Council on Medical Student Education in Pediatrics

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COMSEP Meeting in Ottawa, ON

Poster Presentation:


Need to Reboot? Retention of Patient-Centered EMR Use Skills

Authors:
Lolita Alkureishi,University of Chicago,Chicago,IL,Wei Wei Lee,University of Chicago,Chicago,Illinois,Vineet Arora,University of Chicago,Chicago,Illinois,Jeanne Farnan,University of Chicago,Chicago,IL

Introduction: Electronic medical record (EMR) use in exam rooms can impede patient-doctor communication. Despite rapid EMR adoption in medical learning environments, few curricula address how to teach patient-centered EMR use. In 2013, we piloted a ‘Patient-Centered EMR Use’ curriculum for second year students (2013-MS2).

Objectives: 1) Evaluate 1-year retention of the ‘Patient-Centered EMR Use’ curriculum; 2) Compare OSCE performance of 2013-MS2s to performance one year later as MS3’s (2014-MS3s); 3) Compare OSCE performance of 2014-MS3s (who received training as MS2s) to 2013-MS3 historical controls (who received no training).

Description: 2013-MS2s received a lecture on patient-centered EMR use and one week later participated in ‘Group OSCEs’.  We compared performance on a 16-item standardized patient checklist for MS2s on the 2013 OSCE to their performance on the same OSCE in 2014 as MS3s.  As a control group, we had 2013-MS3 students who received no training on patient-centered EMR use, but did participate in the same OSCE.  The 2013 and 2014 OSCE only varied in the name of the patient, all other variables of the case and the SP remained the same. 

Results: The SP evaluated OSCE performance using a 16-item tool (score range 15-80).  Paired t-test of 17 students with both 2013-MS2 & 2014-MS3 data showed that one year after training, 2014-MS3s performed significantly worse on the OSCE compared to their 2013-MS2 performance [73.4(SD=4.7) vs. 60.8(SD=14.8),p=0.001].  The average score change from 2013 to 2014 was -12.6(SD=13.5).  Eighty-eight  2013-MS3s and 83 2014-MS3s completed the OSCE.  SP ratings of 2014-MS3s (n=83) who received training one year ago were not significantly different from historical control group of 2013-MS3s (n=88) who received no training [60.8(SD=13.5) vs. 58.1(SD=13.1),p=0.19].

Conclusions: One year after receiving the Patient-Centered EMR use training, students’ performance deteriorated to a level indistinguishable from the control group that received no training.  Findings may reflect ‘’negative” role-modeling and the need for continued training. Future directions include: 1) Facilitating ‘direct observation’ and feedback of MS3s interacting with patients while using EMR and 2) Training residents and faculty to optimize their patient-centered EMR use skills to promote positive role-modeling.