1. Embracing the elephant in the room: Teaching students to integrate the EHR into doctor- patient communication Jay B. Morrow, DVM, MS Scott Kinkade, MD, MSPH Alison Dobbie, MD, MRCGP STFM Annual Meeting, Baltimore, MD, April 29 – May 3 The University of Texas Southwestern Medical Center, Dallas, Texas

2. Background  All graduating medical students will practice using EHRs  Medical students concerned about impact of EHR on doctor-patient relationship 1  No published curricula guiding EHR-specific communication for students  Four thematic areas influencing EHR communication in physician-patient encounters: Geographical, Relational, Educational and Structural 2

3. Objectives  Design and test methods to teach first-year medical students to optimally integrate EHRs into physician-patient communication in ambulatory encounters  Research questions: 1. Do first year medical students spontaneously demonstrate EHR-specific communication skills? 2. If not, can they be taught to do so with a brief educational intervention?

4. Study Design 3 Sessions 2 weeks apart Control Group (n=8) Intervention Group (n=9) Session 1 Received standard EHR Training Session 2 Practiced history role- playing and entering into EHR Practiced history role-playing and entering into EHR, along with integrative behaviors training session Session 3 SP case with evaluation and feedback

5. SP Case  A middle-aged SP who expressed a wish to lose weight  Minimal medical content knowledge needed  Students instructed to ‘take and document an HPI in the EHR’  SPs graded students on standard communication skills AND EHR-specific skills

6. SP checklist items  Please see the two checklists on the yellow handout

7. Evaluation / Statistics  Comparison of group scores on individual general and EHR-specific checklist items using Chi Square test with Y/N dichotomous data.  Stats note: Used Yates’ correction to adjust for small sample size

8. Results – please see handout

9. General Communication Skills Both groups generally scored highly, with no statistically significant differences demonstrated on 10 of 11 items.

10. EHR-Specific Communication Skills Intervention group students performed significantly better on 6 of 10 checklist items.

11. DVD comparison InterventionControl

12. Conclusions  First year medical students can learn EHR- specific communication skills early in their medical training. Our students did not spontaneously demonstrate these EHR-specific skills without instruction.  General communication skills did not correlate with HER-specific skills

13. Limitations  Small sample size for pilot  Recruited students by email Selection bias in favor of students who were electronically savvy and positively disposed towards learning the EHR. Any bias would tend to decrease differences between groups, and decrease the intervention effect.  Results apply to first year students only  No extended follow-up (12-month) to assess “stickiness” of training EHR skills  Ventres’ themes address physician/researcher perceptions, not patient perceptions

14. References Rouf, E., H. S. Chumley, et al. (2008). "Electronic health records in outpatient clinics: perspectives of third year medical students." BMC Med Educ 8: 13. Ventres, W., S. Kooienga, et al. (2006). "Physicians, patients, and the electronic health record: an ethnographic analysis." Ann Fam Med 4(2): 124-31.

15. THANK YOU! Questions?