RESULTS

1. Medical student perspectives regarding Electronic Medical Records Laura Rabideau, George Vana, Ben Ware, Charles Maclean, MD, UVM COM, Burlington, VT 2011 VT SEARCH Scholars Project DISCUSSION BACKGROUND RESULTS CONCLUSIONS • Role of Electronic Medical Records in medical student education not clear; their use may help or hinder the educational process • There is no consensus on best practices for both the use of EMRs and how to educate on and with them • Fletcher Allen Health Care installed an EMR in 2009, and other College of Medicine partners are in various stages of EMR adoption • Preceptor expectations and experiences may limit value of education surrounding EMRs • Early instruction on EMR use develops communication skills that do not develop spontaneously • By studying experiences so far, it should be possible to develop best practices Table 1. Student demographics • While more survey responses would help assure better reliability, we can qualitatively conclude that: In general the EMR system is helpful: • Most students surveyed felt like the level and amount of training they received on EMR use was adequate • Most students believed that EMRs helped them accomplish their daily tasks • However: • Only a minority felt that the EMRs were easy to use • A slim majority believed they had adequate computer access to the EMR • A similarly slim majority believed that EMRs did not get in the way of their clinical education • Next steps • Refine survey and larger sample • Preceptor perspective • Amount and level of training are just right or could be increased • Ease of use is highly variable • EMRs are helpful, but have created barriers for a significant minority of students • Open-ended responses helped identify other important themes: • EMRs improved access to clinical information • EMRs improved efficiency and legibility of note writing “They provide easy access to lab results and a more efficient way to write notes. Furthermore, they allow rapid access to the patient’s medical records in many cases, making the life of a medical student that much easier.” • Student suggestions for improving the EMR training process -More training from users closer to their level (e.g. upper-level student TAs or residents) -More specific training on note writing and graduated permission to learn order writing -More consistent guidance from faculty—this raises issues of variability in faculty knowledge and attitudes • Only one student described EMR as potentially negatively affecting their medical education: “Decision support reduces need for memorization but also reduces need for thinking (so good and bad).” • Greatest limitation is low response rate. • To validate the results, distributing the survey to more students would help determine whether the results were affected by selection bias. • The uneven distribution of self-rated technical proficiency (Table 1) could indicate selection bias. • Turning some of the student suggestions into Likert-style questions could resolve the apparent incongruity between the training satisfaction students reported in the quantitative part of the survey and the dissatisfaction expressed in the open-ended questions. Table 2. Student attitudes regarding EMRs GOALS Suggestions… • The goals of this project are: • To assess student perspective regarding the role of the EMR as a barrier or enabler of learning • To use these findings to help improve the College of Medicine curriculum involving electronic medical records • This survey indicates that there are some feasible improvements that can be made to EMR education: • Faculty development • Provide EMR instruction in a graduated way where advanced skills (i.e. templates and pulling data from the EMR) are taught after mastering basic skills • Improve computer access to EMR by allowing students to use school laptops to connect to EMR system • Proactively collect student feedback on the systems in evaluations at end of each rotation • We plan to continue this research by interviewing clerkship faculty and performing a qualitative analysis of the themes from these interviews from which we will develop a survey tool to determine the faculty perspective METHODS To collect student perspectives we utilized a web based survey. It included: Likert-style questions regarding student satisfaction on EMR training and use Information on all EMRs used Qualitative input via open-ended questions This project was funded by U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA)