Friday, November 18, 2011

Dictations can be tricky

I was a surgical residency program director for many years. Not long before I left medical education, I had to stop allowing residents to dictate cases they did. It began to take me longer to proofread and correct their dictation than the time it would have taken for me to dictate them myself.

Here are two examples. The first is from the dictation of an open cholecystectomy.

The next one is the actual dictation of a tracheostomy in its entirety. Parts that are inaccurate and/or incomprehensible are underlined in red. 

I think I was correct in my decision to take over the dictating duties, don't you?


Unknown said...

I actually do let my residents dictate BUT when I read the dictation and find things like the above I have them go in and fix it. Otherwise they won't learn.

There's an interesting EBRS discussion going on right now about synoptic op notes. I would love to see us go that way and obviate the whole discussion about learning to dictate (and deal with awful transcription, which does happen) and focus on learning to document.

Josh said...

As a current chief resident, I completely understand but kind of disagree for a couple of reasons. Residents will be doing these dictations and responsible for their content as soon as they graduate, so they should be confronted with these and made to understand the ramifications of doing such a poor job and taught to do better. Additionally, the dictations reflect their understanding of the case - did they really comprehend what they were doing or were they just dividing between the attending's clamps the whole time? Is the attending not actually teaching this procedure as they are doing it? There are rotations where we don't dictate because of the complexity or rarity of the case from a General Surgery perspective (e.g. Transplant), and that makes sense in those contexts. But this is all part of residents' education really. Dictating intelligently is a skill that needs instruction and practice. (That being said, these examples are terribe!)

plumtree said...

YES. Even the comprehensible parts are poor.

Old Rockin' Dave said...

The best dictation in the world will be screwed up by an ignorant transcriber. I used to dictate my cases in radiation oncology. Even after quite literally hundreds of corrections, "centigray" kept coming back as "centigrade". Even worse was that they kept mangling "daily fractions" as "deli fractions." We finally took to always saying things like, "daily fractions as in once a day, not deli fractions as in corned beef sandwich".

Solitary Diner (Also Known as The Frugalish Physician) said...

I agree with Josh that it's important that residents get practice with dictating, given that we'll be doing it soon out in the real world. At the institution where I'm a resident, we have to review all of our dictations online and make corrections as necessary before they're submitted to the attendings for review, which I think ensures that we're getting the practice without driving our attendings crazy.

Skeptical Scalpel said...

Thanks for the comments. I agree residents need to learn how to dictate. I especially agree that the inability to coherently dictate a case implies that the resident might not have really understood what she did and therefore may not really have learned how to perform said operation.

My problem was that after 30 or so years of correcting dictations, I just couldn't take any longer.

Don't get me started on the quality of transcription services, although I am blessed with an excellent service in my current position.

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