Jennifer G. Christner

Medical Student Documentation in Electronic Health Records: A Collaborative Statement From the Alliance for Clinical Education

Purpose: The electronic health record (EHR) is an important advancement in health care. It facilitates improvement of health care delivery and coordination of care, but it creates special challenges for student education. This article represents a collaborative effort of the Alliance for Clinical Education (ACE), a multidisciplinary group formed in 1992. ACE recognizes the importance of medical student participation in patient care including the ability of documentation. This article proposes guidelines that can be used by educators to establish expectations on medical student documentation in EHRs. Summary: To provide the best education for medical students in the electronic era, ACE proposes to use the following as practice guidelines for medical student documentation in the EHR: (a) Students must document in the patients chart and their notes should be reviewed for content and format, (b) students must have the opportunity to practice order entry in an EHR—in actual or simulated patient cases—prior to graduation, (c) students should be exposed to the utilization of the decision aids that typically accompany EHRs, and (d) schools must develop a set of medical student competencies related to charting in the EHR and state how they would evaluate it. This should include specific competencies to be documented at each stage, and by time of graduation. In addition, ACE recommends that accreditation bodies such as the Liaison Committee for Medical Education utilize stronger language in their educational directives standards to ensure compliance with educational principles. This will guarantee that the necessary training and resources are available to ensure that medical students have the fundamental skills for lifelong clinical practice. Conclusions: ACE recommends that medical schools develop a clear set of competencies related to student in the EHR which medical students must achieve prior to graduation in order to ensure they are ready for clinical practice.

Opportunities and Challenges in Integrating Electronic Health Records Into Undergraduate Medical Education: A National Survey of Clerkship Directors

Background: Few studies have reported on the utilization and the effect of electronic health records on the education of medical students. Purpose: The purpose of this study was to describe the current use of electronic health records by medical students in the United States and explore the opportunities and challenges of integrating electronic health records into daily teaching of medical students. Methods: A survey with 24 questions regarding the use of electronic health records by medical students was developed by the Alliance for Clinical Educators and sent to clerkship directors across the United States. Both quantitative and qualitative responses were collected and analyzed to determine current access to and use of electronic health records by medical students. Results: This study found that an estimated 64% of programs currently allow student use of electronic health records, of which only two thirds allowed students to write notes within the electronic record. Overall, clerkship directors’ opinions on the effects of electronic health records on medical student education were neutral, and despite acknowledging many advantages to electronic health records, there were many concerns raised regarding their use in education. Conclusions: Medical students are using electronic health records at higher rates than physicians in practice. Although this is overall reassuring, educators have to be cautious about the limitations being placed on students documentation in electronic health records as this can potentially have consequences on their training, and they need to explore ways to maximize the benefits of electronic health records in medical education.

Long-Term Gain After Team-Based Learning Experience in a Pediatric Clerkship

Background: Team-based learning (TBL) increases student engagement, value of teamwork, and performance on standardized evaluations. Purpose: The authors implemented a 3rd-year pediatric TBL curriculum, evaluating its effect on satisfaction, engagement, value of teamwork, and short-term and long-term academic performance. Method: Students evaluated the TBL curriculum and core lectures through satisfaction, engagement and value of team surveys. Scores on short-term and long-term examinations were compared to historical data. Results: The first implementation year, students were less likely to enjoy TBL sessions compared to lectures. The 2nd year, this difference lessened. Through both years, students reported dramatic increases in classroom engagement during TBL compared to lecture. Students developed a greater value for teams after participating in TBL. Short-term and long-term examination scores improved significantly. Conclusions: Both short-term and long-term performance improved with implementation of TBL, emphasizing the benefits of a curriculum that allows students to critically engage with material.

Use of simulated electronic mail (e-mail) to assess medical student knowledge, professionalism, and communication skills.

Background Physicians communicate with patients using electronic mail (e-mail) with increasing frequency. Communication skills specific to e-mail do not appear to be taught explicitly in medical school. Therefore, the effect of an instructive session on effective e-mail communication was examined. Method Four simulated e-mails from a parent were developed. Students responded to an initial e-mail and then participated in a session on effective e-mail communication. Responses to a final e-mail were assessed using a rubric with subscores for medical knowledge, communication, and professionalism. Results Performance improved from the first to final e-mail response in the overall score and in each subscore. Improvement was sustained over the course of the academic year. Interrater reliability revealed good agreement. Conclusions Communicating effectively with patients via e-mail is not intuitive but can be taught. It is feasible to introduce responses to a simulated e-mail case in a clinical clerkship as an assessment tool.

Faculty reflections on the implementation of socio‐cultural eportfolio assessment tool

Electronic portfolios (eportfolios) are increasingly used to assess student development. The degree to which faculty in North American medical schools are confident in their ability to evaluate such materials and their perceptions of the utility of eportfolios are unclear. Thirteen medical educators developed skills necessary to critically assess students’ reflective essays. Qualitative methods were used to explore faculty experiences with a socio‐cultural eportfolio. Despite self‐perceptions of being novice users, faculty were willing to engage with the eportfolio and assume an unfamiliar role in guiding medical students’ personal reflections. Additionally, we uncovered unique faculty expectations regarding the quality of students’ essays and their thoughts about the utility of an eportfolio as an assessment tool. Our findings indicate that given adequate time and training, faculty will use an eportfolio. They believe it is an effective method for both longitudinal assessment of student learning and achieving curricular objectives. Our findings also illustrate the numerous unintended ethical challenges faculty encounter as they engage in student assessment.

Students' educational experiences and interaction with residents on night shifts

The purpose of this mixed‐methods study was to investigate whether increased night shifts for students on paediatric rotations had any negative impact on their overall quality of educational experiences in light of the implementation of duty‐hour restrictions.