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

Abstract

BACKGROUND: As electronic health records (EHRs) became broadly available in medical practice, effective use of EHRs by medical students emerged as an essential aspect of medical education. While new federal clinical documentation guidelines have the potential to encourage greater medical student EHR use and enhance student learning experiences with respect to EHRs, little is known nationally about how students have engaged with EHRs in the past. OBJECTIVE: This study examines medical student accounts of EHR use during their internal medicine (IM) clerkships and sub-internships during a 5-year time period prior to the new clinical documentation guidelines. DESIGN: An online survey about EHR use was administered to medical students immediately after they completed USMLE Step 2 CK. PARTICIPANTS: The sample included 16,602 medical students planning to graduate from US medical schools from 2012 to 2016. MAIN MEASURES: Descriptive statistics were computed to determine the average percentage of students engaged in various health record activities during their IM educational experiences by graduation year. KEY RESULTS: The vast majority (99%) of medical students used EHRs during IM clerkships or sub-internships. Most students reported that they entered information into EHRs during the inpatient component of the IM clerkship (84%), outpatient component of the IM clerkship (70%), and the IM sub-internship (92%). Yet, 43% of the students who graduated in 2016 never entered admission orders and 35% of them never entered postadmission orders. CONCLUSIONS: Medical school graduates ought to be able to effectively document clinical encounters and enter orders into EHR systems. Although most students used and entered information into EHRs during their IM clinical training, many students appear to have received inadequate opportunities to enter notes or orders, in particular. Implications for graduate medical education preparedness are considered. Future research should address similar questions using comparable national data collected after the recent guideline changes.

Medical student experiences with accessing and entering patient information in electronic health records during the obstetrics-gynecology clerkship

“…Many of them have shown that most students access EHRs while they are in medical school. [4][5][6][7][8][9][10] This is not surprising given the widespread use of EHR systems in clinical settings and calls to incorporate instruction in EHR competencies early in a physician's education. Studies also suggest, however, that some medical students receive limited opportunities to enter information, including notes and orders, into patient records in EHRs.…”

“…Studies also suggest, however, that some medical students receive limited opportunities to enter information, including notes and orders, into patient records in EHRs. [4][5][6][7][8][9][10] This tends to occur despite their ability to access them generally.…”

Outcomes of an Online Virtual Boot Camp to Prepare Fourth-Year Medical Students for a Successful Transition to Internship

“…In another large survey of around 16,600 graduating medical students, 84% had entered information of some type into the EMR on their internal medicine clerkship or subinternship; however, 43% had never entered admission orders [6]. Yet students are expected to step into residency on July 1 and care for patients, including night shifts and with varying degrees of supervision and support.…”

“…In one recent survey, fewer than 10% of students on their obstetrics clerkship had entered orders and less than half (47%) had written a history and physical note in the patient chart [ 5 ]. In another large survey of around 16,600 graduating medical students, 84% had entered information of some type into the EMR on their internal medicine clerkship or subinternship; however, 43% had never entered admission orders [ 6 ]. Yet students are expected to step into residency on July 1 and care for patients, including night shifts and with varying degrees of supervision and support.…”

Transformation and Innovation at the Nexus of Health Systems and Medical Education

“…The recent changes announced by CMS regarding medical student documentation in patient records have put a spotlight on this complex and often fractious relationship between the health system and medical education. Wallach et al 2 provide important context to how medical students are utilizing the electronic health record and raise key questions about training and residency preparedness. As we move more towards competency-based, objectively measured outcomes in medical education, Stratton et al 3 warn that even the best intentioned, learner-centered curriculum may be subsumed by organizationally centered forces, and that we should not lose the educational value of an activity in the quest to find measurable outcomes valued by the health system.…”