Background: Written patient discharge instructions play an important role in patient education upon discharge from the hospital. Writing clear, concise instructions is documented to reduce re-admission rates. [1,2] Despite the importance of well-written discharge instructions, we found that medical students at our institution received little formal education in writing discharge instructions during their pre-clinical courses or clinical rotations. We developed a rubric to objectively score the quality of discharge instructions written by medical students during an educational workshop.
Purpose: On review of the literature, much has been written on the subject of medical student and resident education in writing discharge summaries, [3,4,5,6,7] but there is a paucity of educational research relating to writing patient discharge instructions. Much of the education in writing discharge instructions medical students receive is from residents during their clinical rotations. This results in variability in the quality and amount of instruction. We also found that, to our knowledge, there was no standardized evaluation tool to grade the quality of discharge instructions. We developed a workshop to educate medical students on best practices in writing discharge instructions. To evaluate the students and assess for improvement after completing the workshop, we developed a rubric to standardize scoring of the instructions.
Description: We developed a rubric to score medical student discharge instructions based on expert opinion of education leaders at our institution and adapted scoring scales published for the purpose of grading discharge summaries. [3,8,9,10] We scored the discharge instructions on a 0-3 point scale across 7 domains [Figure 1]. In addition, ensuring patient instructions are written at a low reading grade level is an important factor in a patient’s ability to understand instructions. [11,12,13,14,15] We utilized a reading level evaluation tool to assign a reading level to the instructions, [16] and assigned point values to reading level ranges. Combining these two measures allowed us to tally a total score for grading the discharge instructions. We developed fictional clinical vignettes and asked students to write discharge instructions before and after completing an educational workshop. We used our rubric to score these discharge instructions and assess for improvement.
Conclusions: We developed a novel rubric to evaluate written discharge instructions by medical students for a workshop during their sub-intern rotation in Hospital Medicine. The standardized grading process will allow for iteration in the design of the workshop to further improve students’ ability to write intelligible discharge instructions. This rubric could be used to evaluate the quality of discharge instructions written by clinical providers in practice, allowing for identification of providers who need additional education on discharge instructions best practices. The rubric could also be utilized to develop standardized patient instructions for the most common admission diagnoses. Finally, the rubric could be used for a variety of other clinical applications, such as comparing re-admission rates or health outcomes for patients who received high-scoring vs low-scoring discharge instructions.
