The objectives of the research were to determine how widely electronic medical records (EMRs) were utilized in teaching medical students among U.S. medical schools; whether schools with EMRs allowed students to record patient information; whether a medical student’s notes were retained as part of the permanent medical record; and perceptions among clerkship directors of the impact of EMRs on medical education. In preparation for this research, the subcommittee developed a survey instrument for email distribution to directors of the five core clerkships at each accredited U.S. medical school.
As a second step towards implementing the project, each subcommittee member applied for an exemption from their respective Institutional Review Boards (IRBs) for this project. By January 2010, exemptions were granted by IRBs at six institutions and several more were well along in the process. As the final exemptions were forthcoming, the subcommittee learned about similar research conducted by other researchers. After a review of the outcomes presented by these groups, the subcommittee made the difficult decision not to go forward with its own research proposal. Despite this setback, the subcommittee was gratified to learn of the shared interest in this topic and applauds the work accomplished. The subcommittee is pleased to present links to this research, as noted below:
“Integrating Electronic Medical Records into Medical Education: Challenges and Opportunities,” Alliance for Clinical Education, presented at Association of American Medical Colleges 2009 Annual Meeting, Boston, Massachusetts, Nov. 10, 2009.
This series of slides presents findings reported by members of the Alliance for Clinical Education at the annual meeting of the Association of American Medical Colleges in November 2009, on challenges and opportunities for integrating electronic medical records into undergraduate medical education. The alliance was formed in 1992 with the mission of promoting excellence in the clinical education of medical students. As noted in the slides, alliance members were surveyed to assess the availability of EMRs in medical schools as well as student participation in these systems.
The survey revealed broad access to EMRs by students, with 87 percent reporting direct access. Of these, 31 percent of students were able to view notes in the record, 40 percent could both view and write notes, and 26 percent could view, write, and also enter orders (to be co-signed). Many students seemed unsure about their preference for electronic records, with 46 percent indicating they were uncertain whether they preferred electronic over paper charts and only 36 percent selected a preference for electronic records. An additional 11 percent were indifferent, indicating no preference for either format.
In the slides, the alliance also provides perspectives on the pros and cons of EMRs for teaching students as well as compliance and ethical issues.
“Do Electronic Medical Records Help or Hinder Medical Education?,” Jonathan U. Peled, Oren Sagher, Jay B. Morrow, and Alison E. Dobbie; Public Library of Science, PLoS Medicine, May 12, 2009.
Similar research was published in the Public Library of Science in May 2009 that focused on a collegial debate between two pairs of researchers, as named above, in responding to the question whether electronic health records (EHRs) help or hinder medical education. The authors explore whether: EHR templates improve a student’s history and physical exam skills, including communications with patients; and its utilization in the clinical teaching environment.
Consensus was reached on the following points: 1) the EHR holds an inexorable, prime role in the health care environment of the 21st century; 2) the EHR is only as good as its user; 3) faculty development around EHR education is key; and 4) it is the role of medical education to provide “standardized knowledge metrics and skills assessments.”
The role of EMRs in medical education remains a topic of great interest to the subcommittee and will continue to be a focus as EMRs are utilized even more fully in medical teaching.
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