Incorporating the human touch: piloting a curriculum for patient-centered electronic health record use

Abstract

Background: Integrating electronic health records (EHRs) into clinical care can prevent physicians from focusing on patients. Despite rapid EHR adoption, few curricula teach communication skills and best practices for patient-centered EHR use. Objective: We piloted a ‘Patient-centered EHR use’ curriculum, consisting of a lecture and group-observed structured clinical examination (GOSCE) for second-year students (MS2s). Design: During the lecture, students watched a trigger tape video, engaged in a reflective observation exercise, and learned best practices. During the GOSCE, one of four MS2s interacted with a standardized patient (SP) while using the EHR. Third-year students (MS3s) received no formal training and served as a historical control group by completing the same OSCE individually. All students completed post-GOSCE/OSCE surveys. The SP evaluated GOSCE/OSCE performance. Results: In 2013, 89 MS2s participated in the workshop and GOSCEs during their required Clinical Skills course and 96 MS3s participated in individual OSCEs during their end of year multi-station formative GOSCE exercise. Eighty MS2s (90%) and 88 MS3s (92%) post-GOSCE/OSCE surveys were analyzed. Compared to MS3s, significantly more MS2s rated their knowledge (19% vs 55%) and training (14% vs 39%) as good (≥4/5 point scale, P < .001 for both). Most learners (85% MS2s and 70% MS3s) thought training should be required for all students. SP ratings on GOSCE/OSCE performance was higher for the 20 MS2s compared to the 88 MS3 controls (73.5 [SD = 4.5] vs 58.1 [SD = 13.1] on 80 point scale, P < .001). Conclusions: A short workshop and GOSCE were effective in teaching patient-centered EHR use. This curriculum is now a permanent part of our Clinical Skills course. Clerkship students who did not receive our curriculum may have been exposed to negative role-modeling on the wards. To address this, training residents and faculty on patient-centered EHR use skills should be considered. Abbreviations: EHR: Electronic health record; EHR: Electronic health record; SP: Standardized patient

Integrating Patient-Centered Electronic Health Record Communication Training into Resident Onboarding: Curriculum Development and Post-Implementation Survey Among Housestaff

“…After conducting a literature review of best practices for patient-centered communication use, we developed a comprehensive patient-centered EHR use curriculum for medical students at the Pritzker School of Medicine as part of the second-year clinical skills course [ 20 , 21 ]. This curriculum consisted of a 1-hour interactive lecture addressing the impact of EHR use on patient-provider communication and summarized best practices using the HUMAN LEVEL mnemonic (ie, “Honor the golden minute” to elicit patients’ concerns before engaging the EHR) ( Table 1 ) [ 7 , 20 , 22 , 23 ]. Students then participated in a group observed structured clinical examination where 1 student per group directly interacted with a standardized patient while the remaining students and a faculty member observed.…”

“…As such, we consolidated the key themes and practical points of the training into a brief 15- to 20-minute, 8-slide curriculum on key patient-centered EHR use skills targeting postgraduate trainees. The curriculum highlighted best practices for patient-centered communication skills and included a review of the HUMAN LEVEL mnemonic ( Table 1 ) [ 7 , 20 , 22 , 23 ].…”

Impact of a brief faculty training to improve patient-centered communication while using electronic health records

“…In 2015, the authors adapted a student curriculum on patient-centered EHR use to meet the needs of faculty providers [20][21][22]. The faculty workshop consisted of a lecture and a GOSCE.…”

“…The faculty workshop consisted of a lecture and a GOSCE. The curriculum was based on best practices derived from a literature review, which was condensed into the 'HUMAN LEVEL' mnemonic to highlight key skills such as, "Honoring the golden minute" to ensure that the first minute of the visit is technology-free, and "Using the 'triangle of trust'" to position the screen where the [20,22]. Direct observations (DOs) were used to assess the participants' patient-centered EHR use skills in clinical practice.…”

Reducing Misses and Near Misses Related to Multitasking on the Electronic Health Record: Observational Study and Qualitative Analysis

“…Clinician transparency with patients about using EHR systems—including tasks such as prescribing that require focused attention to avoid errors—may result in fewer misses while preserving patient trust and satisfaction. As professional schools implement skills-based training in patient-provider communication with EHR system use [ 15 ], trainees may be able to practice empathic ways to negotiate the need for silent EHR use and ways to detect subtle queues from patients signaling that they need the clinician’s full attention.…”