Do peer chart audits improve residents' performance in providing preventive care?

PURPOSE: One recommended method to evaluate residents' competence in practice-based learning and improvement is chart audit. This study determined whether residents improved in providing preventive care after a peer chart audit program was initiated. METHOD: Residents audited 1,005 charts and scored their peers on 12 clinical preventive services. The mean total chart audit scores were compared across five time blocks of the 45-month study. RESULTS: Residents' performance in providing preventive care initially improved significantly but declined in the last ten months. However, their performance remained significantly higher than at the beginning. CONCLUSIONS: By auditing their peers' charts, residents improved their own performance in providing preventive care. The diffusion of innovations theory may explain the prolonged implementation phase and problems in maintaining a chart audit program.

Expectations of and for clerkship directors: a collaborative statement from the Alliance for Clinical Education.

PURPOSE: The clerkship director (CD) is an essential leader in the education of medical students on clinical rotations. This article represents a collaborative effort of the national clerkship organizations that comprise the Alliance for Clinical Education (ACE), a multidisciplinary group formed in 1992. ACE suggests that selection of a CD be regarded as an implied contract between the CD and the department chair that each will take the steps to ensure the success of the clerkship and of the CD. This article sets standards for what should be expected of a CD and provides guidelines for the resources and support to be provided to the person selected for leadership of the clerkship. SUMMARY: In their roles as CDs, educators engage in three principal activities: administration, teaching, and scholarly activity, such as educational research. This article describes (a) the work products that are the primary responsibility of the CD; (b) the qualifications to be considered in selection of a CD; (c) the support structure, resources, and personnel that are necessary for the CD to accomplish his or her responsibilities; (d) incentives and career development for the CD; and (e) the dedicated time that should be provided for the clerkship and the CD to succeed. Studies by several CD organizations conclude that 25% should be considered a minimum estimate of time for the administrative aspects of running a clerkship. With the added teaching and scholarly activities undertaken by a CD, a minimum of 50% of an full-time equivalent has been recognized as appropriate. The complexity and the need for timeliness in the cyclic and often repetitive tasks of the clerkship require that a full-time administrative assistant be part of the structure dedicated to running the clerkship. CONCLUSION: ACE recommends that institutions have clear standards for what is expected of the director of a clinical clerkship and have correspondingly clear guidelines as to what should be expected for CDs in their career development and in the support they are given.