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; clinical skills training; communication skills; curricular development; patient-centered care.

Figure 1.

Applying Kolb’s experiential learning cycle to teach patient-centered electronic health record (EHR) use. We based our curriculum on Kolb’s experiential learning cycle.¹⁷ Second-year students (MS2s) participated in a ‘concrete experience’ by watching a ‘trigger tape’ video and engaged in ‘reflective observation’ during a structured video-debrief discussion. They attended a lecture introducing key concepts for ‘abstract conceptualization’ and participated in a Group Observed Structured Clinical Examination (GOSCE) for ‘active experimentation.’