1. 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):

2. 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):

3. 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):

4. 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):

5. 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):

6. 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):

7. 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 – 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):

8. CSR demo from Practical Doc
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):

9. 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 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):

10. 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):