Chart Stimulated Recall

How can I encourage my resident to consider a broader range of therapeutic options?

Chart stimulated recall (CSR) is a useful technique to use with learners who have considerable clinical independence, such as senior residents. CSR’s main benefit is to provide a window into the resident’s thought processes during the clinical encounter, but consider using it to check more junior learner’s charting skills.

Uses

• If concerned about clinical reasoning skills
  • Premature diagnostic closure
  • Inappropriate management choices
  • Limited clinical knowledge base
  • Poor organization
• As a check on  following a patient- centered agenda
• Reviewing comprehensive care skills
• Evaluating charting skills

Pros and Cons

Time! It is both a plus and a minus. CSR can be done at the end of the day or over lunch, but it does take 15 – 30 minutes. Consider using it occasionally with all your residents but more frequently if you feel they are struggling with the rotation.

The Process of CSR

• Case selection can be random or selected by resident or preceptor
• Preceptor reviews the chart note
• Preceptor guides resident to reveal thought processes during the clinical encounter
• A CSR worksheet with sample questions and space for recording comments is valuable

View Chart Stimulated Recall Video

Sample: Chart Stimulated Recall (CSR) Worksheet

• Premature diagnostic closure
  • What features of the patient’s presentation led you to your top three diagnoses?
  • Is there anything else you wish you would have asked?
• Inappropriate management choices
  • Were there other tests that you thought of but deferred or ruled out?
  • What did you decide was appropriate for follow up?
  • Patient – centeredness
  • What did you learn about the patient’s concerns about the illness? 
  • Do you feel you reached common ground with the patient?
• Comprehensive care skills
  • Did you discuss any preventive interventions, such as quitting smoking, with the patient?

Chart stimulated recall assesses Charting skills Clinical reasoning Patient centeredness Comprehensiveness of care Allow yourself 15 - 30 minutes