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Use of a chart audit: teaching well child care to paediatric house officers
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, New York.
Insights
Regular chart audits with feedback significantly improved paediatric residents' well child care skills. While scores dipped after a year, they remained higher than the control group, showing sustained benefits.
Area of Science:
- Medical Education
- Paediatrics
- Quality Improvement
Background:
- Effective teaching of well child care is crucial for paediatric residents.
- Assessing the impact of educational interventions on clinical practice is essential.
Purpose of the Study:
- To evaluate the effectiveness of chart audits with feedback in teaching paediatric residents well child care components.
- To determine the long-term impact of this educational strategy.
Main Methods:
- A prospective, randomized controlled study design was used.
- Paediatric residents' patient charts (children <5 years) were audited against established criteria.
- Compliance scores were calculated across five key well child care categories.
Main Results:
- No significant baseline differences were observed between the experimental and control groups.
- Initial audits showed no significant changes; however, one month post-feedback, the experimental group improved significantly in present history, behaviour-development, and past history.
- One year later, while scores decreased from the previous audit, the experimental group's scores remained statistically higher than the control group in present history.
Conclusions:
- Regular chart audits coupled with constructive feedback represent a valuable component of paediatric residency primary care curricula.
- This method demonstrates a positive impact on residents' adherence to well child care guidelines.
Abstract:
A prospective study employing a randomly assigned control group was conducted to assess the usefulness of a chart audit in teaching paediatric residents the components of well child care. The charts of children less than 5 years of age were reviewed and compared with audit criteria. Per cent compliance scores were calculated for five categories: present history; behaviour-development; family history; past medical history; and physical assessment. Five separate audits (10 charts per resident per audit) were conducted--two prior to giving the residents feedback, one after informing them that a study was being conducted, once a month after giving feedback, and one a year later. There was no significant difference between the baseline scores of the two groups. In addition, there were no significant changes in the experimental group's scores during the first three audits or the control group's scores over the whole 3-year course of the study. However, one month after receiving feedback, the scores of the experimental group improved significantly in present history, behaviour-development, and past history. One year later, the experimental group's scores were lower in every category than in the preceding audit. However, their scores were higher than the control group and the difference reached statistical significance in present history. We conclude that regular chart audits with feedback are a valuable addition to the primary care curriculum in a paediatric residency programme.