title: Discrepancies between perceptions of students and deans regarding the consequences of restricting students' use of electronic medical records on quality of medical education.
abstract: BACKGROUND
  Electronic medical records (EMR) are more used in university hospitals, but the use of EMR by medical students at the workplace is still a challenge, because the conflict of interest between medical accountability for hospitals and quality of medical education programs for students. Therefore, this study investigates the use of EMR from the perspective of medical school deans and students, and determines their perceptions and concerns about consequences of restricted use of EMR by students on quality of education and patient care.
  
  
  METHODS
  We administered a large-scale survey about the existence of EMR, existing policies, students' use for learning, and consequences on patient care to 42 deans and 789 Residency Physician Applicants in a private university in Colombia. Data from 26 deans and 442 former graduated students were compared with independent t tests and chi square tests.
  
  
  RESULTS
  Only half of medical schools had learning programs and policies about the use of EMR by students. Deans did not realize that students have less access to EMR than to paper-based MR. Perceptions of non-curricular learning opportunities how to write in (E)MR were significantly different between deans and students. Limiting students use of EMR has negative consequences on medical education, according to both deans and students, while deans worried significantly more about impact on patient care than students. Billing issues and liability aspects were their major concerns.
  
  
  CONCLUSIONS
  There is a need for a clear policy and educational program on the use of EMR by students. Discrepancies between the planned curriculum by deans and the real clinical learning environment as experienced by students indicate suboptimal learning opportunities for students. Creating powerful workplace-learning experiences and resolving concerns on students use of EMR has to be resolved in a constructive collaboration way between the involved stakeholders, including also EMR designers and hospital administrators. We recommend intense supervision of students' work in EMR to take full advantage of the technological advances of EMR at the modern clinical site, both for patient care and for medical education.
authors.affiliation: Pontificia Universidad Javeriana School of Medicine, Hospital Universitario San Ignacio, Carrera 7 40-62, Bogota, Colombia. solarte@javeriana.edu.co.
authors.forename: Ivan
authors.identifier: http://orcid.org/0000-0002-0100-1940
authors.initials: I
authors.lastname: Solarte
authors.affiliation: Department of Educational Development & Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
authors.forename: Karen D
authors.initials: KD
authors.lastname: Könings
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003105:Colombia; D004501:Education, Medical / Q000379:methods* / Q000592:standards; D057286:Electronic Health Records; D005180:Faculty, Medical / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D016134:Organizational Policy; D012577:Schools, Medical / Q000458:organization & administration*; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Clerkships; Electronic health records; Electronic medical records; Stakeholders; Student perceptions; Undergraduate medical education; Workplace learning; e-learning