Mitzi S. Scotten,,Kansas City,KS
Skillful usage of the electronic health record (EHR) is a clinical competency for physicians. Medical schools have been charged with incorporating EHR training as a part of medical school curriculum but scant data is available on how students actually interact with the EHR. Early data exists on EHR note writing by students but a review of the literature found no information on student usage of computer physician order entry (CPOE).
All third year students used a logging sheet and recorded student originated orders while on the inpatient services. Quantitative data tracked the number and types of orders written.
Next, a survey, sent via survey monkey, went to all students finishing third year. The survey consisted of eight multiple choice questions and one free text question. Topic areas assessed included student perception of adequacy of CPOE training, student perceptions of competency, faculty and resident availability, and perceived barriers in usage.
Logging sheets showed 44 of 145 students completed orders on inpatient services. Number of orders logged ranged from one to twenty. Multiple types of orders were recorded.
Fifty-three percent of students reported feeling competent using CPOE at the end of third year. Only 25% of students thought that orientation to CPOE was adequate. And while 61% of student responded that residents were helpful in the CPOE learning process, only 9% of students felt that attending staff were helpful.
The survey identified several barriers to order writing which included lack of time on rounds (72%), instruction from staff not to write orders (71%), and a perceived knowledge deficit on how to write the orders (47%). Student suggestions included an area within the EHR to practice writing orders and making order writing a required activity. Survey response rate was 42%.
Moving forward, the clerkship plans to incorporate additional training sessions at orientation, initiate discussions on creating EHR practice sites, faculty development in facilitating CPOE usage and making CPOE a required activity.