9. Using the Electronic Medical Record to Precept Students

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affective preceptor series
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using the electronic medical record to
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precept students
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since the Institute of Medicine strongly
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encouraged electronic medical record use
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to improve patient safety and quality of
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care medical schools have noted
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challenges in integrating the EMR into
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clinical teaching of trainees
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what is our responsibility to medical
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students medical schools should prepare
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students for entry into residency
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including specific instruction in
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communication skills students should be
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able to access and use decision aids
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document and have notes reviewed in the
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EMR the education of students within the
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scope falls upon preceptor to ensure
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effective and appropriate practice and
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preparation for residency
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orienting the learner whether in the
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ambulatory outpatient setting or
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inpatient unit assessment of a student’s
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knowledge and prior utilization of an
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EMR at the start of teaching sessions is
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important
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ensure students have appropriate access
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and guide them through the process of
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finding important data
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medical students can be taught to review
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patient records prior to the start of
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clinic or before rounds including a
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review of vital signs input and outputs
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morning lab results nursing entries
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consultant reports and any overnight
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events
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finally explicit instruction on what the
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student can and cannot do in terms of
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writing notes or orders should be
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spelled out at the beginning of the
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rotation
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a see GME competencies
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the EMR presents an excellent
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opportunity for educators to incorporate
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it to use both of the teaching tool and
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an assessment tool let’s review some of
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the basic competencies that should be
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achieved throughout the rotation
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and care students should be able to
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access vital signs nursing notes allied
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health notes social work notes
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consultation notes and pharmacy
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information
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knowledge
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this learners can improve acquisition of
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key elements in the history by using
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templates for particular diseases
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many EMR systems also allow for access
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to medical literature which can be
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utilized before and after a patient
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encounter
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personal and communication skills the
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EMR provides an opportunity for faculty
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to model how to effectively build
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therapeutic relations while documenting
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in the EMR
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the computer or EMR should be introduced
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and incorporated in a meaningful way
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place the computer in a position so that
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the physician or student is able to face
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the patient while entering data as well
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as show the patient information on the
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computer screen
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teach the student to involve patients in
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their care by using the EMR as a
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teaching tool systems based practice the
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electronic medical record can be used to
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help teach students optimization of
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resources and teamwork within the
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healthcare system
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a great way to introduce this concept is
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by having the student review prior labs
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obtained by other providers before
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recommending additional tests
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more complex tests can also be performed
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such as reviewing patient outcome data
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for quality improvement research or
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outreach
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practice based learning and improvement
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preceptors can use EMR to teach learners
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to investigate and evaluate their care
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of patients for example a provider may
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query the system for a percentage of
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satisfactory collection of endocervical
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cells
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evaluation the rhyme scheme can be
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systematically applied to teaching and
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evaluating EMR specific skills using
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ACGME core competencies
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reporter Records own finding rather than
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cut and paste reviews medical history in
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EMR for relevant conditions
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interpreter independently constructs
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problem lists discusses clinical
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assessment and diagnostic possibilities
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manager inserts images and text into EMR
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to complement a plan
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educator uses embedded clinical support
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tools to access current evidence related
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to patient care
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although the rapid incorporation of EMR
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into clinical care has raised concerns
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such as being a barrier to student
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involvement in patient care
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there are numerous opportunities to
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enhance and facilitate student education
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EMR can improve the efficiency in which
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learners retrieve patient data enhance
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their fund of knowledge teach
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cost-effective care and allow for
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evaluation of student performance
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[Music]
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you