Journal of General Internal Medicine

, Volume 5, Issue 3, pp 218–224

Use of an outpatient medical record audit to achieve educational objectives

Changes in residents’ performances over six years
  • David E. Kern
  • William L. Harris
  • Bradley O. Boekeloo
  • Lee Randol Barker
  • Patricia Hogeland
Original Articles

DOI: 10.1007/BF02600538

Cite this article as:
Kern, D.E., Harris, W.L., Boekeloo, B.O. et al. J Gen Intern Med (1990) 5: 218. doi:10.1007/BF02600538

Abstract

Objective:To evaluate the effectiveness of a process whereby a faculty-resident committee annually audits outpatient record keeping and preventive care practices and provides feedback to resident physicians.

Design:Pre- and postfeedback audits with interventions and observations repeated over six consecutive academic years.

Setting:The adult primary care practice of housestaff in a university-affiliated hospital.

Subjects:All 139 physicians in an internal medicine residency program from 1981–82 through 1986–87, of whom 37 were present for three consecutive years.

Intervention:Each year, residents were given individualized, detailed, typewritten feedback based on audits of their outpatient records.

Measurements and main results:Each resident physician had a minimum of four (mean 5.2) outpatient records per year audited against standards for record-keeping practices and the provision of preventive care. Overall performance scores for each resident audit improved from a mean of 39.7±12.3 (SD) in 1981–82 to a mean of 58.5±14.1 (SD) in 1986–87 (possible range 0 to 100, observed range 9.4 to 86.6). The overall performance scores of individual residents, who received two cycles of feedback, improved an average of 11.5 (95% confidence limits 7.6, 15.3), from a mean of 48.4±11.4 (SD) during their first year of residency to 59.8±13.9 (SD) during their third year. General (primary care) and traditional-track residents improved at similar rates, although mean performance scores were consistently higher for general than for traditional-track residents. Analysis of variance revealed that all changes and differences were statistically significant.

Conclusions:An ongoing chart audit and feedback system can be associated with improvements both in the performance of individual residents and in the long-term performance of a residency program.

Key words

medical auditfeedbackprimary health careinternship and residencymedical records

Copyright information

© Society of General Internal Medicine 1990

Authors and Affiliations

  • David E. Kern
    • 1
  • William L. Harris
    • 2
  • Bradley O. Boekeloo
    • 3
  • Lee Randol Barker
    • 1
  • Patricia Hogeland
    • 1
  1. 1.the Department of MedicineThe Johns Hopkins University, School of Medicine, Francis Scott Key Medical CenterUSA
  2. 2.the Department of Information Systems and Decision SciencesLoyola College in MarylandUSA
  3. 3.the Department of Health Policy and ManagementThe Johns Hopkins University, School of Hygiene and Public Health (BOB)USA
  4. 4.Division of General Internal MedicineFrancis Scott Key Medical CenterBaltimore