Council on Medical Student Education in Pediatrics


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Look at my eyes, not the screen

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 RT, Graichen CC, Rdesinski RE, Kumar KA, Galper AB, Tysinger JW. Academic Medicine 2016 (published online ahead of print).

Reviewed by Valli Annamalai

What was the study question?
Can an EHR-OSCE assess students’ ability to establish patient rapport while using the EHR, as well as students’ data management skills?

How was the study done?
Family Medicine clerkships at two medical schools conducted the same EHR-OSCE, one institution using it for formative feedback several months after didactic EHR training, and the other as part of the clerkship grade, closer to the time of didactic EHR training. EHR competencies assessed included data management skills (identifying parts of the EHR critical to patient safety , identifying discrepancies between EHR and patient’s verbal report) and communication skills (establishing rapport, attending to patient’s needs ahead of computing tasks, using EHR to enhance patient interactions). Faculty used a checklist to evaluate performance.

What were the results?
Most students maintained eye contact while using the EHR, and shared information from the EHR with the patient. Areas that needed improvement included confirming the medical record data with the patient and using the EHR to foster patient engagement. One institution’s students demonstrated better overall performance than the other. Several factors may have contributed to this variance, such as the timing of the didactic training in relation to the OSCE and the fact that the EHR station contributed to the student’s grade at one institution. Faculty and students at both institutions perceived the exercise to be of high value.

What are the implications of these findings?
This study indicates a need for more EHR education. An EHR-OSCE not only provides a method to measure students’ ability to use an EHR in a patient-centered manner, but can identify institutions’ needs for new EHR curricula. The authors call for standardized clinical EHR best practices and urge the LCME to develop educational policies that support students’ use of the EHR in clinical settings.

Editor’s Note: I wonder how seasoned physicians (read old) would stack up against medical students in an OSCE following EHR training (RR).

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