Miller Matthew E, Scholl Gretchen, Corby Sky, Mohan Vishnu, Gold Jeffrey A
Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR, United States.
Department of Medical Informatics, Oregon Health & Science University, Portland, OR, United States.
JMIR Med Educ. 2021 Mar 9;7(1):e25828. doi: 10.2196/25828.
Accurate data retrieval is an essential part of patient care in the intensive care unit (ICU). The electronic health record (EHR) is the primary method for data storage and data review. We previously reported that residents participating in EHR-based simulations have varied and nonstandard approaches to finding data in the ICU, with subsequent errors in recognizing patient safety issues. We hypothesized that a novel EHR simulation-based training exercise would decrease EHR use variability among intervention interns, irrespective of prior EHR experience.
This study aims to understand the impact of a novel, short, high-fidelity, simulation-based EHR learning activity on the intern data gathering workflow and satisfaction.
A total of 72 internal medicine interns across the 2018 and 2019 academic years underwent a dedicated EHR training session as part of a week-long boot camp early in their training. We collected data on previous EHR and ICU experience for all subjects. Training consisted of 1 hour of guided review of a high-fidelity, simulated ICU patient chart focusing on best navigation practices for data retrieval. Specifically, the activity focused on using high- and low-yield data visualization screens determined by expert consensus. The intervention group interns then had 20 minutes to review a new simulated patient chart before the group review. EHR screen navigation was captured using screen recording software and compared with data from existing ICU residents performing the same task on the same medical charts (N=62). Learners were surveyed immediately and 6 months after the activity to assess satisfaction and preferred EHR screen use.
Participants found the activity useful and enjoyable immediately and after 6 months. Intervention interns used more individual screens than reference residents (18 vs 20; P=.008), but the total number of screens used was the same (35 vs 38; P=.30). Significantly more intervention interns used the 10 most common screens (73% vs 45%; P=.001). Intervention interns used high-yield screens more often and low-yield screens less often than the reference residents, which are persistent on self-report 6 months later.
A short, high-fidelity, simulation-based learning activity focused on provider-specific data gathering was found to be enjoyable and to modify navigation patterns persistently. This suggests that workflow-specific simulation-based EHR training throughout training is of educational benefit to residents.
准确的数据检索是重症监护病房（ICU）患者护理的重要组成部分。电子健康记录（EHR）是数据存储和数据审查的主要方法。我们之前报道过，参与基于电子健康记录模拟的住院医师在ICU中查找数据的方法各不相同且不规范，随后在识别患者安全问题时出现错误。我们假设一种新型的基于电子健康记录模拟的培训练习将减少干预组实习生在使用电子健康记录方面的差异，无论其先前的电子健康记录经验如何。
本研究旨在了解一种新颖、简短、高保真、基于模拟的电子健康记录学习活动对实习生数据收集工作流程和满意度的影响。
在2018年和2019学年，共有72名内科实习生在培训初期参加了为期一周的新兵训练营，其中包括一次专门的电子健康记录培训课程。我们收集了所有受试者先前的电子健康记录和ICU经验数据。培训包括1小时对高保真模拟ICU患者病历的引导式回顾，重点是数据检索的最佳导航实践。具体而言，该活动侧重于使用由专家共识确定的高收益和低收益数据可视化屏幕。干预组实习生随后有20分钟时间在小组讨论前查看一份新的模拟患者病历。使用屏幕录制软件记录电子健康记录屏幕导航，并与在相同病历上执行相同任务的现有ICU住院医师的数据（N = 62）进行比较。在活动结束后立即以及6个月后对学习者进行调查，以评估满意度和对电子健康记录屏幕使用的偏好。
参与者在活动结束后立即以及6个月后都认为该活动有用且有趣。干预组实习生使用的单个屏幕比参考住院医师更多（18个对20个；P = 0.008），但使用的屏幕总数相同（35个对38个；P = 0.30）。显著更多的干预组实习生使用了10个最常用的屏幕（73%对45%；P = 0.001）。与参考住院医师相比，干预组实习生更频繁地使用高收益屏幕，更少地使用低收益屏幕，这种情况在6个月后的自我报告中仍然存在。
发现一项专注于特定提供者数据收集的简短、高保真、基于模拟的学习活动既有趣又能持续改变导航模式。这表明在整个培训过程中进行基于工作流程的模拟电子健康记录培训对住院医师具有教育益处。
