Yihan Yang, MD MHS-MedEd Profile picture
Jul 26, 2022 14 tweets 7 min read Read on X
1/ “When you have time, can we look over one of my notes?”

Do you have an approach to teaching when learners ask for feedback on documentation? Check out the following thread for some high-yield tips!

#MedEd #MedEdTwagTeam #TweetorialTuesday #MedTwitter Image
2/ As a reminder, we are still in our series on inpatient teaching. I typically will teach about notes after rounds. Image
3/ First… in your opinion, how valuable is it for learners to receive feedback from notes?
#MedEd #MedTwitter #MedStudentTwitter
4/ Prior studies like the 1 ⬇️ show that trainees spend majority of their days documenting in the electronic health record. Most of the time they don’t receive feedback on this documentation

jamanetwork.com/journals/jamai…
5/ A framework for teaching with notes is below. You may recognize this framework as similar to the GO Ask-Tell-Ask model for feedback

We will focus on purpose-specific teaching in the next few tweets. Image
6/ Purpose: Admittedly, many aspects of note-writing differ due to personal preference/style. However, there are 4 universal purposes for notes around which you can structure your teaching.

I will 1st ask my learners, “What is the purpose of us writing this note?” Image
7/ Depending on interest & level of my learner, I choose to focus on 1 or 2 of these note purposes. Early learners tend to prefer discussing communicating w/ notes & clinical reasoning; I save discussions around billing & legal practicalities for advanced learners Image
8/ Communication: Do your learners’ notes accurately and concisely communicate what is going on with the pt? Below are a few questions to consider when giving feedback on notes with a focus on communication. Image
9/ Clinical Reasoning: When reviewing notes for clinical reasoning, I ask myself:

If someone unfamiliar with the pt read this note, could they understand...

❓WHAT is going on with the pt
❓WHY were these specific diagnoses, tests, & interventions chosen?
10/ Clinical Reasoning: Chart-stimulated recall (CSR) is a useful tool to further explore learners’ clinical reasoning based on a case using notes.

The following checklist by the ACGME provides sample ?s that can be used for CSR: acgme.org/globalassets/4… Image
11/ For learners close to independent practice, I use notes to teach the "business" aspects of charting.

I acknowledge that billing & medical/legal purposes of notes is a byproduct of US healthcare & shouldn’t be the primary driver for what is documented in notes. Image
12/ SHOWING is better than TELLING. An attestation beyond “I saw & discussed the pt & agree with note” is a great way to role model examples of problem representation, concise clinical course summary, discussing complex differential diagnosis/management decisions
13/ Educators: Have you reviewed patient notes with your learners?

Learners: Have you reviewed notes with your attendings/residents?

What have you found helpful?

#MedTwitter #MedStudentTwitter #MedEd Image
14/ Join us again next Tuesday when @ChrisDJacksonMD drops some tips on teaching after hours!
And don't forget to follow @JenniferSpicer4 @GStetsonMD @MedEdTwagTeam to ensure you don't miss a thread! Image

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More from @YihanYangMD

Jul 19, 2022
1/ You’re prepping a 15min post-rounds talk on anticoagulation. To excite the crowd, you say, “This is going to be interactive!”

How do you avoid learners reflexively cringing,waiting to be “socratically” questioned?

#MedEd #MedTwitter #MedEdTwagTeam #TweetorialTuesday
2/ We are still covering teaching in the inpatient setting. Interactive teaching can be done in most settings, but I’ll focus on opportunities before/after rounds. We covered interactive teaching during rounds & @ bedside earlier this series
3/ When people say, “This session is going to be interactive,” a talk where learners are asked a series of ?s akin to the socratic method often comes to mind.

For this thread, I'd like to frame “interactive teaching” as below:
Read 14 tweets
Jul 5, 2022
1/ Last week, @ChrisDJackson dropped some serious 🔥tips on putting together the content of chalk talks. Check it out if you missed it ⬇️

Part 2 this wk will cover high yield delivery tips!

#MedEd #MedTwitter #MedEdTwagTeam #TweetorialTuesday Image
2/ As a reminder, we are still covering teaching in the inpatient setting. Again, chalk talks are fair game both during or after rounds, depending on how much time you have available Image
3/ We will cover the following tips for chalk talk delivery in this week’s🧵: Image
Read 16 tweets
Jun 14, 2022
1/ A new dx of cirrhosis…
Recurrence of cancer…
A Monday procedure is canceled & your pt waited since Friday…

We’re frequently the bearer of bad news in the hospital.

Today #MedEdTwagTeam shares tips on incorporating teaching when giving difficult news.

#MedTwitter #MedEd Image
2/ As a reminder, we are continuing our discussion inpatient teaching.

Last wk, we covered tips on teaching around family meetings:

This wk, we focus on teaching when delivering difficult news, which can also be done during rounds & routine patient care Image
3/ But 1st… what counts as “difficult news?” We often think of cancer or terminal illnesses.

But with the definition ⬇️ I think we can agree there are plenty of times when we may be delivering difficult news to patients without even identifying it as such. Image
Read 11 tweets
Jun 7, 2022
1/ Your intern on rounds: “I’m worried about Ms. H & think we need a family meeting.”

You mentally check your schedule to decide where to fit a 30-60 min family meeting AND make it a good learning experience.

#MedEdTwagTeam is back w tips on the latter!

#MedTwitter #MedEd Image
2/ As a reminder, we are continuing our discussion about opportunities for inpatient teaching after rounds. We return to the bedside this week to discuss teaching around family meetings Image
3/ What are your objectives for using the family meeting as a method of teaching?

Common areas for intentional skill-building with family meetings are highlighted 👇🏼 Image
Read 11 tweets
Apr 12, 2022
1/ A room full of rising chief residents discussing report facilitation - wonderful to teach in person again @AAIMOnline #AIMW22!

If you missed our workshop, please check out the following links for my report facilitation tweetorials! #MedEd #MedTwitter
2/ In our #AIMW22 workshop we shared 8 tips for facilitating resident report

Tip 1 - Starting on Time in the link below!

Tips 2-8 in the following 🧵
Read 7 tweets
Mar 15, 2022
1/ Your student is trying to characterize the pt’s aortic stenosis murmur. The pt looks concerned. The rest of your team looks bored, waiting to examine the pt.

How to make PE teaching fruitful & engaging for EVERYONE?

#TweetorialTuesday #MedTwitter #MedEdTwagTeam #MedEd Image
2/ As a reminder, we are continuing our discussion about opportunities for inpatient teaching during rounds.

Today is the final installment on the physical exam. Image
3/ You’ve decided to teach exam skills. You’ve prepped WHAT you’d like to teach.

But with so many different levels of learners on a team, keeping all your learners & the pt engaged can be a challenge during exam teaching.
Read 16 tweets

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