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A novel approach to supporting relationship-centered care through electronic health record ergonomic training in preclerkship medical education.

ABSTRACT: How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion ("EHR ergonomics")?Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a presurvey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encounter in each of four regularly scheduled Doctoring (clinical skills) course sessions. One group received additional ergonomic training in each session. Ergonomic assessment data were collected from students, faculty, and SPs in each session. A postsurvey was administered to all students, and data were compared across all three groups to assess the impact of EHR use and ergonomic training.There was a significant positive effect of EHR ergonomics skills training on students' relationship-centered EHR use (P<.005). Students who received training reported that they were able to use the EHR to engage with patients more effectively, better articulate the benefits of using the EHR, better address patient concerns, more appropriately position the EHR device, and more effectively integrate the EHR into patient encounters. Additionally, students' self-assessments were strongly corroborated by SP and faculty assessments. A minimum of three ergonomic training sessions were needed to see an overall improvement in EHR use.In addition to replication of these results, further effectiveness studies of this educational intervention need to be carried out in GME, practice, and other environments.

SUBMITTER: Silverman H

PROVIDER: S-EPMC4146679 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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A novel approach to supporting relationship-centered care through electronic health record ergonomic training in preclerkship medical education.

Silverman Howard H Ho Yun-Xian YX Kaib Susan S Ellis Wendy Danto WD Moffitt Marícela P MP Chen Qingxia Q Nian Hui H Gadd Cynthia S CS

Academic medicine : journal of the Association of American Medical Colleges 20140901 9

<h4>Problem</h4>How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion ("EHR ergonomics")?<h4>Approach</h4>Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a presurvey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encou ...[more]

PMID: 24826851

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Project description:ObjectiveDespite procedural skills being recognized as an important component of medical school education, medical students are not confident in their ability to carry out a range of medical procedures. We conducted an institutional needs assessment and used the results to inform the creation of a procedure-based preclinical elective for first- and second-year students.MethodsWe surveyed second-, third-, and fourth-year medical students at Alpert Medical School as well as select program directors to guide selection of a list of procedures to be taught in the elective. We then created an extracurricular 10-week procedural skills course for preclerkship medical students utilizing a hands-on, flipped classroom practice model. Volunteer preceptors were recruited from the Department of Emergency Medicine to participate with a student-to-faculty ratio not exceeding 5:1. Knowledge and skill acquisition were assessed using a multiple-choice knowledge exam and 4-station practical exam, respectively. Pre- and post-course online surveys were used to assess self-perceived confidence for all procedures.ResultsWe implemented our procedural skills training course for first- and second-year medical students in the fall of 2015. Forty-four students applied for the first iteration of the course and 15 students were selected to participate. Fourteen students ultimately completed the elective as well as the subsequent course surveys, multiple-choice exam, and practical exam. Students who participated in the elective had increased levels of self-reported confidence at the conclusion of the elective and performed better on a practical exam and multiple-choice exam compared to students who participated in only the standard curriculum.ConclusionA longitudinal preclerkship procedural course early during medical school is a feasible method of teaching procedural skills to a cohort of learners. A number of adjustments could be made to the course in order to scale up and include a larger cohort of students at our own or another institution.

