Northwestern University Feinberg School of Medicine

Patient Follow-Up Logs: Current Approaches and Innovating the Format to Encourage Self-Directed Learning

David Salzman, MDAssistant Program DirectorAssistant ProfessorDepartment of Emergency MedicineFaculty: Center for Simulation Technology and Immersive LearningNorthwestern University, Feinberg School of Medicine

Collaborators:Nicholas Hartman, MD, Melissa Marinelli, MD, Nathan Olson, MD, Matthew Patton, MD, Amer Aldeen, MD & Michael Gisondi, MD

Disclosures

No financial relationships to disclose

Introduction “The program must assure that the residents follow-up on a representative sample of patients so as to learn about the results of diagnostic studies, the outcome of interventions, and the final patient diagnosis.”

“Physician must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their practice of medicine.”

http://www.acgme.org/acWebsite/RRC_110/110_pdChecklist.pdfhttp://www.abms.org/Maintenance_of_Certification/ABMS_MOC.aspx

Nationwide Follow-up Trends158 Allopathic PD’s Invited

87 Completed Survey

80 Responses

99 Started Survey

7 Duplicates Removed

Survey Completed By:PD (81.25%) APD (13.75%)

CR (2.5%) PC (2.5%)

Distribution of Results:3 Year 61 (76.25%)4 year 19 (23.75%)

Method of Completion

Frequency of CompletionEvery Shift 3Every Week 1Every EM “Month” 45Calendar Month 64 times per year 2Once per Year 2Other 15

Assessment of COMPLETIONProgram Director 55Asst/Assoc PD 38Program Coordinator 38Chief Resident 5Nobody 1Other 5

Assessment of CONTENTProgram Director 45Asst/Assoc PD 32Program Coordinator 4Chief Resident 3Nobody 17Other 13

Overall SatisfactionStrongly

AgreeAgree Neutral Disagree Strongly

Disagree

System isEASY to use 35.14% 52.70% 8.11% 4.05% 0.00%

System is an EFFECTIVE Learning Tool

17.57% 31.08% 43.24% 8.11% 0.00%

Current System is an EFFICIENTLearning Tool

13.51% 29.73% 37.84% 16.22% 2.70%

Would use different system 6.76% 29.73% 33.78% 14.86% 14.86%

Multi-residency Collaboration 16.67% 30.56% 26.39% 12.50% 13.89%

Innovating the Approach

Content EvaluationImages 1.22/post

Learning Points 1.04/post

References 1.38/post

Longitudinal Follow-up 138/283 Posts = 53%

Main Content

Follow-Up Blog Utilization

Version 1.0 Version 2.0

Initial 150 day totals (7/6/11-12/2/11):1978 Visits 33.3 Views/day

Creating Posts

Developing novel posts

•July - 59.41 min •February – 44.29 min

Commenting on other posts

•July – 11.05 min•February – 9.71 min

Compliance for Block 1-4

Overall – 74.3%

PGY 1 – 95.6%PGY 2 – 85.8%PGY 3 – 56.7%PGY 4 – 54.5%

Site UsabilityStrongly Disagree

Disagree Unsure/Neutral

Agree Strongly Agree

N/A

Easy to Navigate 0.0% 4.3% 4.3% 56.5% 34.8% 0.0%

Easy to Post entry

4.3% 8.7% 8.7% 26.1% 43.5% 8.7%

Easy to Search 4.3% 17.4% 4.3% 39.1% 34.8% 0.0%

Collaboration 0.0% 0.0% 4.3% 60.9% 34.8% 0.0%

Strongly Disagree

Disagree Unsure/Neutral

Agree Strongly Agree

N/A

Easy to Navigate 0.0% 0.0% 0.0% 57.1% 42.9% 0.0%

Easy to Post entry

0.0% 0.0% 0.0% 28.6% 57.1% 14.3%

Easy to Search 0.0% 0.0% 14.3% 42.9% 42.9% 0.0%

Collaboration 0.0% 14.3% 0.0% 57.1% 28.6% 0.0%

ResultsInitial Implementation - Do they like it?

I complete the follow-up logs because I find them a useful and beneficial activity for my learning

Entirely Agree 21.7%Agree 43.5%Unsure / Neutral 17.4%Disagree 8.7%Entirely Disagree 0.0%

How have they used the information?

•Changed treatment•Changed diagnostic strategies•Different dispositions

Mobile Devices

Version 3.0 Use

Version 3.0 day totals (1/9/12-2/22/12):996 Visits = 22.13 Visits/Day

Version 1.0 Version 2.0

Version 3.0

Lessons LearnedKeywords

Security

Implementation

Software Compatibility

Version 1.0 Version 2.0

Future Directions

Integration of technology & learning theory to allow individual approach to accomplishing requirements

Transition from competency to outcomes

Long term compliance

Northwestern University EM ResidencyCollaborators:

Nicholas Hartman, MD, Melissa Marinelli, MD, Nathan Olson, MD, Matthew Patton, MD, Amer Aldeen, MD & Michael Gisondi, MD

Special Thanks for Mentorship and IT support:

John Vozenilek, MD, Kadriye Lewis, Ed.D, Lanty O’Connor, Andrew BoehmContact: dsalzman005@northwestern.edu