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Letter to the Editor
We have read with great interest the study “Internal Medicine Intern Preparedness to Document Clinical Encounters in the Era of Open Notes: a Needs Assessment Survey” by Schiller et al.that evaluated the current knowledge and educational gaps of early internal medicine trainees when writing “open notes” as it relates to the 21st Century Cures Act.1
Early residents’ lack of comfort in using appropriate language for open notes and inability to recognize the indications to withhold the documentation from patients reflect the fact that medical students receive inadequate electronic health record (EHR) training, even though this training is a core competency designated by the AAMC.2
There is consensus within the medical education community that additional EHR training in undergraduate medical education (UME) is critical, especially given the near ubiquity of EHRs and the link between EHRs and clinician burnout.3,4 However, there are few published curricula targeting UME learners that align with proposed EHR competencies.5 The Alliance for Clinical Education suggested such a curriculum should develop didactic benchmarks that aim to teach the skills of documentation, order entry, and the use of clinical decision-making tools. This approach may integrate a formal EHR curriculum within the pre-clinical years comparable to medical undergraduate courses of practicing the art of doctoring and physical examination skills. Furthermore, students may have a dedicated specialty-based EHR course that focuses on collecting and reporting data, understanding acronyms, and providing patient education within their chosen field.6 After the development of national benchmarks for EHR interaction, students’ skills could be formally evaluated through objective structured clinical examinations, ensuring adequacy in EHR-based skills prior to residency training.
Training courses at Wake Forest School of Medicine in the USA and University Hospital of Tübingen in Germany have pioneered the way in which medical students learn how to interact with and utilize EHR using a simulated EHR system that mimicked the hospital’s actual implemented health information technology. Students received formal training in navigating their EHR and were able to document their clinical reasoning skills as they concurrently practiced from simulated cases and on standardized patients. They participated in interactive discussions throughout their undergraduate medical training as they developed integral EHR skills.2,7 We have an exciting opportunity to grow and learn as we progress through this new era of practicing clinical medicine in the digitized age.
References
Schiller PT, Wong CJ, Golob AL, et al. Internal Medicine Intern Preparedness to Document Clinical Encounters in the Era of Open Notes: a Needs Assessment Survey. J Gen Intern Med. 2023. https://doi.org/10.1007/s11606-023-08099-2.
Hermann-Werner A, Holderried M, Loda T, et al. Navigating Through Electronic Health Records: Survey Study on Medical Students’ Perspectives in General and With Regard to a Specific Training. JMIR Med Inform. 2019;7(4):e12648. https://doi.org/10.2196/12648.
Atwater AR, Rudd M, Brown A, et al. Developing Teaching Strategies in the EHR Era: A Survey of GME Experts. J Grad Med Educ. 2016;8(4):581-586. https://doi.org/10.4300/jgme-d-15-00788.1.
Jha AK, Iliff AR, Chaoui AA, et al. A crisis in healthcare: a call to action on physician burnout. Available at: https://cdn1.sph.harvard.edu/wp-content/uploads/sites/21/2019/01/PhysicianBurnoutReport2018FINAL.pdf. Accessed 13 March 2023.
Rajaram A, Hickey Z, Patel M, et al. Training medical students and residents in the use of electronic health records: a systematic review of the literature. Journal of the American Medical Informatics Association. 2020;27(1):175-180. https://doi.org/10.1093/jamia/ocz178.
Hammoud MM, Dalrymple JL, Christner JG, et al. Medical Student Documentation in Electronic Health Records: A Collaborative Statement From the Alliance for Clinical Education. Teaching and Learning in Medicine. 2012;24(3):257-266. https://doi.org/10.1080/10401334.2012.692284.
Cristiano JA, Jackson JM, Shen E, et al. Integrating the Electronic Health Record Into Patient Encounters: An Introductory Standardized Patient Exercise for Preclinical Medical Students. MedEdPORTAL. 2022;18:11209. https://doi.org/10.15766/mep_2374-8265.11209.
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Solanki, P., Nikiforova, T. & Feterik, K. Let EHRs Click in the Medical School Curriculum. J GEN INTERN MED 38, 2214 (2023). https://doi.org/10.1007/s11606-023-08198-0
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DOI: https://doi.org/10.1007/s11606-023-08198-0