A novel approach to supporting relationship-centered care through electronic health record ergonomic training in preclerkship medical education.
OBJECTIVE
How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion ("EHR ergonomics")?


METHODS
Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a presurvey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encounter in each of four regularly scheduled Doctoring (clinical skills) course sessions. One group received additional ergonomic training in each session. Ergonomic assessment data were collected from students, faculty, and SPs in each session. A postsurvey was administered to all students, and data were compared across all three groups to assess the impact of EHR use and ergonomic training.


RESULTS
There was a significant positive effect of EHR ergonomics skills training on students' relationship-centered EHR use (P<.005). Students who received training reported that they were able to use the EHR to engage with patients more effectively, better articulate the benefits of using the EHR, better address patient concerns, more appropriately position the EHR device, and more effectively integrate the EHR into patient encounters. Additionally, students' self-assessments were strongly corroborated by SP and faculty assessments. A minimum of three ergonomic training sessions were needed to see an overall improvement in EHR use.


CONCLUSIONS
In addition to replication of these results, further effectiveness studies of this educational intervention need to be carried out in GME, practice, and other environments.
Dr. Silverman is chair and professor, Department of Biomedical Informatics, and professor, Departments of Family and Community Medicine and Bioethics and Medical Humanism, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, and clinical professor of biomedical informatics, Arizona State University, Tempe, Arizona. Dr. Ho is research manager, Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee. Dr. Kaib is assistant director, Doctoring Program, and assistant clinical professor, Department of Family and Community Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona. Dr. Ellis is behavioral health director, Scottsdale Healthcare Family Medicine Residency and Scottsdale Healthcare NOAH (Neighborhood Outreach Access to Health) clinics, Scottsdale, Arizona, and instructor, Department of Family and Community Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona. Dr. Moffitt is director, Doctoring Program, and associate professor of internal medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona. Dr. Chen is assistant professor, Departments of Biostatistics and Biomedical Informatics, Vanderbilt University, Nashville, Tennessee. Ms. Nian is a biostatistician, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee. Dr. Gadd is professor and vice chair for educational affairs, Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Howard
H
Silverman
Yun-Xian
YX
Ho
Susan
S
Kaib
Wendy Danto
WD
Ellis
Marícela P
MP
Moffitt
Qingxia
Q
Chen
Hui
H
Nian
Cynthia S
CS
Gadd
D000328:Adult; D001130:Arizona; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D057286:Electronic Health Records; D006804:Ergonomics; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D012647:Self-Assessment