Chart Stimulated Recall: A Method for Workplace-Based Assessment Lyuba Konopasek, MD DIO New-York Presbyterian Hospital Bar-on ME, Konopasek L. Snippets: An Innovative Method for Efficient, Effective Faculty Development. J Grad Med Educ. 2014;6(2):207-210.

Objectives Describe Chart Stimulated Recall as method for work-place based assessment Distinguish CSR from Medical Record Audit Compare two CSR tools Consider Blooms taxonomy – challenge to go beyond knowledge – remember brief interactive activity that matches your purpose Bar-on ME, Konopasek L. Snippets: An Innovative Method for Efficient, Effective Faculty Development. J Grad Med Educ. 2014;6(2):207-210.

Miller’s Triangle: Levels of Assessment Performance integrated into Practice: direct observation, undercover simulated patient, chart audits Does Interpretation/Application: Case presentations, essay exams Shows How Fact Gathering: Multiple choice exams Knows How Use opportunity to demonstrate medical education fundamental Demonstration of learning: Clinical performance exams, simulations Knows Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990;65:563-7 Bar-on ME, Konopasek L. Snippets: An Innovative Method for Efficient, Effective Faculty Development. J Grad Med Educ. 2014;6(2):207-210.

Workplace-Based Assessment Direct observation with feedback Min-CEX SCO Direct observation of procedural skills Multi-source feedback Chart stimulated recall Set stage for further snippets Bar-on ME, Konopasek L. Snippets: An Innovative Method for Efficient, Effective Faculty Development. J Grad Med Educ. 2014;6(2):207-210.

Medical Record Audits Systematic evaluation of patient encounter documentation with or without explicit criteria Way to monitor both competence and quality Strengths Readily accessible and patient centered Preparation for life-long scrutiny Limitations Time intensive Incomplete picture Anchor to something most already know Holmboe, NCC PD Development Course, 2009 Bar-on ME, Konopasek L. Snippets: An Innovative Method for Efficient, Effective Faculty Development. J Grad Med Educ. 2014;6(2):207-210.

Chart Stimulated Recall Extension of MRA to include both learner and evaluator in in-depth review together MRA plus conversation with feedback Explicit criteria on evaluation form Assesses knowledge and clinical problem solving skills Why did you make the choices you did? Assesses documentation skills Opportunity for immediate feedback Opportunity for documentation of competence Medical Knowledge, Patient Care, PBLI Make point clearly….picture can be worth a thousand words! Bar-on ME, Konopasek L. Snippets: An Innovative Method for Efficient, Effective Faculty Development. J Grad Med Educ. 2014;6(2):207-210.

CSR: Method 20-30 minutes Note selected Chart audit – 5-10 minutes Learner or evaluator Chart audit – 5-10 minutes Consider which questions will be asked in CSR CSR conversation – 15 -20 minutes Questions asked Feedback given Documentation on CSR form Submission to Portfolio Outline technique – make clear that not overly onerous Bar-on ME, Konopasek L. Snippets: An Innovative Method for Efficient, Effective Faculty Development. J Grad Med Educ. 2014;6(2):207-210.

CSR demo from Practical Doc http://www.practicaldoc.ca/teaching/practical-prof/teaching-nuts-bolts/chart-stimulated-recall/ Decide which interactive activity best fits your objectives. Can show a video or discuss tools in the next slide but will not have enough time for both. Bar-on ME, Konopasek L. Snippets: An Innovative Method for Efficient, Effective Faculty Development. J Grad Med Educ. 2014;6(2):207-210.

Two Tools Pair-Share University of Alberta CSR Open-ended Clinical Reasoning CSR - local More specific questions to select from Which would suit your purposes? Are there other types of questions you would like to ask? You could compare tools instead of the demo if your goal is to have the faculty make a decision on a tool to try. Alberta CSR is available at http://www.practicaldoc.ca/wp-content/uploads/2012/10/chart.pdf You can contact LK for the NYPH CSR. Bar-on ME, Konopasek L. Snippets: An Innovative Method for Efficient, Effective Faculty Development. J Grad Med Educ. 2014;6(2):207-210.

Take Homes on CSR Engages learner to explore their thinking Clinical reasoning Therapeutic reasoning Critical thinking Allows assessment of medical knowledge and patient care Documentation evaluated explicitly Involves a conversation with feedback Must be documented Bar-on ME, Konopasek L. Snippets: An Innovative Method for Efficient, Effective Faculty Development. J Grad Med Educ. 2014;6(2):207-210.