Project description:Background and objectivesAn unintended consequence of electronic medical record use in the United States is the potential effect on graduate physician training. We assessed educational burdens and benefits of electronic medical record use on United States nephrology fellows by means of a survey.Design, setting, participants, & measurementsWe used an anonymous online opinion survey of all United States nephrology program directors (n=148), their faculty, and fellows. Program directors forwarded survey links to fellows and clinical faculty, indicating to how many they forwarded the link. The three surveys had parallel questions to permit comparisons.ResultsTwenty-two percent of program directors (n=33) forwarded surveys to faculty (n=387) and fellows (n=216; 26% of United States nephrology fellows). Faculty and fellow response rates were 25% and 33%, respectively; 51% of fellows agreed/strongly agreed that the electronic medical record contributed positively to their education. Perceived positive effects included access flexibility and ease of obtaining laboratory/radiology results. Negative effects included copy-forward errors and excessive, irrelevant documentation. Electronic medical record function was reported to be slow, disrupted, or completely lost monthly or more by >40%, and these were significantly less likely to agree that the electronic medical record contributed positively to their education. Electronic medical record completion time demands contributed to fellow reluctance to do procedures (52%), participate in conferences (57%), prolong patient interactions (74%), and do patient-directed reading (55%). Sixty-five percent of fellows reported often/sometimes exceeding work-hours limits due to documentation time demands; 85% of faculty reported often/sometimes observing copy-forward errors. Limitations include potential nonresponse and social desirability bias.ConclusionsRespondents reported that the electronic medical record enhances fellow education with efficient and geographically flexible patient data access, but the time demands of data and order entry reduce engagement in educational activities, contribute to work-hours violations, and diminish direct patient interactions.

Project description:Electronic health record (EHR) use can enhance or undermine the ability of providers to deliver effective, humanistic patient-centered care. Given patient-centered care has been found to positively impact patient health outcomes, it is critical to provide formal education on patient-centered EHR communication skills. Unfortunately, despite increasing worldwide EHR adoption, few institutions educate trainees on EHR communication best practices.The goal of this research was to develop and deliver mandatory patient-centered EHR training to all incoming housestaff at the University of Chicago.We developed a brief patient-centered EHR use curriculum highlighting best practices based on a literature search. Training was embedded into required EHR onboarding for all incoming housestaff (interns, residents, and fellows) at the University of Chicago in 2015 and was delivered by institutional Clinical Applications Trainers. An 11-item posttraining survey consisting of ten 5-point Likert scale questions and 1 open-ended question was administered. Responses at the high end of the scale were grouped to dichotomize data.All 158 of the incoming 2015 postgraduate trainees participated in training and completed surveys (158/158, 100.0%). Just over half (86/158, 54.4%) were interns and the remaining were residents and fellows (72/158, 45.6%). One-fifth of respondents (32/158, 20.2%) were primary care trainees (defined as internal medicine, pediatric, and medicine-pediatric trainees), and the remaining 79.7% (126/158) were surgical or specialty trainees. Self-perceived pre- versus posttraining knowledge of barriers, best practices, and ability to implement patient-centered EHR skills significantly increased (3.1 vs 3.9, P<.001 for all). Most felt training was effective (90.5%), should be required (86.7%), and would change future practice as a result (70.9%). The only significant difference between intern and resident/fellow responses was prior knowledge of patient-centered EHR use barriers; interns endorsed higher prior knowledge than resident peers (3.27 vs 2.94 respectively, P=.03). Response comparison of specialty or surgical trainees (n=126) to primary care trainees (n=32) showed no significant differences in prior knowledge of barriers (3.09 vs 3.22, P=.50), of best practices (3.08 vs 2.94, P=.37), or prior ability to implement best practices (3.11 vs 2.84, P=.15). Primary care trainees had larger increases posttraining than surgical/specialty peers in knowledge of barriers (0.8 vs 0.7, P=.62), best practices (1.1 vs 0.8, P=.08), and ability to implement best practices (1.1 vs 0.7, P=.07), although none reached statistical significance. Primary care trainees also rated training as more effective (4.34 vs 4.09, P=.03) and felt training should be required (4.34 vs 4.09, P=.10) and would change their future practice as a result (4.13 vs 3.73, P=.02).Embedding EHR communication skills training into required institutional EHR training is a novel and effective way to teach key EHR skills to trainees. Such training may help ground trainees in best practices and contribute to cultivating an institutional culture of humanistic, patient-centered EHR use.

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A novel approach to supporting relationship-centered care through electronic health record ergonomic training in preclerkship medical education.

Publications

A novel approach to supporting relationship-centered care through electronic health record ergonomic training in preclerkship medical education.

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