Solarte Ivan, Könings Karen D
Pontificia Universidad Javeriana School of Medicine, Hospital Universitario San Ignacio, Carrera 7 40-62, Bogota, Colombia.
Department of Educational Development & Research and Graduate School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
BMC Med Educ. 2017 Mar 13;17(1):55. doi: 10.1186/s12909-017-0887-2.
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.
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.
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.
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.
电子病历（EMR）在大学医院中使用更为广泛，但医学生在工作场所使用电子病历仍然是一项挑战，因为医院的医疗责任与学生医学教育项目质量之间存在利益冲突。因此，本研究从医学院院长和学生的角度调查电子病历的使用情况，并确定他们对限制学生使用电子病历对教育质量和患者护理的影响的看法和担忧。
我们对哥伦比亚一所私立大学的42位院长和789名住院医师申请人进行了一项关于电子病历的存在情况、现有政策、学生用于学习的情况以及对患者护理的影响的大规模调查。将26位院长和442名往届毕业生的数据进行独立t检验和卡方检验。
只有一半的医学院有关于学生使用电子病历的学习项目和政策。院长们没有意识到学生获取电子病历的机会比纸质病历少。院长和学生对如何在电子病历中书写的非课程学习机会的看法存在显著差异。院长和学生都认为，限制学生使用电子病历对医学教育有负面影响，而院长比学生更担心对患者护理的影响。计费问题和责任方面是他们主要关注的问题。
需要制定关于学生使用电子病历的明确政策和教育项目。院长计划的课程与学生实际体验的临床学习环境之间的差异表明学生的学习机会不理想。必须通过包括电子病历设计者和医院管理人员在内的相关利益攸关方之间的建设性合作，来创造强大的工作场所学习体验并解决对学生使用电子病历的担忧。我们建议对学生在电子病历中的工作进行严格监督，以便在现代临床场所充分利用电子病历的技术进步，既用于患者护理，也用于医学教育。
