Council on Medical Student Education in Pediatrics


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You are not alone - struggles with students and electronic health records. Hammoud M et al. Opportunities and challenges in integrating electronic health records into undergraduate medical education: A national survey of clerkship directors. Teaching and Learning in Medicine 2012;24(3):219--224.

Reviewed by Julie Noffsinger

What was the study question?
How is the electronic health record (HER) utilized in medical schools in different specialties in the United States and how do clerkship directors feel its utilization affects medical student education?

How was the study done?
A 24 question survey regarding the use of EHRs by medical students was developed by the Alliance for Clinical Education (ACE) and distributed to clerkship directors in the United States. Data were analyzed and comments collated.

What were the results?
Overall, 64% of respondents report that students are allowed access to the HER. Thirty--two percent of programs allow students to only view the record, 41% allow students to view and write notes, and 27% allow students to view, write notes, and enter orders to be co--signed. Overall, respondents felt neutral about the HER effect on student learning, but Pediatrics respondents felt the Teacher--Learner relationship was more negatively affected than some other specialties. Themes identified from the clerkship directors' responses were: 1) templates stifling student thinking, 2) limited teaching time due to increased time for faculty documentation, 3) students marginalized due to lack of access or notes not "counting", and 4) student--patient relationship adversely affected by the computer.

What are the implications of these findings?
Even though there is a large body of data showing EHRs reduce errors, their impact on medical education needs to be considered. If students do not obtain sufficient experience and/or feedback in their note writing and order entry in medical school, they may be less able to write notes and enter orders as residents. Also, if medical students perceive no value to their notes, they may lose out on a sense of responsibility and ownership for their patients.

Editor's note: This study, co--authored by COMSEP's Jennifer Christner, is a great example of a collaborative project across programs and disciplines. The data was collected in 2009 and judging from the comments recently posted on our list--serv, these quantitative data may not be that accurate anymore. The qualitative data, though, representing some of the challenges of EHRs still ring true (SLB).

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