title: Medical students' observations, practices, and attitudes regarding electronic health record documentation.
abstract: BACKGROUND
  Medical students are increasingly documenting their patient notes in electronic health records (EHRs). Documentation short-cuts, such as copy-paste and templates, have raised concern among clinician-educators because they may perpetuate redundant, inaccurate, or even plagiarized notes. Little is known about medical students' experiences with copy-paste, templates and other "efficiency tools" in EHRs.
  
  
  OBJECTIVE
  We sought to understand medical students' observations, practices, and attitudes regarding electronic documentation efficiency tools.
  
  
  METHODS
  We surveyed 3rd-year medical students at one medical school. We asked about efficiency tools including copy-paste, templates, auto-inserted data, and "scribing" (documentation under a supervisor's name).
  
  
  RESULTS
  Overall, 123 of 163 students (75%) responded; almost all frequently use an EHR for documentation. Eighty-six percent (102/119) reported at least sometimes observing residents copying data from other providers' notes and 60% (70/116) reported observing attending physicians doing so. Most students (95%, 113/119) reported copying from their own previous notes, and 22% (26/119) reported copying from residents. Only 10% (12/119) indicated that copying from other providers is acceptable, whereas 83% (98/118) believe copying from their own notes is acceptable. Most students use templates and auto-inserted data; 43% (51/120) reported documenting while signed in under an attending's name. Greater use of documentation efficiency tools is associated with plans to enter a procedural specialty and with lack of awareness of the medical school copy-paste policy.
  
  
  CONCLUSIONS
  Students frequently use a range of efficiency tools to document in the electronic health record, most commonly copying their own notes. Although the vast majority of students believe it is unacceptable to copy-paste from other providers, most have observed clinical supervisors doing so.
authors.affiliation: a Department of Medicine and Augusta Webster, MD, Office of Medical Education , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Heiman
authors.forename: Sonya
authors.initials: S
authors.lastname: Rasminsky
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Bierman
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Evans
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Kinner
authors.forename: Julie
authors.initials: J
authors.lastname: Stamos
authors.forename: Zoran
authors.initials: Z
authors.lastname: Martinovich
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
mesh_terms: D002641:Chicago; D057286:Electronic Health Records; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires