Medical Student Documentation in Electronic Health Records: A Collaborative Statement From the Alliance for Clinical Education

Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Teaching and Learning in Medicine (Impact Factor: 0.66). 07/2012; 24(3):257-66. DOI: 10.1080/10401334.2012.692284
Source: PubMed


The electronic health record (EHR) is an important advancement in health care. It facilitates improvement of health care delivery and coordination of care, but it creates special challenges for student education. This article represents a collaborative effort of the Alliance for Clinical Education (ACE), a multidisciplinary group formed in 1992. ACE recognizes the importance of medical student participation in patient care including the ability of documentation. This article proposes guidelines that can be used by educators to establish expectations on medical student documentation in EHRs.
To provide the best education for medical students in the electronic era, ACE proposes to use the following as practice guidelines for medical student documentation in the EHR: (a) Students must document in the patient's chart and their notes should be reviewed for content and format, (b) students must have the opportunity to practice order entry in an EHR--in actual or simulated patient cases--prior to graduation, (c) students should be exposed to the utilization of the decision aids that typically accompany EHRs, and (d) schools must develop a set of medical student competencies related to charting in the EHR and state how they would evaluate it. This should include specific competencies to be documented at each stage, and by time of graduation. In addition, ACE recommends that accreditation bodies such as the Liaison Committee for Medical Education utilize stronger language in their educational directives standards to ensure compliance with educational principles. This will guarantee that the necessary training and resources are available to ensure that medical students have the fundamental skills for lifelong clinical practice.
ACE recommends that medical schools develop a clear set of competencies related to student in the EHR which medical students must achieve prior to graduation in order to ensure they are ready for clinical practice.

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Available from: Jennifer Christner, Feb 24, 2015
    • "Thus, students may not receive formal education in this area'' (Dattakumar et al. 2012). Despite calls for common competency-based approaches to ehealth (Bari et al. 2011; Ellaway et al. 2011; Bygholm et al. 2012; Lam et al. 2012), there have so far been few candidate models (Hammoud et al. 2012). Of the few that have come forward, some, such as the: ''Reporter–Interpreter–Manager– Educator scheme'' (Stephens et al. 2011) are applied within wider competency frameworks (ACGME in this case), while others are more standalone in nature reflecting significant variance in focus on electronic health records between different regions and jurisdictions (Grain & Hovenga 2011). "
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    ABSTRACT: This paper reflects on the extent to which we are preparing learners for practice in an electronic health record (EHR)-mediated world. We are currently training the last generation to remember a world without the Internet and the first who will practice in a largely EHR-mediated practice environment. We undertook a thematic review of the literature connecting medical education with e-health using the concepts of 'electronic health record' or 'electronic medical record' as a proxy for the broader notion of e-health. Our findings are more equivocal and cautious than earlier commentators might have expected and while there are examples of good practice and successful integration, the majority of articles we reviewed raised issues and problems with the current links between EHRs and medical education. Medical professionals in particular are quite ambivalent about many of the changes brought about by EHRs, and in the absence of changes in perception and practice it is likely that the connections between medical education and e-health will continue to be problematic. We hope that this paper will lead to an improved understanding of these problems and will serve to advance the discourse on how medical education should engage with the world of e-health and the world of e-health with medical education.
    No preview · Article · Mar 2013 · Medical Teacher
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    • "Considering the increased EHR adoption since then, (23) it is plausible that the trend has been expanded to other medical schools. To address this EHR trend in medical schools, a multidisciplinary group of clinical education recently provided a guideline regarding medical students’ EHR documentation (12). Their guidelines include a gradual exposure to templates, opportunity to practice order entry in the EHR, introduction of decision aids, and communication skills with a patient-centered approach. "
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    ABSTRACT: Background: Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians' electronic health record (EHR)-writing and -reading competence. Purposes: This study aims to investigate physicians' self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. Methods: Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. Results: Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r= - 0.33, p<0.001) and narrative (r= - 0.36, p<0.001) EHR notes than physicians with lower perceived EHR competence. Physicians' perceived EHR-writing and -reading competence was strongly related to their EHR navigation skills (r=0.55, p<0.0001). Conclusions: Writing and reading EHR documentation is different for physicians. Maximizing navigation skills can optimize non-linear EHR writing and reading. Pedagogical questions remain related to how physicians and medical students are able to retrieve correct information effectively and to understand thought patterns in collectively lengthier and sometimes fragmented EHR chart notes.
    Full-text · Article · Feb 2013 · Medical Education Online
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    ABSTRACT: This article aims to review the past practices of educational technology and envision future directions for medical education. The discussion starts with a historical review of definitions and perspectives of educational technology, in which the authors propose that educators adopt a broader process-oriented understanding of educational technology. Future directions of e-learning, simulation, and health information technology are discussed based on a systems view of the technological process. As new technologies continue to arise, this process-oriented understanding and outcome-based expectations of educational technology should be embraced. With this view, educational technology should be valued in terms of how well the technological process informs and facilitates learning, and the acquisition and maintenance of clinical expertise.
    No preview · Article · Nov 2013 · Teaching and Learning in Medicine
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