ANN ARBOR, Mich. — The electronic health record (EHR) has improved health care delivery, but also has presented a challenge for medical student training. Educational mandates that can provide guidelines to medical schools on how to teach and assess student skills in EHR proficiency do not exist.
In two studies published this month by the journal Teaching and Learning in Medicine, the Alliance for Clinical Education describes the importance of medical student participation in the EHR. The Alliance, made up of education leaders from a broad range of medical specialties, was formed to enhance clinical instruction of medical students.
“Currently only 64 percent of medical school programs allow students any use of EHRs, and of those only two-thirds allowed students to write notes with in the electronic record,” says Maya M. Hammoud, the study’s lead author and associate professor of Obstetrics and Gynecology at the University of Michigan Medical School.
“Previously, students were just able to pick up a physical patient chart. Now they need permission to use hospital computers and passwords to access the EHR. There also are concerns surrounding Medicare rules about physicians using trainees’ findings in the HER,” says Hammoud, who is chair of the Alliance’s Research Committee.
But the Alliance stresses that students have to be trained about documentation in EHRs.
In the articles, the Alliance recommends these practice guidelines:
1. Students must document in the patient’s chart, and their notes should be reviewed for content and format
2. Students must have the opportunity to practice order entry in an EHR – in actual or simulated patient cases – prior to graduation.
3. Students should be exposed to using the decision aids that typically accompany EHRs.
4. Schools must develop a set of medical student competencies related to charting in the EHR.
The Alliance also recommends that accreditation bodies like the Liaison Committee for Medical Education use stronger language in their educational directives to guarantee that the necessary training and resources in the EHR are available for medical students.
“Schools have a responsibility to graduate students with the expertise and sense of duty in the basics of practice. The EHR is now part of that skill set,” says Lynn Cleary, M.D., president of the Alliance for Clinical Education, and professor of medicine at Upstate Medical University at the State University of New York.
“We found a large majority of students are allowed to write traditional notes in the EHR. Although this is an encouraging finding overall, concerns remain over those who do not allow students to use it and those who do not consider these notes part of the official medical record.”
The Alliance, which formed in 1992, fosters collaboration across specialties in order to promote excellence in clinical education of medical students. More information is available at http://www.allianceforclinicaleducation.org/default.htm.
Additional authors: Jennifer G. Christner, Department of Pediatrics, University of Michigan; Katherine Margo, Department of Family Medicine and Community Health University of Pennsylvania; Jonathan Fisher, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Shira H. Fischer, University of Massachusetts; Louis N. Pangaro, Department of Medicine, Uniformed Services University of Health Sciences; John L. Dalymple, Obstetrics, Gynecology and Reproductive Sciences, University of Texas; Robyn A. Stewart, Breast Services, Cleveland Clinic; Imran I. Ali, Neurology, University of Toledo; Gregory W. Briscoe, Psychiatry, Eastern Virginia Medical School.
About the University of Michigan’s Women’s Health services: The University of Michigan provides comprehensive treatment for patients with normal and high-risk pregnancies, and expertly addresses a wide range of gynecologic and women's health concerns. In 2012, U-M’s Women’s Health program was ranked fifth in the nation in the Best Graduate Schools rankings by U.S. News and World Report. Learn more athttp://www.uofmhealth.org/medical-services/adult-womens-health