Abstract
BackgroundStandardized doctor’s orders are replacing traditional order writing in teaching hospitals. The impact of this shift in practice on medical education is unknown. It is possible that preprinted orders interfere with knowledge acquisition and retention by not requiring active decision-making. The objective of the study was to evaluate the impact of standardized admission orders on disease-specific knowledge among undergraduate medical trainees.MethodsThis prospective cohort study enrolled Year 3 (n = 121) and Year 4 (n = 54) medical students at two academic hospitals in Toronto (Ontario, Canada) during their general internal medicine rotation. We used standardized orders for patient admissions for alcohol withdrawal (AW) and for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) as the intervention and manual order writing as the control. Educational outcomes were assessed through end-of-rotation questionnaires assessing disease-specific knowledge of AW and AECOPD.Results and discussionsOf 175 students, 105 had exposure to patients with alcohol withdrawal during their rotation, and 68 students wrote admission orders. Among these 68 students, 48 used standardized orders (intervention, n = 48) and 20 used manual order writing (control, n = 20). Only 3 students used standardized orders for AECOPD, precluding analysis. There was no significant difference found in mean total score of questionnaires between those who used AW standardized orders and those who did not (11.8 vs. 11.0, p = 0.4). Students who had direct clinical experience had significantly higher mean total scores (11.6 vs. 9.0, p < 0.0001 for AW; 13.8 vs. 12.6, p = 0.02 for AECOPD) compared to students who did not. When corrected for overall knowledge, this difference only persisted for AW.ConclusionsNo significant differences were found in total scores between students who used standardized admission orders and traditional manual order writing. Clinical exposure was associated with increase in disease-specific knowledge.
Highlights
Standardized doctor’s orders are replacing traditional order writing in teaching hospitals
No significant differences were found in total scores between students who used standardized admission orders and traditional manual order writing
The information contained in the order sets may allow for new knowledge acquisition by the trainee (e.g. criteria for use of antibiotics in patients presenting with chronic obstructive pulmonary disease (COPD) exacerbation)
Summary
Standardized doctor’s orders are replacing traditional order writing in teaching hospitals The impact of this shift in practice on medical education is unknown. It is unclear whether standardized orders have a positive or negative impact on medical education. Preprinted orders may improve certainty in the application of previously acquired knowledge It can provide recommended dosages for benzodiazepine dosage in alcohol withdrawal, or details on specific therapies such as appropriate use of antibiotics for COPD exacerbations. Reliance on a checkbox included in an order set to order deep vein thrombosis (DVT) prophylaxis may result in this particular intervention not being implemented in the absence of the preprinted orders This issue is concerning if trainees subsequently rotates to a clinical site where the DVT order set is not available. Knowledge of drug dosages may not be retained because of the lack of the reinforcement provided by writing the dose
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