Frances E. Biagioli

Simulated electronic health record (Sim-EHR) curriculum: teaching EHR skills and use of the EHR for disease management and prevention.

Electronic health records (EHRs) can improve many aspects of patient care, yet few formal EHR curricula exist to teach optimal use to students and other trainees. The Simulated EHR (Sim-EHR) curriculum was introduced in January 2011 at Oregon Health & Science University (OHSU) to provide learners with a safe hands-on environment in which to apply evidence-based guidelines while learning EHR skills. Using an EHR training platform identical to the OHSU EHR system, learners review and correct a simulated medical chart for a complex virtual patient with chronic diseases and years of fragmented care. They write orders and prescriptions, create an evidence-based plan of care for indicated disease prevention and management, and review their work in a small-group setting. Third-year students complete the Sim-EHR curriculum as part of the required family medicine clerkship; their chart work is assessed using a rubric tied to the curriculum’s general and specific objectives. As of January 2014, 406 third-year OHSU medical students, on campus or at remote clerkship sites, and 21 OHSU internal medicine interns had completed simulated charts. In this article, the authors describe the development and implementation of the Sim-EHR curriculum, with a focus on use of the curriculum in the family medicine clerkship. They also share preliminary findings and lessons learned. They suggest that the Sim-EHR curriculum is an effective, interactive method for providing learners with EHR skills education while demonstrating how a well-organized chart helps ensure safe, efficient, and quality patient care.

Medical student exposure to components of the patient-centered medical home during required ambulatory clerkship rotations: implications for education.

Purpose To determine the extent to which third-year medical students are exposed to elements of the patient-centered medical home (PCMH) during required family medicine (FM) clerkships and how this exposure varies among a sample of medical schools. Method In 2008, the authors conducted a cross-sectional survey of 104 ambulatory teaching practices that host required third-year FM clerkship students from nine U.S. medical schools. Descriptive statistics characterized learning settings and the status of PCMH features, and generalized linear mixed models examined variation among medical schools (as the 104 clinics were nested within nine medical schools). Results Participating schools captured data on 104 eligible clerkship sites (44%). These practices were primarily community-based, single-specialty clinics (n = 48; 46%), and more than half (n = 55; 53%) were part of integrated health systems. Electronic health records (EHRs) were in place in 60 (58%), and no significant difference existed in EHR use according to medical school, despite up to a 10-fold variation from school to school in other PCMH features. Among sites with EHRs, 8 (14%) did not allow access to medical students. Preceptor attitudes about how practice transformation and new information technology are affecting the quality of medical education differ widely from site to site. Conclusions Primary care transformation toward the PCMH is already well under way in a national sample of FM teaching sites, and this transformation is having important effects on medical student education.

Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review.

Purpose Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies. Method The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality. Results Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills. Conclusions These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development.

Surgery clerkship evaluations drive improved professionalism

PURPOSE To determine whether a brief student survey can differentiate among third-year clerkship students professionalism experiences and whether sharing specific feedback with surgery faculty and residents can lead to improvements. METHODS Medical students completed a survey on professionalism at the conclusion of each third-year clerkship specialty rotation during academic years 2007-2010. RESULTS Comparisons of survey items in 2007-2008 revealed significantly lower ratings for the surgery clerkship on both Excellence (F = 10.75, p < 0.001) and Altruism/Respect (F = 15.59, p < 0.001) subscales. These data were shared with clerkship directors, prompting the surgery department to discuss student perceptions of professionalism with faculty and residents. Postmeeting ratings of surgery professionalism significantly improved on both Excellence and Altruism/Respect dimensions (p < 0.005 for each). CONCLUSIONS A brief survey can be used to measure student perceptions of professionalism and an intervention as simple as a surgery department openly sharing results and communicating expectations appears to drive positive change in student experiences.