Student documentation of multiple diagnoses in family practice patients using a handheld student encounter log.

Patient encounter logs may provide an important early opportunity to assess beginning clinical students' attention to and experience with many medical problems. However, there are reasons to doubt the completeness of traditional paper logs. The family practice clerkship at Washington University in St. Louis has tried a series of structured paper and hand held computer logs in search of a format that permits students to completely document their patients' diagnoses. The clerkship introduced a Palm computer log, designed with PumaTech's Satellite forms (R), that uses patient demographics to select a diagnosis entry screen displaying many likely diagnoses as checkboxes. Additional drop lists and combinations of drop lists provide access to less common diagnoses. Students using this log document 2.4 problems per patient on average, and as many as 14 problems in a single patient. Differences between students and preceptors are readily apparent. It is now possible to prepare students to rotate with specific preceptors, and to identify or predict gaps in experience that deserve remedial intervention.