Barriers to Medical Students’ Electronic Health Record Access Can Impede Their Preparedness for Practice

Abstract

Medical students need hands-on experience documenting clinical encounters as well as entering orders to prepare for residency and become competent physicians. In the era of paper medical records, students consistently acquired experience writing notes and entering orders as part of their clinical experience. Over the past decade, however, patient records have transitioned from paper to electronic form. This change has had the unintended consequence of limiting medical students' access to patient records. This restriction has meant that many students leave medical school without the appropriate medical record skills for transitioning to residency.In this article, the authors explore medical students' current access to electronic health records (EHRs) as well as policy proposals from medical societies, innovative models implemented at some U.S. medical schools, and other possible solutions to ensure that students have sufficient experiential learning opportunities with EHRs in clinical settings. They also contend that competence in the use of EHRs is necessary for students to become physicians who can harness the full potential of these tools rather than physicians for whom EHRs hinder excellent patient care. Finally, the authors argue that meaningful experiences using EHRs should be consistently incorporated into medical school curricula and that EHR-related skills should be rigorously assessed with other clinical skills.

Electronic Health Record Use in Internal Medicine Clerkships and Sub-internships for Medical Students Graduating from 2012 to 2016

“…14 Similar work also suggests that students, particularly those from IM Core residency programs, 15 may enter residency training without essential clinical documentation skills. 16 Demonstrating association between student engagement with EHRs and subsequent performance in residency is beyond the scope of this study. When data are available, future research should empirically examine the relationships between medical student levels of EHR utilization and the quality of that engagement during IM clinical experiences with their subsequent performance as IM residents.…”

Assessing the Status Quo of EHR Accessibility, Usability, and Knowledge Dissemination

“…Previous research has demonstrated wide variation in levels of EHR access among medical students, ranging from no-access to read-only access to full-access [6]. Tiwari and Kumar explored the use of algorithm-based permissions for users seeking access to patient-level EHR access by role, but their work did not seek to quantify current levels of EHR access among users across various roles [22].…”

“…In addition to these barriers, many usability researchers and scientists often have limited EHR access to facilitate usability testing. While EHR access status has been described among medical student [6] and remote clinician populations [7], to our knowledge there have been no prior reports of EHR access status among the broader population of informatics professionals, which importantly includes a subset of usability researchers.…”

Assessing Entrustable Professional Activities Using an Orientation OSCE: Identifying the Gaps

“…Limited opportunities for documentation reduces medical students' experiential learning and feedback. 11 If these EPAs are reasonable expectations for medical school graduation, we need to consider how undergraduate curricula can meaningfully incorporate them and develop a consistent framework for longitudinal observation. 2 We learned several lessons during implementation of this exercise.…”