Date of Award

January 2013

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Grace Jenq

Subject Area(s)

Medicine, Education

Abstract

Background: Discharge summaries (DS) are a tool for transitioning care from hospital to the post-acute environment as well as for assessing residents' strengths and deficiencies across many competencies.

Objective: 1) To compare residents' self-assessment of their skills in writing DSs to the assessments of faculty members. 2) To determine whether a brief online educational intervention can change residents' perceptions of their skills writing DSs. Methods: We distributed a survey regarding residents' skill in writing DSs to both internal medicine residents and department faculty members. Following the survey, residents were randomized to either a) review one of their own DSs by comparing it to checklist of inclusion criteria or b) review their DSs by comparing it to a an example of a model DS. Following the intervention, residents repeated the online survey about their skills. Faculty and resident responses were compared using two-tailed independent T-tests; resident pre- and post-tests were compared using two-tailed paired T-tests. Results: Compared to the residents' self-evaluation, faculty rated the residents as less competent in creating DSs that are useful to outpatient providers (p = 0.01) and in effectively reviewing their DSs and making appropriate changes (p = 0.01). Residents who were randomized to compare their own DSs to an ideal showed a significant change in attitudes about their ability to organize a DS (p = 0.03); residents who compared their own DSs to a checklist of inclusion elements showed no significant change in attitudes about their abilities. Conclusion: In order to improve care transitions and maximize resident learning in this area, residents need tools to aid self-assessment of their DSs that go beyond the traditional provision of a checklist of components to include in the summary.

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