Resident education through electronic medical record counselling prompts

Abstract

Electronic medical records (EMRs) are used by most residency training programmes and have the potential to improve medical education and patient counselling. Few studies have assessed the impact of EMRs on medical education and current literature is focused on experience tracking for curriculum adjustment and evaluation. Prenatal visits allow for resident and patient education over multiple encounters, but often residents lack the time to seek information or lack sufficient confidence in their skills to deliver effective counselling. Electronic medical records systems are particularly valuable in prenatal care as they improve documentation and allow multiple providers to track patient data. Incorporating patient counselling information into the prenatal EMR enables accurate information to be immediately accessible to residents, which is vital to the patient encounter as well as to the education of the clinical trainee. Prompts on 28 prenatal counselling topics were created from clinical practice guidelines published by several national academies and compiled into our EMR system in a concise bulleted counselling format. Of note, these prompts were not simple pop-up reminders, but were detailed, allowing the trainee to counsel a patient without having to use any other source in real time. Corresponding patient handouts were also created. To gather data, surveys and tests were administered to 23 second- and third-year family medicine residents before and for 6 months after prompts were released into the EMR. The surveys assessed confidence levels with counselling, current information resources, and average use and effectiveness of prompts. The tests used a multiple-choice format and were based on essential information included within the prompts. Resident counselling confidence level and test scores before and after using prompts were compared with Student’s t-tests. Results revealed that the majority (88%) of residents used electronic sources including personal digital assistants (PDAs) and the Internet to find medical information. Many residents reported that information was not immediately available to them during patient encounters (30%). Residents reported using the EMR prompts during most patient visits and rated their effectiveness as high. Although residents had average higher confidence levels and average higher test scores after prompt use, comparison of these means showed no significant difference. Counselling prompts in the EMR have potential for use in patient education, but their use as an educational tool for residents requires further research. Our study was limited to postgraduate second- and third-year residents, which resulted in a high baseline rate of confidence and test scores, indicating a solid foundation of prior knowledge. During the 6 months between the tests and surveys, residents also gained varying levels of in-patient and clinic prenatal experience. Given our small sample size and high baseline pre-test score average, it was not possible to prove a significant difference between resident counselling confidence ratings and pre- and post- test scores. Studies involving a greater number of residents at several different training levels and employing a variety of assessments, including chart reviews, observed encounters and patient satisfaction surveys, are needed in the future. Prompts in EMRs may also prove useful for giving guidance in counselling on the management of other chronic conditions such as diabetes, heart disease and asthma.