Abstract
ABSTRACTBackground: Integrating electronic health records (EHRs) into clinical care can prevent physicians from focusing on patients. Despite rapid EHR adoption, few curricula teach communication skills and best practices for patient-centered EHR use.Objective: We piloted a ‘Patient-centered EHR use’ curriculum, consisting of a lecture and group-observed structured clinical examination (GOSCE) for second-year students (MS2s).Design: During the lecture, students watched a trigger tape video, engaged in a reflective observation exercise, and learned best practices. During the GOSCE, one of four MS2s interacted with a standardized patient (SP) while using the EHR. Third-year students (MS3s) received no formal training and served as a historical control group by completing the same OSCE individually. All students completed post-GOSCE/OSCE surveys. The SP evaluated GOSCE/OSCE performance.Results: In 2013, 89 MS2s participated in the workshop and GOSCEs during their required Clinical Skills course and 96 MS3s participated in individual OSCEs during their end of year multi-station formative GOSCE exercise. Eighty MS2s (90%) and 88 MS3s (92%) post-GOSCE/OSCE surveys were analyzed. Compared to MS3s, significantly more MS2s rated their knowledge (19% vs 55%) and training (14% vs 39%) as good (≥4/5 point scale, P < .001 for both). Most learners (85% MS2s and 70% MS3s) thought training should be required for all students. SP ratings on GOSCE/OSCE performance was higher for the 20 MS2s compared to the 88 MS3 controls (73.5 [SD = 4.5] vs 58.1 [SD = 13.1] on 80 point scale, P < .001).Conclusions: A short workshop and GOSCE were effective in teaching patient-centered EHR use. This curriculum is now a permanent part of our Clinical Skills course. Clerkship students who did not receive our curriculum may have been exposed to negative role-modeling on the wards. To address this, training residents and faculty on patient-centered EHR use skills should be considered.Abbreviations: EHR: Electronic health record; EHR: Electronic health record; SP: Standardized patient
Highlights
Integrating electronic health records (EHRs) into clinical care has altered patient-doctor communication [1,2,3,4]
The two groups differed when asked about knowledge; MS2s interacting with the standardized patient (SP) rated higher knowledge compared to observers (3.9 [standard deviations (SD) = .7] vs 3.5 [SD = .9], P = .04). This is the first study to show that a formal lecture and group-observed structured clinical examination (GOSCE) are effective in teaching medical students how to use the EHR to promote patient-centered communication
We found that MS2s who received a brief one-hour lecture performed better on a GOSCE than more clinically experienced MS3s who received no formal training
Summary
Integrating electronic health records (EHRs) into clinical care has altered patient-doctor communication [1,2,3,4]. Despite rapid EHR adoption, few curricula teach communication skills and best practices for patient-centered EHR use. Objective: We piloted a ‘Patient-centered EHR use’ curriculum, consisting of a lecture and group-observed structured clinical examination (GOSCE) for second-year students (MS2s). Third-year students (MS3s) received no formal training and served as a historical control group by completing the same OSCE individually. Results: In 2013, 89 MS2s participated in the workshop and GOSCEs during their required Clinical Skills course and 96 MS3s participated in individual OSCEs during their end of year multi-station formative GOSCE exercise. Conclusions: A short workshop and GOSCE were effective in teaching patient-centered EHR use. This curriculum is a permanent part of our Clinical Skills course.
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