Use of an outpatient medical record audit to achieve educational objectives: changes in residents' performances over six years.
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.


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


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


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


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


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.
Kern
D E
DE
Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD.
Harris
W L
WL
Boekeloo
B O
BO
Barker
L R
LR
Hogeland
P
P
D015142:Baltimore; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005246:Feedback; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000592:standards*; D008485:Medical Audit; D008499:Medical Records; D010044:Outpatient Clinics, Hospital / Q000592:standards; D013997:Time Factors