Would you like to break down how you are managing patients and ensure that they receive top-notch care? This can be done by a simple exercise that allows for a deep-dive evaluation into the contents of your consultations through keeping a consecutive case log. The log can span few days if you choose!
A consecutive case log is an anonymised record (to ensure confidentiality!) of all the patients you have seen back to back with details of the consultation. It can be as simple as a repeat script request but even this has a potential for learning. For example a patient simply requesting a script may not have had any blood tests to ensure that the medication is not causing adverse effects (consider anti-psychotic medication and risk of developing diabetes). For hospital based doctors this can be the first 15 patients on the list for one day.
A case log can help you to reflect on the management of the patient as a whole and assist you to learn in a case based format. The reason why I have suggested a consecutive case log is to avoid cherry picking of cases that went well and avoiding the difficult ones. I have summarised this process of starting a consecutive case log below for ease of reading.
How to start a consecutive case log:
Choose a day/ few days (consecutive) to start a consecutive case log.
At the end of each day review all your consultations by summarizing them in the categories on a table with the following headings: presenting complaint, important history points, important examination findings, review of results (if applicable), management plan, reflection and finally comments from your supervisor. For hospital based doctors this can be the list of patients for one day of your choosing.
From the case reflections and comments from your supervisor complete an overall reflection (see our article: https://www.doctorologypodcast.com/post/reflection-made-easy).
Formulate SMART (specific, measurable, attainable, realistic, time orientated) goals.
Complete your learning plan as per your SMART plan.
Choose another day(s) to complete another consecutive case log and reflect on any new learning needs and how you have gone with the previous SMART goals.
This is an effective method of collating all your cases and providing a qualitative analysis on how you managed each patient. In addition, you can present them to your supervisor so they can offer their feedback and ideas on ways to improve. This doesn’t cover the professionalism and communication aspects of consultations but that is what a MINI-CEX is for!
By breaking down the different elements of a medical consultation it becomes easier to reflect on how you can improve your skills and find ways to implement changes. I know that it can be challenging in a busy clinic or a ward to keep a running log after you see each patient but it is possible to review your notes at the end of the day and fill in the case log.
I have completed this activity several times and each time I pick up something new and use this to improve the quality of care for my patients. I have also found it is an effective way to demonstrate to your supervisor that you are undertaking ongoing learning.
This can be used by doctors who have finished their training and are still keen to ensure they keep up to date and instead of a supervisor, a work colleague can provide feedback.
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