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Students struggle with EHR’s too!

The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record

Biagioli FE, Elliot DL, Palmer L, Graichen CC, Rdesinski RE, Kumar KA, Galper AB, Tysinger JW. Acad Med. 2017 Jan;92(1):87-9

Reviewed by William Sasser

Tags: simulation, clerkship, clinical skills

What was the study question?

This study describes the development of an objective structured clinical exam (OSCE) integrating use of the electronic health record (EHR) to assess clerkship students’ a) EHR-related communication skills and b) data management skills.  Performance data and student perceptions are reported.

How was the study done?

EHR competencies, linked to Accreditation Council for Graduate Medical Education competencies, were developed and used as a foundation to develop an EHR-OSCE scenario rater checklist.  The EHR-OSCE involved an encounter with a standardized patient (SP) in which students took a focused history, reviewed EHR data with the SP, communicated their assessment, and entered a prescription in the EHR.  .  Trained faculty members observed the encounter and provided feedback along with the SP. The OSCE was piloted at two institutions.

What were the results?

282 third year students participated in the OSCE during their family medicine clerkship.  Students from both institutions performed well in communication skills such as maintaining eye contact while using EHR and sharing information from the EHR with the patient (both >90%).  Students from both schools struggled with data management skills such as reviewing past medical history and reconciling medications.   At one of the institutions, students who participated later in the academic year did not outperform those who participated earlier in the year.  The intervention was well received by students and faculty.

What are the implications?

This study highlights the need to set educational objectives (goals/competencies) for medical trainees related to use of EHR.  It also highlights the inherent challenges in patient-provider communication and data management when using EHR during patient encounters.  Variability in student access to EHR data, documentation, and order entry abilities will likely persist but intentional training efforts, such as those developed by the authors, may help students develop these important skills. 

Editor’s note: There are many barriers to teaching EHR skills, including inconsistent access to EHR’s for students, limited faculty development and lack of curricular effort.  This OSCE is a great first step, and for some students seemed to have served as a teaching opportunity rather than an assessment. (JG)

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