SWOT Analysis of Outpatient Teaching

Angkor Hospital for Children Faculty Development Course

What are the goals (eKalbMNg) of the outpatient department? • Treat patients and provide education for the doctors/nurses/patients/families • Treating patients is the primary goal; education is second

Strengths (PaBxøaMg): What do we do well? Database/documentation Triage nurses (2-3) help with patient flow Good communication with other depts/doctors Learn together through discussing cases Internet access for reference/teaching Friendly environment (between staff) Respect from patients/families

Weaknesses (PaBexSay): What do we do poorly? Patients wait a long time Patients overlap Sometimes doctors/nurses talk too long Over-diagnosis/too many tests/over-medicate Not enough information recorded in the chart, illegible Sometimes doctors lazy/low motivation Not enough staff Not as much direct teaching Poor English skills Poor chart review

Opportunities (PaBGacnWgceRmInrugerOg): Where can we do better? Review charts

• Daily: review10 charts (maybe need to review all undergrad charts and some of graduate charts) • Weekly: review 4-5 charts with juniors (7-7:30am) Discuss what they did well and areas that they could

improve • Role of nursing staff in chart review (Quality control nurse)

Review interesting cases together • Chief needs to manage time well (prep patient ahead of time, keep learning focused)

Chiefs need to encourage juniors – encourage questions, be good role models, motivate them • Between each patient, ask a different junior, “Are you doing okay? Do you have any questions? Have you seen

anything interesting?” “OPD Handbook” idea

1. Schedule 2. The Junior Doctor

o Appearance o Responsibilities o Attitudes o Confidentiality

3. Patient Interview (components)

4. Physical Examination (components) Progress Notes

o Standard o Disease-specific

Clinical Skills they should learn Common Conditions algorithms Feedback & Evaluations

Threats (GVI²EdlKMramkMEhg): What may cause us to fail? Noisy room/no privacy Cannot control for good quality

What can we do to help the outpatient department better reach its goals? (eFVIeGaysMerceKalbMNg) • OPD vice-chiefs can get together and discuss a policy for outpatient teaching focusing on the

opportunities discussed. • I’ve just put together a quick example of an outpatient template… it makes things quicker, easier to

read, and hopefully reminds the provider what to examine. They don’t have to examine everything – just whatever systems are relevant to the illness.

Progress Note Template Example

Angkor Hospital for Children Faculty Development Course

Date: _______________ Provider: __________________ Chief Complaint: _________________________________ Meds: ____________________ Allergies: _____________ Temp: ___ Pulse: ___ Resp: ___ BP: ___ Wt: ___ Ht: ___ HC: ___ (triage completes this section)

Circle indicates a normal exam finding. Write abnormal findings in space provided

Gen: A&R, NAD ________________________________________________________________________

HEENT: PERRL, EOMI, +RR, TMs, NP, nodes, neck ___________________________________________

Lungs: CTAB ___________________________________________________________________________

CV: Rate, rhythm, no murmur, no gallop, no rubs _______________________________________________

Abdomen: Flat, soft, NT, nl BS, no hepatosplenomegaly _________________________________________

GU: CVA non-tender, normal ext. genitalia, ↓↓ testes, no hernia ___________________________________

Extremities: no cyanosis, no clubbing, no edema, FROM _________________________________________

Neuro: DTR nl, non-focal exam _____________________________________________________________

Skin: no rashes, no jaundice ________________________________________________________________

Developmental: age appropriate (write exam) _________________________________________________

A/P: __________________________________________________________________________________

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RTC in ___ days/weeks/months ________________________________ Provider signature Explanation of abbreviations: Gen: A&R – alert and responsive, NAD – no apparent distress. HEENT: PERRL – pupil equal, round, reactive to light, EOMI – extraocular movement intact, +RR – red reflex, TMs – tympanic membranes, NP – nasopharynx. Lungs: CTAB – clear to auscultation bilaterally. Abdomen: NT – non-tender, nl BS – bowel sounds. GU: CVA – costovertebral angle. Extremities: FROM – full range of motion. Neuro: DTR – deep tendon reflexes. RTC – return to clinic

Patient name / birth date

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