By Zaiba Jetpuri, DO; Thomas Dalton, MD; Dan Sepdham, MD; Kate Bridges; Tamara McGregor, MD

Introduction
Communication between health care professionals within the electronic health record (EHR) is common and increasingly necessary for efficient and effective patient care. Medical professionals communicate frequently with providers across professional lines through the EHR, but limited curricula exists to train medical students in this critical skill.¹ In a 2009 pilot study conducted at the University of Texas Southwestern Medical Center (UTSW), researchers found that medical students need further guidance and instruction in order to display appropriate EHR skills, as they do not otherwise typically get the opportunity to practice or demonstrate these skills.² 

The purpose of this educational intervention was to introduce a standardized, simulated experience in a family medicine (FM) clerkship, with the goal of teaching students about the principles of interprofessional communication in a simulated EHR environment.

Methods
In this exploratory study, medical students at the beginning of a 4-week family medicine (FM) clerkship were asked to evaluate their understanding of electronic communication with health professionals and patients using eight Likert scale questions. The questionnaire exhibited strong reliability (α =.86). Clerkship students were also asked to complete a seven-item, multiple choice test to assess their knowledge on EHR communication (Appendix 1). Students participated in an online didactic module reviewing the importance of professional communication and interprofessional roles, and then simulated collaborative health care practices to complete weekly EHR tasks over their 4 weeks of clerkship. At the end of FM clerkship, participants completed the same confidence and knowledge evaluation posttest. Multiple choice answers were coded for correctness (1=Correct, 0=Incorrect) a paired t-test was used to compare pre vs post results.

Results
Students (N=423) completed the pretest from May 2016 throughJanuary 2018, with 378 (89.4%) participants completing both the pretest and posttest measures. Of the 378 participants, 65% had not previously engaged in communication with other professionals using an EHR system.

Medical student confidence significantly increased on all eight questions (see Table 1), indicating the intervention had a positive effect on participants’ comfort in interprofessionally using an EHR. The knowledge sum scores increased significantly (P<.001) over the course of the clerkship, and the mean increased almost a full point (pretest M=3.37, SD=.60; posttest M=4.31, SD=.48). Finally, those who scored higher on the knowledge test at the pretest were more likely to score higher on the posttest.

Table 1

Discussion
Medical students have the potential to gain confidence and knowledge about interprofessional EHR communication through skills training and practice. Though many students exhibited growth from this process, this study had several limitations. Primarily, we found the educational tool was limited in its ability to automatically message students for the weekly assignments. This made it time exhaustive and required manual input from staff. Also, since students were simulating communication with mock health professionals, they were less motivated to complete the tasks assigned as there was no immediate application of their skill and there was no evaluation of students utilizing these skills. Students also were only expected to use the educational EHR four times over the clerkship. As there was no heavy use, it is difficult to adequately assess if a student’s skill improved.

Future directions for improvement would be to implement a longitudinal simulation during the entire clerkship phase and expand the communication scenarios so they are more robust. Additionally, incorporating a method for evaluating the students over their practice sessions would allow for real-time formative feedback and create further value of the experience.  Another consideration would be to integrate this project within the Allied Health profession schools so medical students could practice interprofessional communication directly with their Allied Health student contemporaries.

Conclusion
By introducing an EHR simulation to students, medical programs have the potential to train students in a meaningful skill to enhance their future medical practice and communication with interprofessional colleagues.

References

1. Hammoud MM, Dalymple JL, Christner JG, et al. Medical student documentation in electronic health records: a collaborative statement from the Alliance for Clinical Education. Teach Learn Med. 2012;24(3):257-266. https://doi.org/10.1080/10401334.2012.692284
2. Morrow JB, Dobbie AE, Jenkins C, Long R, Mihalic A, Wagner J. First-year medical students can demonstrate EHR-specific communication skills: a control-group study. Fam Med. 2009;41(1):28-33.