Teaching Medical Students to Engage Meaningfully and Judiciously With Patient Data | Electronic Health Records | JAMA Internal Medicine | JAMA Network
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Editor's Note
September 2016

Teaching Medical Students to Engage Meaningfully and Judiciously With Patient Data

JAMA Intern Med. 2016;176(9):1397. doi:10.1001/jamainternmed.2016.3886

Electronic medical records (EMRs) are now ubiquitous and proficiency in their use is a necessary component of undergraduate medical education. Clerkship directors of medical schools have set national standards for how students should learn to access, document, and write orders in an EMR.1 However, these standards minimally address how students might use their patients’ electronic information after the clinical encounter concludes.

In this issue of JAMA Internal Medicine, Brisson and Tyler2 describe survey results in which 96.1% of medical students track patients electronically after direct patient care ends, largely to confirm diagnoses, check results of pending tests, and understand what happened during their subsequent clinical course. Although this is a single-institution survey, it is reasonable to imagine that resident and medical students across the country similarly track their former patients electronically to various degrees.

When done well, medical student tracking via EMRs can benefit patients. On my inpatient teams, students who were tracking their patients were able to follow up on postdischarge diagnostic test results that altered their patients’ courses. Also, tracking enriches learning, offering students feedback on clinical questions such as, “Did we really need to order that?” or “Did we estimate her prognosis well?,” to help them develop deliberate practice patterns.

However, there are 2 important problems with medical students tracking former patients via EMRs as it is currently practiced. First, patients do not explicitly provide consent to be tracked after their care ends, a problem that physicians and students could easily address through discussion with their patients. Second, some tracking is extracurricular. The Health Insurance Portability and Accountability Act likely only permits tracking of patients for education and quality assurance.3 However, 39.8% of medical students in the study by Brisson and Tyler2 tracked former patients because they were curious about what had happened or liked the patient. Medical school informatics and EMR curricula need to teach students to engage meaningfully and judiciously with patients’ data.

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Article Information

Correction: This article was corrected on August 22, 2016, for a typographical error in the text.

Conflict of Interest Disclosures: None reported.

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(3):257-266.PubMedGoogle ScholarCrossref
Brisson  GE, Tyler  PD.  Medical student use of electronic health records to track former patients [published online July 25, 2016].  JAMA Intern Med. doi:10.1001/jamainternmed.2016.3878.Google Scholar
Brisson  GE, Neely  KJ, Tyler  PD, Barnard  C.  Should medical students track former patients in the electronic health record? an emerging ethical conflict.  Acad Med. 2015;90(8):1020-1024.PubMedGoogle ScholarCrossref