Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Med Educ. 2012 Aug;46(8):795-806. doi: 10.1111/j.1365-2923.2012.04317.x.
Many academic medical centres (AMCs) have introduced institutional policies, changed processes of care and implemented new technologies to improve health care quality. The impact of such changes on medical education has received little attention. We examine the impact of computerised provider order entry (CPOE) on the educational experiences of medical trainees who work and train in AMCs.
We conducted semi-structured interviews of postgraduate trainees and attending physicians in internal medicine at five AMCs (two with CPOE, three without CPOE). Trainees routinely rotate from CPOE to non-CPOE AMCs, whereas some attending physicians work at both types of AMC and are therefore well positioned to reflect on differences between CPOE and non-CPOE learning environments. Data collection and analysis used grounded theory methods. We sampled purposively until we achieved theoretical saturation.
Our study included 11 residents and six attending physicians. Computerised provider order entry had both positive and negative impacts on five aspects of postgraduate training: (i) learning (better for medication interactions and availability of learning resources; worse for learning medication doses); (ii) teaching (more medication information available to enhance case discussions; fewer face-to-face teaching opportunities); (iii) feedback (improved ability to observe medication ordering behaviours to inform feedback; less provision of direct feedback); (iv) clinical supervision (facilitates efficient and safe supervision from a distance; may impede trainee independence), and (v) trainee assessment (increased opportunity to assess clinical decision-making and organisational skills).
We identify five key educational themes that are positively and negatively impacted by CPOE. These themes form a conceptual framework that could be applied to define the educational impact of other health care quality and patient safety practices. This will help educators to identify educational opportunities and protect the safety of the training experience of residents in AMCs.
许多学术医疗中心（AMC）已经出台了机构政策，改变了护理流程并采用了新技术，以提高医疗质量。这些变化对医学教育的影响却很少受到关注。我们调查了计算机化医嘱录入（CPOE）对在 AMC 中工作和培训的住院医师培训生的教育体验的影响。
我们对五家 AMC 的内科住院医师培训生和主治医生进行了半结构化访谈（两家有 CPOE，三家没有 CPOE）。住院医师通常从 CPOE 轮转至非 CPOE AMC，而有些主治医生则在两种 AMC 工作，因此能够很好地反映 CPOE 和非 CPOE 学习环境之间的差异。数据收集和分析采用扎根理论方法。我们采用目的性抽样，直到达到理论饱和。
我们的研究包括 11 名住院医师和 6 名主治医生。CPOE 对住院医师培训的五个方面产生了积极和消极的影响：（i）学习（更好的药物相互作用和学习资源可用性；药物剂量学习更差）；（ii）教学（更多的药物信息可用于增强病例讨论；面对面教学机会减少）；（iii）反馈（更好地观察药物医嘱行为以提供反馈的能力；较少的直接反馈）；（iv）临床监督（促进远程高效和安全的监督；可能会阻碍学员的独立性）和（v）学员评估（增加评估临床决策和组织能力的机会）。
我们确定了五个关键的教育主题，这些主题受到 CPOE 的积极和消极影响。这些主题构成了一个概念框架，可以应用于定义其他医疗质量和患者安全实践对教育的影响。这将帮助教育工作者识别教育机会并保护 AMC 住院医师培训体验的安全性。
