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How to deal with criticism on ur rotations? I try to do my best when writing discharge summaries and spend so much time on them but then when a staff reads they always make changes... I spend so much time on my work, but my staff always tells me about things that I can improve or change... I am not sure how to improve!! 

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13 minutes ago, Bookmark311 said:

How to deal with criticism on ur rotations? I try to do my best when writing discharge summaries and spend so much time on them but then when a staff reads they always make changes... I spend so much time on my work, but my staff always tells me about things that I can improve or change... I am not sure how to improve!! 

Staff all have their own preferences, and it’s almost impossible to do something ‘perfectly‘ unless you think just like them. When they make changes or suggestions, trying thinking about what changes are preference (I.e. they like the ‘how’ of the presentation a certain way) and what are actual mistakes/deficiencies (I.e. content or detail you missed) that you shouldn’t forget next time. This will help you put their feedback into context and identify what’s most important to try to improve on, and what’s more style or just another way to do something. 

And reflect on why you like things done a certain way and what details you think are important. For something like a discharge summary, the goal over time is to build a filter for your own work that meets a standard you’re happy with and mostly fulfills the expectations of those who need it (I.e. will this answer the questions of the family doc this patient is going to follow up with later). If you’re learning, you’ll likely change how you do things throughout residency and as staff. 

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Some staff are also honestly just really really picky and need things "their way" to feel comfortable signing it off.  So you don't always need to take it too much to heart.

When I correct clerks' notes, if I make changes it's often related to considerations that I don't expect them to know about yet - e.g. I make a lot of corrections and additions based on addressing medicolegal risk.  I document very defensively, especially in the ED, and while I teach the clerks why I am doing what I'm doing, I don't really expect them to have the language for that yet.  In my specialty there is also just very specific language around things like consent, capacity, and risk - certain words or phrases that need to be used in a very particular way, whereas if it's not your specialty you might never need to know that.

I remember when I was a clerk on paeds ED I thought a kid's belly looked a bit round so I wrote "distended" on my note and I got absolutely reamed by the staff because apparently that meant something very specific and pathognomic to her, but I just didn't know.

You could definitely ask your staff if s/he has any overall feedback for you about what to work on next - it can be hard to just see their changes and distill it down to how you need to change your approach.  Often with clerks it's about some combination of getting more concise (excluding details that are irrelevant to the audience and including everything that is important) and using certain specialty-specific language/phrases that convey certain things.

But really the reason our training is so long is that it really does take time.  If a clerk were ready to function at the level of a staff, there would really be no point in any of the rest of it.  So I wouldn't interpret it to mean that they're displeased with you as a clerk or that there's something wrong with your performance.

 

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