Are discharge summaries teachable? The effects of a discharge summary curriculum on the quality of discharge summaries in an internal medicine residency program.

BACKGROUND: Interns are often required to dictate discharge summaries without formal training. We investigated the impact of a curriculum aimed at improving the quality (i.e., complete, organized, succinct, internally consistent, and readable) of interns' discharge summaries. METHOD: Fifty-nine medicine interns were randomized to a: (1) control group; (2) discharge summary curriculum; or (3) curriculum plus individualized feedback. Pre- and post-intervention, seven discharge summaries were graded using a 9-item instrument. T-tests, analysis of covariance, and effect sizes assessed group differences. RESULTS: There were multiple, significant within-group improvements for the intervention groups and between group differences post-intervention. The average effect size was large when the curriculum plus feedback group was compared to the control group (.70) and moderate when compared to the curriculum only group (.36). CONCLUSIONS: Interns who received instruction on discharge summary skills improved the quality and of their discharge summaries. Adding feedback to the curriculum provided more benefit.

Improving adherence with antimicrobial therapy for respiratory tract infections: a discussion of directly observed therapy (DOT) and short-course therapies.

Although some of the variables associated with adherence (eg, patient age, place of residence) cannot be influenced, others are very amenable to modifications. Levels of adherence correlate with the convenience of dosage regimens, as shown in a number of clinical trials. Therefore, antimicrobial agents that are well accepted by patients should be considered whenever feasible. Such agents include those that enable shortterm therapy with the fewest daily doses and shortest effective treatment regimens. DOT, a cost-effective and clinically effective approach for certain chronic conditions, may also have practical implications for the treatment of acute infectious diseases, such as CAP, AECB, and otitis media. Although there are a number of challenges to the implementation of DOT for these conditions, such an approach may be beneficial, particularly when short-course antibiotic therapy is indicated and appropriate candidates are identified for treatment.