title: Opening Residents' Notes to Patients: A Qualitative Study of Resident and Faculty Physician Attitudes on Open Notes Implementation in Graduate Medical Education.
abstract: OBJECTIVE
  OpenNotes is a growing national initiative inviting patients to read clinician progress notes (open notes) through a secure electronic portal. The goals of this study were to (1) identify resident and faculty preceptor attitudes about sharing notes with patients, and (2) assess specific educational needs, policy recommendations, and approaches to facilitate open notes implementation.
  
  
  METHODS
  This was a qualitative study using focus groups with residents and faculty physicians who supervise residents, representing primary care, general surgery, surgical and procedural specialties, and nonprocedural specialties, from Beth Israel Deaconess Medical Center and Geisinger Health System in spring 2013. Data were audio recorded and transcribed verbatim, then coded and organized into themes.
  
  
  RESULTS
  Thirty-six clinicians (24 [66.7%] residents and 12 [33.3%] faculty physicians) participated. Four main themes emerged: (1) implications of full transparency, (2) note audiences and ideology, (3) trust between patients and doctors, and (4) time pressures. Residents and faculty discussed how open notes might yield more engaged patients and better notes but were concerned about the time needed to edit notes and respond to patient inquiries. Residents were uncertain how much detail they should share with patients and were concerned about the potential to harm the patient-doctor relationship. Residents and faculty offered several recommendations for open notes implementation.
  
  
  CONCLUSIONS
  Overall, participants were ambivalent about resident participation in open notes. Residents and faculty identified clinical and educational benefits to open notes but were concerned about potential effects on the patient-doctor relationship, requirements for oversight, and increased workload and burnout.
authors.affiliation: B.H. Crotty is instructor in medicine, Division of Clinical Informatics and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. M. Anselmo is national program coordinator, OpenNotes, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. D.N. Clarke is manager for implementation, research, and evaluation, Center for Clinical Innovation, Geisinger Health System, Danville, Pennsylvania. L.M. Famiglio is chief academic officer, Graduate Medical Education, Geisinger Health System, Danville, Pennsylvania. L. Flier is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts. J.A. Green is associate physician and clinical investigator, Department of Nephrology and Center for Health Research, Geisinger Health System, Danville, Pennsylvania. S. Leveille is lecturer on medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. R. Mejilla is data analyst, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. R.A. Stametz is administrative director of innovation, research, and evaluation, Center for Clinical Innovation, Geisinger Health System, Danville, Pennsylvania. M. Thompson is associate chief academic officer, Interprofessional Education and Quality, Graduate Medical Education, Geisinger Health System, Danville, Pennsylvania. J. Walker is assistant professor of medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. S.K. Bell is assistant professor of medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Crotty
authors.forename: Melissa
authors.initials: M
authors.lastname: Anselmo
authors.forename: Deserae N
authors.initials: DN
authors.lastname: Clarke
authors.forename: Linda M
authors.initials: LM
authors.lastname: Famiglio
authors.forename: Lydia
authors.initials: L
authors.lastname: Flier
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Green
authors.forename: Suzanne
authors.initials: S
authors.lastname: Leveille
authors.forename: Roanne
authors.initials: R
authors.lastname: Mejilla
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Stametz
authors.forename: Michelle
authors.initials: M
authors.lastname: Thompson
authors.forename: Jan
authors.initials: J
authors.lastname: Walker
authors.forename: Sigall K
authors.initials: SK
authors.lastname: Bell
mesh_terms: D001291:Attitude of Health Personnel; D030881:Disclosure; D004503:Education, Medical, Graduate; D005180:Faculty, Medical; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency; D008499:Medical Records; D010817:Physician-Patient Relations; D014481:United States