Giving Effective Feedback in the ER

Giving feedback to students in the ER is easy. If they did well, you say “STRONG WORK!” and if they did poorly… “READ MORE.” Of course, this provides nothing the student can use to improve. Drs. Ester Choo and Michelle Lin from San Francisco General Hospital created this video on how to give effective feedback.

Concrete and on-the-spot feedback is important to allow students to understand how they are doing and make changes to their behavior. Be nice, but don’t be afraid to give constructive criticism. Remember our goal is to help create good doctors.

One trick I like to use is to have the student at the beginning of their shift identify one area they want to work on. This may be reading EKG’s, creating appropriate differential diagnoses or presenting in a concise and focused way. If they don’t provide something, then you can suggest something: “Today, why don’t we concentrate on appropriate ordering of testing.”

Having one item to work on makes it easier to observe the student’s performance and offer a plan for them to improve. Offer this feedback, at several times during the shift and announce it as such.

“Let me give you some feedback on how you’re doing so far on your presentation. Your HPI was disjointed, you can really tighten it up by using your differential to come up with the pertinent positives and negatives. Why don’t you you see this lady with chest pain and try that before the next patient you present to me.”

Reversing Anti-Coagulation

So you got a patient who’s throwing up blood all over the place, is on coumadin and has an INR of 400. What do you do? Well, after you change your underwear.

The first two videos go over the basic science of clotting (platelets and the coagulation cascade) and the next three then go over what to do in the above situation. Please feel free to put any questions or comments below.

Primary Hemostasis

Secondary Hemostasis

Reversing Coumadin

Reversing Other Drugs

How Ed gets great Patient Satisfaction scores

We’re all expected to get great patient satisfaction scores in addition to providing excellent care. No one does this more consistently than Ed Ward (click for his scores). So, we talked and he let me know what he does to get great scores. Not only are his scores good, but he also gets more surveys submitted.

This is an open-book heavily-weighted test and you know the questions already. So why not play to these questions and get a good grade? Doe these things every time.

  1. Overall doctor’s score: give them your card and let them complain to you instead of someone else
  2. Doctor was courteous: introduce yourself to everyone, shake hands
  3. Concern for comfort: keep asking them if they are comfortable
  4. Informed about treatment: tell them about delays, explain results to them, put your Cisco phone number on the board
  5. Took time to listen: sit down on the bed or available chair

One more thing I read which may help is explaining what every maneuver you do is for and how it affects your thinking. For example, when checking for meningeal signs tell the patient “the fact that your neck bends like this really reassures me that you don’t have meningitis” or “pain in this part of your belly makes me worry about appendicitis.” Patients like knowing what’s going on.

Feel free to put questions and comments below.

Here’s a great chapter on Service Recovery in the ED (Complaint Management)