Letters to the Editor
To the Editor
In their recent article, Tierney et al1 discuss potential roles of the electronic medical record (EMR) in developing core competencies, including interpersonal and communication skills. We agree that the EMR is an essential tool in developing this competency, and we share the authors’ concern that limiting students’ EMR use to templates and copy/paste functions impairs the development of clinical reasoning and documentation skills. These skills cannot be developed if students are denied access to the EMR and the ability to document in a meaningful manner.
Many medical schools are not fully including students in the EMR.2,3 It is our experience that often this is because of individual institutions’ interpretation of the Centers for Medicare and Medicaid Services (CMS) guidelines. In an effort to achieve compliance, some schools are denying students any access beyond documenting the review of systems and/or past family/social history; other schools limit students to read-only access. While there must be close attention paid to how students’ EMR documentation is used by physicians, CMS guidelines clearly state: “Students may document services in the medical record”4 [emphasis added].
The Association of American Medical Colleges states that student documentation of patient encounters serves an essential function and is an important educational outcome.5 With mounting work hours restrictions, it is important that schools make the process of patient care more efficient with all team members contributing to their fullest ability.
Student learning should not be sacrificed out of inappropriate fear of compliance rules. Institutions can remain in com pliance with CMS guidelines without limiting students’ ability to document and, by extension, develop necessary clinical reasoning and documentation skills. We agree with the Alliance for Clinical Education that “students must document in the patient’s chart” and that there should be a “call for a unified policy among medical educators regarding medical student documentation in”6 EMRs.
Karly Pippitt, MD
Director, Medical Student Education in Family Medicine, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah; firstname.lastname@example.org.
Adam Stevenson, MD
Associate dean for student affairs, University of Utah School of Medicine, Salt Lake City, Utah.
Wayne Samuelson, MD
Vice dean for education, University of Utah School of Medicine, Salt Lake City, Utah.
1. Tierney MJ, Pageler NM, Kahana M, Pantaleoni JL, Longhurst CA. Medical education in the electronic medical record (EMR) era: Benefits, challenges, and future directions. Acad Med. 2013;88:748–752
2. Mintz M, Narvarte HJ, O’Brien KE, Papp KK, Thomas M, Durning SJ. Use of electronic medical records by physicians and students in academic internal medicine settings. Acad Med. 2009;84:1698–1704
3. Hammoud MM, Margo K, Christner JG, Fisher J, Fischer SH, Pangaro LN. Opportunities and challenges in integrating electronic health records into undergraduate medical education: A national survey of clerkship directors. Teach Learn Med. 2012;24:219–224
4. . Centers for Medicare and Medicaid Services. Pub 100-02 Medicare Claims Processing, Transmittal 2303. Sept 14, 2011 Baltimore, MD: CMS
5. Association of American Medical Colleges. Report I: Learning Objectives for Medical Student Education, Guidelines for Medical Schools. 1998 Washington, DC Association of American Medical Colleges
6. Hammoud MM, Dalymple JL, Christner JG, et al. Medical student documentation in electronic health records: A collaborative statement from the Alliance for Clinical Education. Teach Learn Med. 2012;24:257–266