The Button Project: Using Chart Rounds for Teaching Clinical Ophthalmology with an Electronic Medical Record

Figures & data

Table 1 Cross-Sectional Survey on Chart Rounds

	Faculty (n=43)	Trainees
		Total (n=29)	Residents (n=13)	Fellows (n=16)
How do you define chart rounds?	n/a=1
Review all cases at the end of clinic	8 (19%)	16 (55%)	9 (69%)	7 (44%)
Review select cases at end of clinic	34 (79%)	25 (86%)	11 (85%)	14 (88%)
Review cases throughout clinic	21 (49%)	9 (31%)	7 (54%)	2 (12%)
Types of cases	n/a=3
Routine cases	17 (42%)	11 (38%)	6 (46%)	5 (31%)
Rare cases	32 (80%)	26 (90%)	10 (77%)	16 (100%)
Management challenges	40 (100%)	28 (97%)	12 (92%)	16 (100%)
Surgical cases	30 (75%)	20 (69%)	8 (62%)	12 (75%)
Diagnostic dilemmas	38 (95%)	28 (97%)	12 (92%)	16 (100%)
How useful are chart rounds for your clinical education?
Mean (SD)  1 (not useful) to 5 (very useful)		4.5 (0.6)	4.3 (0.6)	4.6 (0.6)
Number who rated useful or very useful (%)		26 (90%)	12 (92%)	14 (88%)
How often do you do chart rounds?	n/a=2
Mean (SD)  1 (not at all) to 5 (every time)	3.7 (1.3)
Number who rated at least sometimes (%)	36 (88%)
Are you interested in changing the frequency of chart rounds?
Mean (SD)  1 (decrease frequency) to 5 (increase frequency)		4.2 (0.8)	4.2 (0.6)	4.1 (1.0)
Number who rated any increase (%)		23 (79%)	12 (92%)	11 (69%)
If there was an easy way to identify cases for chart rounds in Epic, would you use it?	n/a=2
Mean (SD)  1 (not likely at all) to 5 (very likely)	4.1 (1.1)	4.4 (0.6)	4.2 (0.6)	4.7 (0.5)
Number who rated likely or very likely (%)	30 (73%)	28 (97%)	12 (92%)	16 (100%)

Abbreviations: n/a, faculty respondents who did not answer the question; SD, standard deviation.

Table 2 Before and After Implementation of the Education Button

	Faculty		Trainees
	Before n=21	After n=21	Before n=13	After n=17
Educational experience Number who rated positive (%)	16/20* (80%)	15/16* (94%)	13/13 (100%)	13/17 (76%)
Frequency of chart rounds Number who rated most or all sessions (%)	12/20* (60%)	10/17* (59%)	3/13 (23%)	4/17 (24%)
Impression of chart rounds Number who rated positive (%)	14/17* (82%)	11/13* (85%)	10/11* (91%)	14/15* (93%)
Learning objectives Average rating (SD)	3.41 (0.54)	3.46 (0.54)	3.97 (0.51)	4.32 (0.62)

Note: *not all questions were answered by all respondents.

Abbreviation: SD, standard deviation.

Table 3 Recommendations for Future Clinical Educational Interventions

Recommendation	Lessons Learned
Consider clinical education at the time of implementation of a new electronic health record system	Identifying the education button color a priori would have allowed for team members to incorporate it as they are learning the system, as opposed to trying to fit it in at a later time when work-flows have already been established.
Multiple rounds of educating the educators are needed.	Multiple emails and presentations at faculty meetings were used, but were found to be inadequate. Consider additional signs at work stations, 1-on-1 instructions for key clinician educators, and incorporating it into the initial electronic health system training.
Incorporate clinical staff at all levels, during development of clinical educational tools.	To achieve “buy-in” from all of the stakeholders in the clinical team, trainees, faculty, and clinical staff and leadership.
Address the chief barrier—not enough time—if possible	Consider alternative compensation models to incentivize clinical teaching activities.