1. The EMR in Medical Education: What Role do the Students Play? Aaron J. Michelfelder, M.D., FAAFP, FAAMA Associate Professor of Family Medicine and Bioethics & Health Policy Mícheál Macken, M.D., MRCPI Assistant Professor of Neurology Kayhan Parsi, J.D., Ph.D. Associate Professor of Bioethics & Health Policy Photo from “Anonymous Med Student” blog.tiredmed.com/?p=91

2. Presenter Introductions

3. Session Objectives By the End of the Session, Participants Should be Able to: –Have an Understanding of How the EMR Impacts the Doctor-Patient Relationship –Articulate Some Strategies for Directly Using the EMR in Medical Student Education –Take Away Ideas of How to Involve Medical Students in Their Own Education Using the EMR

4. Session Outline Presentation of Loyola EMR in Medical Student Education –Introduction to PCM and the Issues – Michelfelder –First Year of Medical School – Parsi –Second Year of Medical School – Macken –Third Year of Medical School (Optional Preview) Open Forum to Share Ideas and Ask Questions Summary

5. Patient Centered Medicine PCM is a 3 year course designed for Loyola medical students to develop the skills needed to become balanced, competent, patient-centered physicians with life-long career satisfaction. Patient Centered Medicine is based on the idea that the patient is at the center of the health care team, and each member of the team has an important role to play in promoting the patient’s health and happiness.

6. Patient Centered Medicine I Aug Sept Oct Nov Dec Jan Feb Mar Apr May Core Curriculum Ethics, Justice, & Professionalism Communication Skills Interviewing/History Taking Behavioral Development Evidence Based Medicine Prevention Counseling Risk Factor Screening Integrative Medicine Cultural Medicine Nutrition Health Care Access Clinical Skills Experiential Components Physician, Student, Nurse, & Chaplain Mentor Programs SP Workshop HPI Difficult Topics Standardized Patients Combined Structure/Function Physical Exam Skills Real Patient Interviews SP Practice Exercise SP Exercise I Complete Medical History Head & Neck Thorax Abdomen Musculoskeletal PE OSCE I PE OSCE II Patient Interview I Patient Interview II Patient Interview III SP Workshop Intimate Partner Violence SP Workshop Challenging Patient-Physician Relationships SP Exercise Screening II Heart Lungs

7. Patient Centered Medicine 2 2006-2007 Aug. Oct. Nov. Dec. Jan. Feb.Mar. Jun. COMBINED SESSIONS: Neuroscience & Mechanisms of Disease CORE CURRICULUM EXPERIENTIAL COMPONENTS: PHYSICIAN MENTOR / PRECEPTORSHIP FEEDBACK SESSIONSCLINICAL SKILLS WORKSHOPS & COMPREHENSIVE SKILLS ASSESSMENT 4 COMPREHENSIVE SKILLS ASSESSMENT 3 Communication skills Interviewing/History-taking Physical exam skills Ethics & Legal issues Health Promotion/DP Clinical decision-making HC Access/Finance PE Review Neuro OSCE

8. Issues LUHS Went to EMR Phased in From 2004- 2007 Patient Satisfaction Low Patients Left Loyola – “The Doctor is More Concerned about the Computer than Me!” Students Notice the Change in Doctor Patient Relationship

9. Issues Physicians Trained Only in Technical Aspects of EMR Use Only Third and Fourth Year Medical Students Trained in EMR and Only in Technical Aspects

10. Issues PCM Course Administration –We Have Responsibility to Train Years 1 and 2 to Use the EMR –We Are Unsure of How Best to Use the EMR in the Clinical Encounter Asked First Year Students To Help –Almost “Lay” View of Medicine –But With Some Medical Enculturation

11. PCM Project Year 1 First Year of Medical School – Semester 1 –Students Assigned to Physician and Student Mentors –Students Asked to Observe Mentor Encounters With Patients While Using the EMR –Observations Discussed in Weekly Small Groups –As the Students Learned To Take a Medical History, Discussed How Using the EMR Might Have an Impact

12. PCM Project Year 1 Health System IT People Created 5 “Dummy” Patients in Production System Students Given Access Limited to Those 5 Patients Only, and Their Note Only

13. PCM Project Year 1 First Year of Medical School – Semester 2 –All 15 Small Groups with 140 Students Came Up With Lists of Ideas of How to Use the EMR and Still Maintain Rapport –Examples: Turn the Computer Toward the Patient Introduce the Computer to the Patient Push Away from the Computer When Discussing Sensitive Topics

14. PCM Project Year 1 First Year of Medical School – Semester 2 –Lists From All 15 Groups Collated and Combined to 24 Items –Standardized Patients Trained to Recognize the Techniques –Students Entered SP Encounter and Had to Use the EMR While Taking a History to Take Notes –Students Finished Note After Exercise and Printed Out for Feedback –SP, Peer, and Self all Gave Feedback on the Techniques Used

15. PCM Project Year 1 Students and SPs Felt was Valuable Exercise Students Enjoyed Being Asked to Help With This Project Results of the Techniques Used is Pending

16. PCM Project Year 2 Students Given Access to a Cohort of Dummy Patients Will Follow Patients Through Year 2 in the EMR Collaboration Among PCM 2, Mechanisms of Human Disease (Pathology), and Therapeutics

17. PCM Project Year 2 As Students Learn About CV Disease in MHD, Will Learn How to Read EKG in PCM2 Will Log in to EMR, Find Patient and Notice The Patient is Admitted for Chest Pain –Students Will Need to Read EKG, CXR –Will Discuss in PCM 2 Small Group The Next Week

18. PCM Project Year 2 Will Start With AY 07-08 Had to Pre-Load EKGs, X-Rays, CTs, Lab Test IT Needed to Figure Out How to Release Information Only When Needed Some Faculty May Not Have Access to Loyola EMR (They May Be From Other Institutions)

19. EMR Project Year 3 Top Secret Preview

20. Things to Think About Politics Who Controls the EMR? Environment to Create in the EMR Level of Access for Students All Students Will Need Access and Training You Need A Lot of IT Support

21. Group Discussion Please Tell Us Who You Are and Where You Are From We Are Open to Questions and Comments Please Share Your Thoughts and Ideas With The Group

22. Summary

23. Thank You!!

24. Patient Centered Medicine Katherine Walsh, M.D. – Senior Course Director PCM 1 –Aaron Michelfelder, M.D. – Course Director –Micheal Macken, M.D. – Co-Course Director –Kayhan Parsi, J.D., Ph.D. – Co-Course Director –Ms. Diane Stancik – Educational Specialist PCM 2 –Michael Koller, M.D. – Course Director –Mary Boyle, M.D. – Co-Course Director –Mr. Lester Medley – Education Specialist PCM 3 –Eva Bading, M.D. – Co-Course Director –Mark Kuczewski, Ph.D. – Co-Course Director –Ms. Sandra Cavalieri – Education Specialist