Practical Doc

Chart Stimulated Recall


“How can I encourage my resident to consider a broader range of therapeutic options?”

Chart stimulated recall (CSR) is a useful technique to use with learners who have considerable clinical independence, such as senior residents. CSR’s main benefit is to provide a window into the resident’s thought processes during the clinical encounter, but consider using it to check more junior learner’s charting skills.

Uses

  • If concerned about clinical reasoning skills
    • Premature diagnostic closure
    • Inappropriate management choices
    • Limited clinical knowledge base
    • Poor organization
  • As a check on  following a patient- centered agenda
  • Reviewing comprehensive care skills
  • Evaluating charting skills

Pros and Cons

Time! It is both a plus and a minus. CSR can be done at the end of the day or over lunch, but it does take 15 – 30 minutes. Consider using it occasionally with all your residents but more frequently if you feel they are struggling with the rotation.

The Process of CSR

  • Case selection can be random or selected by resident or preceptor
  • Preceptor reviews the chart note
  • Preceptor guides resident to reveal thought processes during the clinical encounter
  • A CSR worksheet with sample questions and space for recording comments is valuable

Sample: Chart Stimulated Recall Worksheet (Resource not available)

  • Premature diagnostic closure
    • What features of the patient’s presentation led you to your top three diagnoses?
    • Is there anything else you wish you would have asked?
  • Inappropriate management choices
    • Were there other tests that you thought of but deferred or ruled out?
    • What did you decide was appropriate for follow up?
    • Patient – centeredness
    • What did you learn about the patient’s concerns about the illness?
    • Do you feel you reached common ground with the patient?
  • Comprehensive care skills
    • Did you discuss any preventive interventions, such as quitting smoking, with the patient?

Reference: Schipper S, Ross S. Stuctured teaching and assessment. Canadian Family Physician 2010;56;958-9 http://www.cfp.ca/cgi/reprint/56/9/958

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