Why some medical schools don't teach students how to use EHRs

A lack of educational mandate is one reason that many medical schools do not teach their students how to use electronic health record (EHR) systems, even though use of the systems is increasing in the practice of medicine.

So say two studies from the Alliance for Clinical Education (ACE) appearing in the journal Teaching and Learning in Medicine.

The organization, which has a membership of education leaders from a variety of medical specialties, was formed to enhance the clinical instruction medical students receive, and it favors students receiving training on how to document in EHRs.

About 64% of educational programs let students use EHRs, but only two-thirds of them allowed students to write notes in them, according to one of the studies,  “Opportunities and challenges in integrating electronic health records into undergraduate medical education: A national survey of clerkship directors ,” citing a survey the alliance developed. Although medical students are using EHRs at higher rates than practicing physicians, educators must be careful that the limits they place on students’ use of EHRs does not restrict training, the authors maintain.

The ACE recommends that accrediting bodies such as the Liaison Committee for Medical Education include stronger language in their educational guidelines to ensure compliance so that medical students receive the EHR training and resources they need.

“Previously, students were just able to pick up a physical patient chart,” says Maya M. Hammoud, MD, lead author of the study and associate professor of obstetrics and gynecology at the University of Michigan Medical School. “Now they need permission to use hospital computers and passwords to access the EHR.” She says Medicare rules regarding a physician’s use of a trainee’s findings in the EHR are also a concern.

The other study, “Medical student documentation in electronic health records: A collaborative statement from the Alliance for Clinical Education," includes practice guideline recommendations from the organization:

• Students must document in the patient’s chart, and their notes should be reviewed for content and format.

• Students must have the opportunity to practice order entry in an EHR-in actual or simulated patient cases-before graduation.

• Students should be exposed to using the decision aids that typically accompany EHRs.

• Schools must develop a set of medical student competencies related to charting in the EHR.

"Schools have a responsibility to graduate students with the expertise and sense of duty in the basics of practice. The EHR is now part of that skill set,” says Lynn Cleary, MD, president of the ACE and professor of medicine at Upstate Medical University at the State University of New York. “We found a large majority of students are allowed to write traditional notes in the EHR. Although this is an encouraging finding overall, concerns remain over those who do not allow students to use it and those who do not consider these notes part of the official medical record."

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