Logbooks to Track Clinical Teaching?

By Jonathan Sherbino (@sherbino)

I’ve commented previously on the ICE blog about the challenges that a CE faces in being recognized for their academic productivity.  In the Department of Medicine at McMaster University, there is a fairly egalitarian (if not highly reductionistic) approach to determining academic productivity.  Every year, each faculty member conducts a census of all their academic outputs.  Every paper published (with modifiers based on impact factor), every committee chaired (with extra points if it’s a committee everyone hates), and (here’s the point of this post) every clinical teaching activity part of a global score.  Based on this composite score, faculty are ranked (and rewarded) according to their global productivity.

You can only imagine the politics behind such a system.  In an attempt to “smooth” the signal, different types of clinical (i.e. bedside) teaching is weighted more heavily.  (For example, teaching medical students is valued at a ratio of 4:1 in comparison to teaching residents. Long story.) Of course, there is no metric that looks to the quality of the teaching.  Or the sustainability of learning. Or integration of your clinical teaching into a larger curriculum. Yet, none of these problems are the biggest flaw in this incredibly blunt system. Rather, the number of weeks spent on the ward, the shifts in the emergency department or the half–days in the clinic are used as surrogates for time spent teaching.  Regardless of whether you ignore the learners that are assigned to your service or teach your heart out, everyone gets the same teaching credit for simply showing up.

To make this blunt instrument slightly sharper I’ve been experimenting with the Royal College Springboard app, which allows me to track in real time the type and volume of teaching (that I actually do!) Designed for the iPhone, there is a version for Emergency Medicine and Pediatrics.  (Other specialties are planned.)

The Royal College Springboard app has two functions.  For junior clinical teachers, the app provides a searchable database of common clinical scenarios (springboards) and suggests a high yield teaching moment to use in the situation.

Tues post_Springboards2

There are more than 70 common clinical scenarios that map to all of the CanMEDS Roles.

More relevant to a CE, the Springboard app serves as a “point-of-care” teaching logbook.  While the shortcomings of logbooks as a stand alone assessment instrument have been acknowledged in the literature, the utility of this app is found in its’ ability to quantify (but not qualify) the amount of clinical teaching you do.

Tues post_Springboards3

The app captures the topic, the related CanMEDS Role and the type of learners involved in the teaching moment.  Reports can be generated by type of learner, topic, period of time and clinical setting. While I never use the app to continuously track my teaching, I find that random audits are a very effective way to capture and quantify my clinical teaching for the departmental leadership.  (Don’t worry if you are not an emergency physician or pediatrician, the teaching log function is generic, so if you are interested, either version will work.)

Ok, I get it.  A logbook provides only superficial data.  And yes, you don’t want to quantify every moment of your life.  But, a chart that graphically represents the hundreds of teaching encounters from the past month of your CE practice is a very powerful argument to the department chair that wants to know what a CE does and why there is no multi-year multi-figure peer-reviewed grant included in their annual performance review.