Emergency Medicine, Stanford University, Palo Alto, California, USA.
Centre for Education Research and Innovation, Health Sciences Addition, Western University Schulich School of Medicine, London, Ontario, Canada.
Med Educ. 2020 Aug;54(8):738-747. doi: 10.1111/medu.14147. Epub 2020 Apr 3.
The electronic health record (EHR) has been identified as a potential site for gathering data about trainees' clinical performance, but these data are not collected or organised for this purpose. Therefore, a careful and rigorous approach is required to explore how EHR data could be meaningfully used for assessment purposes. The purpose of this study was to identify EHR performance metrics that represent both the independent and interdependent clinical performance of emergency medicine (EM) trainees and explore how they might be meaningfully used for assessment and feedback.
Using constructivist grounded theory, we conducted 21 semi-structured interviews with EM faculty members and residents. Participants were asked to identify the clinical actions of trainees that would be valuable for assessment and feedback and describe how those activities are represented in the EHR. Data collection and analysis, which consisted of three stages of coding, occurred iteratively.
When faculty members and trainees in EM were asked to reflect on the usefulness of using EHR performance metrics for resident assessment and feedback they expressed both widespread support for the idea in principle and hesitation that aspects of clinical performance captured in the data would not be representative of residents' individual performance, but would rather reflect their interdependence with other team members and the systems in which they work. We highlight three categorisations of system-level interdependence - medical directives, technological systems and organisational systems - identified by our participants, and discuss strategies participants employed to navigate these forms of interdependence within the health care system.
System-level interdependence shapes physicians' performances, and yet, this impact is rarely corrected for or noted within clinical performance data. Educators have a responsibility to recognise system-level interdependence when teaching and consider system-level interdependence when assessing the performance of trainees in order to most effectively and fairly utilise the EHR as a source of assessment data.
电子健康记录（EHR）已被确定为收集关于受训者临床表现数据的潜在场所，但这些数据并未为此目的进行收集或组织。因此，需要采取谨慎和严格的方法来探索如何有意义地使用 EHR 数据进行评估。本研究的目的是确定代表急诊医学（EM）受训者独立和相互依存临床表现的 EHR 绩效指标，并探讨如何将其有意义地用于评估和反馈。
使用建构主义扎根理论，我们对 EM 教师和住院医师进行了 21 次半结构化访谈。要求参与者确定对评估和反馈有价值的受训者临床行为，并描述这些活动如何在 EHR 中得到体现。数据收集和分析由三个编码阶段的迭代组成。
当 EM 的教师和住院医师被要求反思使用 EHR 绩效指标进行住院医师评估和反馈的有用性时，他们原则上普遍支持这一想法，但犹豫不决的是，数据中捕获的临床表现方面是否代表住院医师的个人表现，而是反映他们与其他团队成员和他们工作的系统的相互依存关系。我们强调了我们的参与者确定的三种系统级相互依存关系的分类 - 医疗指令、技术系统和组织系统 - 并讨论了参与者在医疗保健系统中采用的策略来应对这些形式的相互依存关系。
系统级相互依存关系塑造了医生的表现，但在临床表现数据中，这种影响很少得到纠正或注意。教育工作者有责任在教学中认识到系统级相互依存关系，并在评估受训者的表现时考虑系统级相互依存关系，以便最有效地、公平地利用 EHR 作为评估数据的来源。
