Using review of medical clinic charts to teach occupational health

The authors evaluated the effectiveness of chart audit with written feedback as a tool for encouraging second- and third-year residents to obtain and record occupational information during history-taking. Baseline information was obtained by reviewing the charts of 20 residents of patients who presented for complete history-taking and physical examination and scoring for various aspects of occupational history-taking. Intervention was directed at 10 of the residents; the other 10 served as controls. Between five and 12 charts were reviewed for each of the 10 residents in the intervention group; the scoring sheet, scoring criteria, results, and a brief discussion of potentially relevant occupational concerns for the given patient were returned to the resident, along with copies of the relevant pages of the patient's record. Chart review showed no difference in total scores for occupational history-taking between the two groups before intervention. The postintervention scores improved insignificantly for the intervention group; however, the scores deteriorated significantly for the control group (1.38 to 0.92, .05 greater than p greater than .025).