Thursday, July 2, 2015

EHRs and Medical Students: How to educate Medical Students

Practicing medicine today means interacting not just with patients, but also with computers. As of 2013, nearly 80% of office-based physicians were using electronic health records. But medical schools have been slow to keep up with the trend. There's no national standard yet for how med students should be trained on EHRs. Some are using computer systems from day one of their education. While others may be forced to sink or swim once they start to practice. This is a report for iHealthBeat, a daily news service of the California HealthCare Foundation.

<Audio Transcript>

I'm Ali Budner Priyanka Chilakamarri is a fourth-year medical student at the University of Vermont. From very early on, she and her fellow students were expected to engage with their lessons through computer screens. (Chilakamarri): "When I first started medical school ... they gave all the students laptops." They also immediately started using computers in their interactions with patients. That meant learning how to use an EHR system. But EHRs are complex and notoriously hard to teach. (Jemison): "Because inevitably the computers are attached to walls, your back is to a patient, there's a lot of physical reconfiguring you have to do in order to take notes." Jill Jemison is the director of technology services at UVM, Chilakamarri's school. (Jemison): "We're teaching them how to do a good note, how to put all the information in it, how to collect the right thing." The third year of med school is when students would typically be exposed to EHRs, when they start clinical rotations. But in her very first year at UVM, Chilakamarri was already practicing on what's called a "dummy EHR," a system that's been stripped of identifying personal information to protect patient privacy.


Harold Lehmann
Consider constructing a curriculum around a virtual (or multiple virtual patients). Cases should be created in the training environment, not only for the purpose of training in the use of the EHR per se, but also for teaching how to practice medicine in this machine-centric environment. Hopefully, one can teach how to be efficient, yes, but also, how to *think* in multiple screens that are not designed necessarily to aid cognition.
Lauren La Barge
Many of my friends and colleagues are medical students, and I was fortunate to live with many medical students at a top ranked institution. They are interested in curious about EHRs generally, but lose interest as they are unable to interact with them. Suddenly when they are in a clinical setting using EHRs for the first time, there is a lot of frustration and confusion. My friend, a first year anesthesia resident, used to take hours of work home on Epic! Teaching EHR use in the medical curriculum needs to be a part of the medical school experience.
Michael Warner
Medical students are in a tough position today as they are hands-off when it comes to the EHR. I was not allowed to write in the chart either, when I was a nurse's aid. I realize the legal ramifications, but patients are now able to view their records on patient portals and enter information. Why not allow the student doctor to partner with the patients and construct the History component of the encounter note? In research study that just concluded, patients where able to "co-author" their health record by writing a Pre-History. Imagine if medical student partnered with a patient to document her or her story? This might lead to a future where patients and providers get closer - while using the EHR as a tool.

July 2, 2015
Gary Levin M.D.
The clinical practice of medicine is changing rapidly. Advances in basic and clinical science challenge praactitioners as well as neophyte trainees. Today a new curriculum is developing in medical school focused on health information technology. Electronc health records and eRX are just two of the niches.

Today pre- medical students have a computer, pc tablet or are given one when they enter medical school. Much of the curriculum and even examinations are offered via this tool. Medical students enter school with considerable exposure to computer technology and operating systems.  They are facile with the hardware.  This is not so for EHR software.

Some thought is being given to  training students to use EHRs. However hospitals, and clinics may use different EHRs, and training students to use one does not necessarily translate to using another one.  In fact studies have shown it is easier to teach a student an  EHR if they have never used one.  Changing EHRs requires unlearning the original EHR to use the new EHR.

In general it may be more important to teach  adaptive skills, such as where to place a computer monitor or keyboard to minimize visual isolation from a patient. Digital health space believes that tablet PCs are the most user-friendly in the clinical environment.  It can be used much like a classical paper progress note... The addition of touch screen functionality is even more useful.

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