Thread by @JenniferSpicer4

1/ *Re-consult 📞*

You: What did the last consult note say?

Them: I don't know how to interpret it...

*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data

You: 🤦 I feel you... We'll see the patient again.

2/ You wonder...

💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?

And you're not the only one wondering...

How can we ✍️ more effective notes?

3/ Clinical notes are used for many purposes, as previously highlighted by @YihanYangMD

https://twitter.com/YihanYangMD/status/1551959943036538880

4/ As specialists, our notes are an important way for us to communicate with the primary team & other consultants to:

📌 Summarize relevant data
📌 Explain our thought process
📌 Communicate our recommendations

5/ Therefore, on consult teams, we need to teach our learners (and ourselves) how to ✍️ effective notes.

So what makes an effective consult note?

6/ Whereas primary team notes are a "journal entry" of the patient's hospitalization, consult notes should be more focused by:

📌 Defining the consult "ask"
📌 Curating data relevant to the "ask"
📌 Clearly answering the consult "ask"

7/ 1⃣ Data GATHERING:

Specialists have expertise in gathering data relevant to their field, including:

✅ Specific historical information
✅ Specialized physical exam findings
✅ Outside records (hospitals, health department, etc)

And we go to their notes to find these things!

8/ 2⃣ Data INTERPRETATION:

But sometimes it's not new data we seek but rather a curation +/- interpretation of existing data, including:

✅ Lab tests
✅ Imaging
✅ Other reports (ex: EKGs, EGD/colonoscopy, etc.)

It's helpful when the relevant info is gathered in a single note!

9/ 3⃣ Data SYNTHESIS:

Although data listed in consultants' notes is often helpful, the MOST important part of the note is the assessment & recommendation.

So how should we structure them?

10/ Here are 2 key articles on the topic:

*⃣ pubmed.ncbi.nlm.nih.gov/19898909/
*⃣ pubmed.ncbi.nlm.nih.gov/17296883/

11/ These studies surveyed primary teams re: consult preferences.

There were some differences between surgical & non-surgical teams, but most agreed that notes should:

✅ Be concise
✅ Describe decision-making rationale
✅ Indicate importance & urgency of recs

12/ Importantly, most did NOT care about:

📌 Limiting # of recommendations
📌 Including references

13/ Based on this data, we should probably teach 3 important aspects of the data synthesis (i.e., "assessment & recommendations"):

1⃣ Synthesis - description of patient's problem with ddx
2⃣ Recommendations - clear, concise, specific
3⃣ Structure - well-organized, easy-to-read

14/ So how can we teach our learners, esp those new to a consult team, how to write effective notes?

I've summarized some strategies in the table below.

Two keys to doing this effectively:
🗝️ Providing explicit guidance
🗝️ Practicing what we 🗣️

15/ Next week @VarunPhadke2 will continue this series on "Teaching Consultant Skills" with ”Dealing with Conflict” ...

...including in our notes!

Remember to check out #SubspecialtyTeaching @MedEdTwagTeam to find all our threads in one place!