Medical Student Use of Electronic and Paper Health Records During Inpatient Clinical Clerkships: Results of a National Longitudinal Study

Foster, Lauren M.; Cuddy, Monica M.; Swanson, David B.; Holtzman, Kathleen Z.; Hammoud, Maya M.; Wallach, Paul M.

doi:10.1097/acm.0000000000002376

Cited by 29 publications

(37 citation statements)

References 13 publications

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“…They also have to make a holistic assessment regarding the patients. EHR systems are a commonly used health record format (9), and proper documentation of health records is an important skill (9,10). In this study, performance regarding writing daily medical records and medical summaries in self-assessments signi cantly improved.…”

Section: Discussionmentioning

confidence: 77%

Alternative approaches for clinical clerkship during the COVID-19 pandemic: Online clinical practice for inpatients and outpatients - A mixed method -

Kasai¹,

Shikino

Saito

et al. 2020

Preprint

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Background The COVID-19 pandemic has created a need for educational materials and methods that can replace clinical clerkships (CCs) for online clinical practice (online-CP). This study evaluates the impact of using simulated electronic health records (sEHR) for inpatients, and electronic problem-based learning (e-PBL) and online virtual medical interviews (online-VMI) for outpatients, for an online clinical practice using a learning management system (LMS) and online meeting system facilitated by a supervising physician. Methods The sEHR was reviewed by medical students and subsequently discussed with a supervising physician using an online meeting system. In the e-PBL, medical students reviewed the simulated patients and discussed on the LMS. For the online-VMI, a faculty member acted as outpatient and a student as doctor. Small groups of students discussed the clinical reasoning process using the online meeting system. A mixed methods design was implemented. Medical students self-assessed their clinical competence before and after the online-CP. They answered questionnaires and participated in semi-structured focus group interviews (FGIs) regarding the advantages and disadvantages of the practice. Results Forty-three students completed the online-CP during May and June 2020. All students indicated significant improvement in all aspects of self-evaluation of clinical performance after the online-CP. Using sEHR significantly improved performance in writing daily medical records and medical summaries (from 2.5 ± 2.0 to 4.3 ± 1.9, p < 0.001; from 2.6 ± 1.6 to 4.0 ± 2.0, p < 0.001, respectively). By e-PBL and online-VMI, performance in terms of medical interviews and counselling improved significantly (from 3.7 ± 1.7 to 5.0 ± 2.0, p = 0.009; from 4.2 ± 1.7 to 5.1 ± 1.8, p = 0.043, respectively). Students indicated CCs as more useful for learning associated with medical interviews, physical examinations, and humanistic qualities or professionalism than the online-CP. Eight FGIs were conducted (n = 42). The advantages of online-CP were segregated into five categories (learning environment, efficiency, accessibility, self-paced learning, and interactivity); meanwhile, the disadvantages of online-CP were classified into seven categories (clinical practice experience, learning environment, interactivity, motivation, memory retention, accessibility, and extraneous cognitive load). Conclusions Online-CP with sEHR, e-PBL, and online-VMI could be useful in learning some of the clinical skills acquired through CC. These methods can be implemented with limited preparation and resources.

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Section: Discussionmentioning

confidence: 77%

Alternative approaches for clinical clerkship during the COVID-19 pandemic: Online clinical practice for inpatients and outpatients - A mixed method -

Kasai¹,

Shikino

Saito

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Simulated systems are created to prepare for reality. There is ample literature regarding the rights of medical students in live EHR systems [3,48]. When using real systems, one has to find the balance between allowing students to be part of the team with the same duties and ownership as other team members on the one hand [3], whereas, on the other hand, taking into account legal issues of responsibility that might exceed a student’s capability level and will need to be reviewed [49,50].…”

Section: Discussionmentioning

confidence: 99%

Navigating Through Electronic Health Records: Survey Study on Medical Students’ Perspectives in General and With Regard to a Specific Training

Herrmann–Werner¹,

Holderried²,

Loda³

et al. 2019

JMIR Med Inform

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BackgroundAn electronic health record (EHR) is the state-of-the-art method for ensuring all data concerning a given patient are up to date for use by multidisciplinary hospital teams. Therefore, medical students need to be trained to use health information technologies within this environment from the early stages of their education.ObjectiveAs little is known about the effects of specific training within the medical curriculum, this study aimed to develop a course module and evaluate it to offer best practice teaching for today’s students. Moreover, we looked at the acceptance of new technologies such as EHRs.MethodsFifth-year medical students (N=104) at the University of Tübingen took part in a standardized two-day training procedure about the advantages and risks of EHR use. After the training, students performed their own EHR entries on hypothetical patient cases in a safe practice environment. In addition, questionnaires—standardized and with open-ended questions—were administered to assess students’ experiences with a new teaching module, a newly developed EHR simulator, the acceptance of the health technology, and their attitudes toward it before and after training.ResultsAfter the teaching, students rated the benefit of EHR training for medical knowledge significantly higher than before the session (mean 3.74, SD 1.05). However, they also had doubts about the long-term benefit of EHRs for multidisciplinary coworking after training (mean 1.96, SD 0.65). The special training with simulation software was rated as helpful for preparing students (88/102, 86.2%), but they still did not feel safe in all aspects of EHR.ConclusionsA specific simulated training on using EHRs helped students improve their knowledge and become more aware of the risks and challenges of such a system. Overall, students welcomed the new training module and supported the integration of EHR teaching into the medical curriculum. Further studies are needed to optimize training modules and make use of long-term feedback opportunities a simulated system offers.

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“…An increasing emphasis has been placed on standardizing EHR use and exposure from the start of medical education. [38][39][40] Most medical schools and academic medical centers provide medical students and residents with EHR access, 41 but training in these settings may be varied and can result in a wide range of documentation styles and outcomes. 42 How different methods of EHR training impact educational outcomes and efficiency (whether for trainees or for practicing physicians) may be worthwhile future directions of study.…”

Section: Discussionmentioning

confidence: 99%

Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures

et al. 2019

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Objective Electronic health records (EHRs) are widely adopted, but the time demands of EHR use on ophthalmology trainees are not well understood. This study evaluated ophthalmology trainee time spent on clinical activities in an outpatient clinic undergoing EHR implementation. Design Prospective, manual time-motion observations of ophthalmology trainees in 2018. Participants Eleven ophthalmology residents and fellows observed during 156 patient encounters. Methods Prospective time-motion study of ophthalmology trainees 2 weeks before and 6 weeks after EHR implementation in an academic ophthalmology department. Manual time-motion observations were conducted for 11 ophthalmology trainees in 6 subspecialty clinics during 156 patient encounters. Time spent documenting, examining, and talking with patients were recorded. Factors influencing time requirements were evaluated using linear mixed effects models. Main Outcome Measures Total time spent by ophthalmology residents and fellows per patient, time spent on documentation, examination, and talking with patients. Results Seven ophthalmology residents and four ophthalmology fellows with mean (standard deviation) postgraduate year of 3.7 (1.2) were observed during 156 patient encounters. Using paper charts, mean total time spent on each patient was 11.6 (6.5) minutes, with 5.4 (3.5) minutes spent documenting (48%). After EHR implementation, mean total time spent on each patient was 11.8 (6.9) minutes, with 6.8 (4.7) minutes spent documenting (57%). Total time expenditure per patient did not significantly change after EHR implementation (+0.17 minutes, 95% confidence interval [CI] for difference in means: –2.78, 2.45; p = 0.90). Documentation time did not change significantly after EHR implementation in absolute terms (+1.42 minutes, 95% CI: –3.13, 0.29; p = 0.10), but was significantly greater as a proportion of total time (48% on paper to 57% on EHR; +9%, 95% CI: 2.17, 15.83; p = 0.011). Conclusion Total time spent per patient and absolute time spent on documentation was not significantly different whether ophthalmology trainees used paper charts or the recently implemented EHR. Percentage of total time spent on documentation increased significantly with early EHR use. Evaluating EHR impact on ophthalmology trainees may improve understanding of how trainees learn to use the EHR and may shed light on strategies to address trainee burnout.

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Medical Student Use of Electronic and Paper Health Records During Inpatient Clinical Clerkships: Results of a National Longitudinal Study

Cited by 29 publications

References 13 publications

Alternative approaches for clinical clerkship during the COVID-19 pandemic: Online clinical practice for inpatients and outpatients - A mixed method -

Alternative approaches for clinical clerkship during the COVID-19 pandemic: Online clinical practice for inpatients and outpatients - A mixed method -

Navigating Through Electronic Health Records: Survey Study on Medical Students’ Perspectives in General and With Regard to a Specific Training

Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures

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