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.