Incorporating the human touch: piloting a curriculum for patient-centered electronic health record use

ABSTRACT

Background: Integrating electronic health records (EHRs) into clinical care can prevent physicians from focusing on patients. Despite rapid EHR adoption, few curricula teach communication skills and best practices for patient-centered EHR use.

Objective: We piloted a ‘Patient-centered EHR use’ curriculum, consisting of a lecture and group-observed structured clinical examination (GOSCE) for second-year students (MS2s).

Design: During the lecture, students watched a trigger tape video, engaged in a reflective observation exercise, and learned best practices. During the GOSCE, one of four MS2s interacted with a standardized patient (SP) while using the EHR. Third-year students (MS3s) received no formal training and served as a historical control group by completing the same OSCE individually. All students completed post-GOSCE/OSCE surveys. The SP evaluated GOSCE/OSCE performance.

Results: In 2013, 89 MS2s participated in the workshop and GOSCEs during their required Clinical Skills course and 96 MS3s participated in individual OSCEs during their end of year multi-station formative GOSCE exercise. Eighty MS2s (90%) and 88 MS3s (92%) post-GOSCE/OSCE surveys were analyzed. Compared to MS3s, significantly more MS2s rated their knowledge (19% vs 55%) and training (14% vs 39%) as good (≥4/5 point scale, P < .001 for both). Most learners (85% MS2s and 70% MS3s) thought training should be required for all students. SP ratings on GOSCE/OSCE performance was higher for the 20 MS2s compared to the 88 MS3 controls (73.5 [SD = 4.5] vs 58.1 [SD = 13.1] on 80 point scale, P < .001).

Conclusions: A short workshop and GOSCE were effective in teaching patient-centered EHR use. This curriculum is now a permanent part of our Clinical Skills course. Clerkship students who did not receive our curriculum may have been exposed to negative role-modeling on the wards. To address this, training residents and faculty on patient-centered EHR use skills should be considered.

Abbreviations: EHR: Electronic health record; EHR: Electronic health record; SP: Standardized patient

KEYWORDS:

• Electronic health records
• patient-centered care
• communication skills
• clinical skills training
• curricular development

Acknowledgments

The authors wish to thank the University of Chicago’s Medical Education Research, Innovation, Technology and Scholarship (MERITS) Fellowship Program, the Pritzker School of Medicine’s Simulation Center, and Sandra Webb from the University of Chicago’s EPIC EHR Training Center.

This paper was previously presented at the following meetings: Society of General Internal Medicine Midwest meeting 2013 and 2014, Society of General Internal Medicine National meeting 2013 and 2014, Academic Internal Medicine Week 2013 and 2014, Council on Medical Student Education & Association of Pediatric Program Directors 2013 and 2014, AAMC Central Group on Educational Affairs Spring Meeting 2014.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Arnold P Gold Foundation Mapping the Landscape Grant. The University of Chicago Bucksbaum Institute Pilot Grant. The University of Chicago Academy of Distinguished Medical Educators Grant. Picker Gold Challenge Grants for Residency Training.