Wednesday, October 5, 2011

A Strategy for Improving Clinical Performance

Author: Sheetal Chowdhary

Whether you are a medical student, resident, or budding attending, improving your clinical performance is likely a constant concern since clinical medicine is fast-paced and quickly evolving. Ideally, a physician should have the ability to be self-critical and correct deficiencies accordingly. However, no matter how self-critical a person is, a perspective from only one point of view is always limited – especially for those who are relatively inexperienced. Therefore, incorporating multiple perspectives into improving clinical performance is likely to be the most holistic route to improvement.

Step 1: Which perspectives matter? The perspectives that count are yours, your evaluators, and others who you may choose. At the core, you know your own strengths and limits better than anyone else will. However, alternate views can enhance your current understanding. Your evaluator(s) perspective matter by default and they must be taken into account if you want to improve in their eyes. Other perspectives you choose may be based on your assessment of the views to aid your performance.

Step 2: Open the platform and know the level of expectations. Show that you are open to feedback, criticism, and other opinions. The key is to understand the other’s expectations. Different people have different expectations and it is not advisable to guess their expectations. Most likely, if you ask for feedback and you fall below any expectations, then you will be told so.

Step 3: Show you are listening and admit errors. It is critical to show you are listening when you get feedback. A way to demonstrate listening is to ask for details about a broad observation. For example, a concern may be that one needs to be more cost-effective. One can ask, “When did you notice that I could be more cost-effective?” By using some of the same words in a follow up question the advisor feels that you are listening. Also, one needs to acknowledge the concern even if one completely disagrees with it.

Step 4: Build the bridge. If one is in agreement with the advisor, then it should be easy to admit an error and discuss future prevention of the error. However, let’s say there is a disagreement. For example, let’s say a patient with an asthma exacerbation is admitted and placed on medications by a resident. The advisor believes that the patient is on excessive medication which is not cost-effective. To bridge the gap between the disagreement the resident should: First, acknowledge the concern of being cost-effective. Express how being cost-effective is important. Second, explain why the resident felt that the patient needed additional medication. Third, discuss how to be more cost-effective for the future. Using the above strategy, one is able to build a bridge between different perspectives even if there is a disagreement.

Step 5: Follow up with pertinent action. Hopefully, reflecting on cost-effectiveness with the advisor made the resident more cost-effective overall, despite disagreements with certain cases. Following up with the advisor and showing how cost-effective changes are implemented for future patients is advisable. The advisor may feel rewarded with the follow up and facilitate further improvement.

About the author:

Sheetal Chowdhary is a candidate for Doctor of Osteopathic Medicine in 2012 from Touro University Nevada College of Osteopathic Medicine. In 2008, she was nominated for Student D.O. of the Year. She attended New York Institute of Technology on the T.K. Steele undergraduate scholarship and majored in Life Sciences. Her interests include research, writing, the outdoors, and philosophy.

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