussing a new clinical case. It’s also part of several models for education including the One-Minute Preceptor and SNAPPS.

For the most part, students are good at coming up with answers to the differential, but what do you do when they strike out? Or what if the answer is always the same, i.e. chest pain = myocardial infarction?

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Article Review: Use of Effective Questioning

3D Character and Question MarkAsking effective questions is a valuable skill for any teacher. As a junior faculty member working to improve my teaching, I’m often in awe of my more experienced colleagues when I have the chance to watch them teach. At times, it’s quite easy to pick out the skills that they put into action but occasionally, their expertise is much more subtle.

Effective questioning falls into this category.

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Incorporating debriefing into clinical practice

plus-delta-pic2

I’m in the middle of an intense weeklong course on debriefing for medical simulation here in Cambridge, MA. One of the goals many of the participants share is our desire to improve our skills in the art of debriefing after clinical simulations. Although the course focuses on “Debriefing with Good Judgement” 1 today the faculty also offered a simple tool to structure a brief debrief when time is very limited.

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By |2016-11-11T19:02:23-08:00Aug 19, 2010|Medical Education|

Article Review: Premature diagnostic closure


DrugsAlocholYou are taking care of a patient, who frequently presents to the ED for polysubstance use. You are pretty sure his altered mental status is from polysubstance use again. He was found in his home next to drug paraphernalia. He intermittently becomes severely agitated, and so you give him sedatives. He has a low-grade fever, but you attribute that to his psychomotor agitation and likely stimulant use. Because he remains confused and lethargic after 8 hours, you admit him to an inpatient team to await further metabolism of his recreational drugs and your sedation medications.

 The next day, you learn that had meningoencephalitis.

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By |2016-11-11T19:00:36-08:00Jul 26, 2010|Education Articles, Medical Education|