Leveraging the Electronic Health Record to Measure Resident Clinical Experiences and Identify Training Gaps: Development and Usability Study.

Abstract

Competence-based medical education requires robust data to link competence with clinical experiences. The SARS-CoV-2 (COVID-19) pandemic abruptly altered the standard trajectory of clinical exposure in medical training programs. Residency program directors were tasked with identifying and addressing the resultant gaps in each trainee's experiences using existing tools. This study aims to demonstrate a feasible and efficient method to capture electronic health record (EHR) data that measure the volume and variety of pediatric resident clinical experiences from a continuity clinic; generate individual-, class-, and graduate-level benchmark data; and create a visualization for learners to quickly identify gaps in clinical experiences. This pilot was conducted in a large, urban pediatric residency program from 2016 to 2022. Through consensus, 5 pediatric faculty identified diagnostic groups that pediatric residents should see to be competent in outpatient pediatrics. Information technology consultants used International Classification of Diseases, Tenth Revision (ICD-10) codes corresponding with each diagnostic group to extract EHR patient encounter data as an indicator of exposure to the specific diagnosis. The frequency (volume) and diagnosis types (variety) seen by active residents (classes of 2020-2022) were compared with class and graduated resident (classes of 2016-2019) averages. These data were converted to percentages and translated to a radar chart visualization for residents to quickly compare their current clinical experiences with peers and graduates. Residents were surveyed on the use of these data and the visualization to identify training gaps. Patient encounter data about clinical experiences for 102 residents (N=52 graduates) were extracted. Active residents (n=50) received data reports with radar graphs biannually: 3 for the classes of 2020 and 2021 and 2 for the class of 2022. Radar charts distinctly demonstrated gaps in diagnoses exposure compared with classmates and graduates. Residents found the visualization useful in setting clinical and learning goals. This pilot describes an innovative method of capturing and presenting data about resident clinical experiences, compared with peer and graduate benchmarks, to identify learning gaps that may result from disruptions or modifications in medical training. This methodology can be aggregated across specialties and institutions and potentially inform competence-based medical education.