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

2. 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)

3. 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

4. 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?

5. 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.

6. 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.

7. 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

8. 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?

9. 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

10. 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