Northwestern University Feinberg School of Medicine Patient Follow-Up Logs: Current Approaches and Innovating the Format to Encourage Self-Directed Learning David Salzman, MD Assistant Program Director Assistant Professor Department of Emergency Medicine Faculty: Center for Simulation Technology and Immersive Learning Northwestern University, Feinberg School of Medicine Collaborators: Nicholas Hartman, MD, Melissa Marinelli, MD, Nathan Olson, MD, Matthew Patton, MD, Amer Aldeen, MD & Michael Gisondi, MD

Disclosures No financial relationships to disclose

Introduction “The program must assure that the residents follow-up on a representative sample of patients so as to learn about the results of diagnostic studies, the outcome of interventions, and the final patient diagnosis.” “Physician must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their practice of medicine.”

Nationwide Follow-up Trends 158 Allopathic PD’s Invited 87 Completed Survey 80 Responses 99 Started Survey 7 Duplicates Removed Survey Completed By: PD (81.25%) APD (13.75%) CR (2.5%) PC (2.5%) Distribution of Results: 3 Year 61 (76.25%) 4 year 19 (23.75%)

Method of Completion

Frequency of Completion Every Shift3 Every Week1 Every EM “Month”45 Calendar Month6 4 times per year2 Once per Year2 Other15

Assessment of COMPLETION Program Director55 Asst/Assoc PD38 Program Coordinator38 Chief Resident5 Nobody1 Other5 Assessment of CONTENT Program Director45 Asst/Assoc PD32 Program Coordinator4 Chief Resident3 Nobody17 Other13

Overall Satisfaction Strongly Agree AgreeNeutralDisagreeStrongly Disagree System is EASY to use 35.14%52.70%8.11%4.05%0.00% System is an EFFECTIVE Learning Tool 17.57%31.08%43.24%8.11%0.00% Current System is an EFFICIENT Learning Tool 13.51%29.73%37.84%16.22%2.70% Would use different system 6.76%29.73%33.78%14.86% Multi-residency Collaboration 16.67%30.56%26.39%12.50%13.89%

Innovating the Approach

Content Evaluation Images 1.22/post Learning Points 1.04/post References 1.38/post Longitudinal Follow-up 138/283 Posts = 53% Main Content

Follow-Up Blog Utilization Version 1.0 Version 2.0 Initial 150 day totals (7/6/11-12/2/11): 1978 Visits 33.3 Views/day

Creating Posts Developing novel posts July min February – min Commenting on other posts July – min February – 9.71 min Compliance for Block 1-4 Overall – 74.3% PGY 1 – 95.6% PGY 2 – 85.8% PGY 3 – 56.7% PGY 4 – 54.5%

Site Usability Strongly Disagree DisagreeUnsure/N eutral AgreeStrongly Agree N/A Easy to Navigate0.0%4.3% 56.5%34.8%0.0% Easy to Post entry 4.3%8.7% 26.1%43.5%8.7% Easy to Search4.3%17.4%4.3%39.1%34.8%0.0% Collaboration0.0% 4.3%60.9%34.8%0.0% Strongly Disagree DisagreeUnsure/Ne utral AgreeStrongly Agree N/A Easy to Navigate0.0% 57.1%42.9%0.0% Easy to Post entry 0.0% 28.6%57.1%14.3% Easy to Search0.0% 14.3%42.9% 0.0% Collaboration0.0%14.3%0.0%57.1%28.6%0.0%

Results Initial Implementation - Do they like it? I complete the follow-up logs because I find them a useful and beneficial activity for my learning Entirely Agree 21.7% Agree 43.5% Unsure / Neutral17.4% Disagree8.7% Entirely Disagree0.0% How have they used the information? Changed treatment Changed diagnostic strategies Different dispositions

Mobile Devices

Version 3.0 Use Version 3.0 day totals (1/9/12-2/22/12): 996 Visits = Visits/Day

Version 1.0 Version 2.0 Version 3.0

Lessons Learned Keywords Security Implementation Software Compatibility Version 1.0 Version 2.0

Future Directions Integration of technology & learning theory to allow individual approach to accomplishing requirements Transition from competency to outcomes Long term compliance

Northwestern University EM Residency Collaborators: Nicholas Hartman, MD, Melissa Marinelli, MD, Nathan Olson, MD, Matthew Patton, MD, Amer Aldeen, MD & Michael Gisondi, MD Special Thanks for Mentorship and IT support: John Vozenilek, MD, Kadriye Lewis, Ed.D, Lanty O’Connor, Andrew Boehm Contact: