The Challenge: How to Improve Students’ Understanding of and Skills in Writing a Medical History?

Medical Clinical Writing Differs from Academic Writing Seeks to uncover the diagnosis/issues rather than substantiate thesis Language used is highly technical Abbreviated style is preferred – complete sentences discouraged Traditional revision not permitted – errors must remain legible (though crossed out and initialed)

Rubric – Centered Teaching of This Genre Construct a rubric to outline the elements of a successful HPI Center teaching around those elements Use rubric to explain the elements and articulate levels of performance for the complete task

How an Expert Writes the HPI for Mr. P.L. 10/5/07 CC: “I’ve been falling a lot over the past 2 days” HPI: Mr. P.L. is a 62 y/o male with a history of HTN, NIDDM and hypercholesterolemia who presents to the ED today after an office visit with his PMD this AM with a complaint of falling at home several times. He also c/o slurred speech and weakness on the left side of his body. These complaints started acutely ~ 3pm on 10/3/07. The symptoms have been constant with no clear alleviating or aggravating factors. Pt. denies loss of consciousness, chest pain, vertigo, palpitations, headache, dyspnea, seizure activity, history of head trauma/epilepsy. No fever or ill contacts. No syncope or injuries in recent past or as a result of the current falls. Pt. denies any pain at this time. Concerned re: symptoms b/c he is unable to walk more than 1-2 steps without assistance. Possibly ask here for feedback about the unique features of this genre?

Constructing the Rubric – How does an expert do it? First Line (P)OLD CARTS + What can’t you do? HPI tells Story of CC Mechanism of Injury if relevant Hospital course if relevant F/U of any serious symptoms elicited in history Pertinent positives/negatives Relevant information from PMH/ROS Succinctness Grammar/spelling Drug names Correction of Errors 62 y/o male with a history of HTN, NIDDM and hypercholesterolemia  Compare the list with the Rubric you have in front of you.

HPI Rubric Rubric for History of Present Illness Element Excellent Performance (3) Needs Improvement (2) Unacceptable performance (1) First Line Contains age, gender, & imp. pre-existing conditions Omits some of these variables Does not include any of these variables (P)OLD CARTS + What can’t you do? Are all present Only 5-7 are present Fewer than 5 are present HPI tells story of CC From trigger event to present in orderly fashion & includes all relevant information Includes most of the relevant information, but is poorly organized Lacks important information Pertinent positive/negatives Are addressed thoroughly Are addressed, but significant items are left out Are not addressed at all Had developed WI PD Lab to give more practice in writing with scaffolded component tasks and wanted a way to grade it, but with further reading and listening to colleagues and students, came to realize that it could be used in many other ways.

Rubric – Can Be Used as Both Instructional & Assessment Tool Instructional tool  Early in course rubric is explained & students use the rubric to grade an HPI Formative assessment  Graded rubric is returned with each assignment Performance assessment Compare early and late performance for each student Can also be used as a course assessment

Rubric can be used for Course Assessment Students = 20 Assignment: Hx 1 Hx 4 Hx 7 First Line 2.10 2.70 3.00 OPQRST 2.05 2.60 2.95 Story of CC 1.70 2.25 Hospital Course 0.00 0.95 1.83 Serious symptoms elicited in history 1.45 2.45 Pertinent positives/negatives 1.95 Relevant information from ROS 1.50 2.35 Succinctness 2.80 2.90 Grammar 2.65 2.85 Drug Names 1.25 2.53 Correction of Errors 1.00 Average 1.51 2.00 Did the majority of the students achieve the target level of performance?

Other Health Care Clinical Genres The Multidisciplinary Care Plan The Social Work Psychosocial Assessment The Nursing Assessment The Discharge Plan Disability Assessment Consultation Letter Patient Education Plan Each one has its own conventions and constraints Each one also incorporates essential aspect of professional thinking and doing

Some Other Professional Genres Which Might Benefit from This Approach The Legal Brief The Flight Plan or Quartermaster’s Report Architectural Consultation Report Business Plan Engineering Report Advertising Copy