Measuring the Clinical Learning Environment for Residents Using EHR Data
by Mark Olaf, D.O. | August 13, 2024
Article Citation: Lees AF, Beni C, Lee A, Wedgeworth P, Dzara K, Joyner B, Tarczy-Hornoch P, Leu M. Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review. Acad Med 2023; 98(11):1326–1336. DOI: 10.1097/ACM.0000000000005288
What is this article about?
In an effort to embrace competency-based medical education, researchers have explored use of the electronic health record (EHR) to evaluate the six core competencies of graduate medical education (GME). This first-ever systematic review of studies using the EHR to evaluate the six core competencies found 86 original research articles meeting two criteria: 1) secondary use of patient care data for 2) evaluation of a GME trainee (resident or fellow). Sixteen themes were derived from the data, which encompassed five of the GME core competencies, notably not including interpersonal communication. The authors propose a digital learning cycle that includes EHR data to augment other methods of trainee assessment, using the framework of Kolb’s model of experiential learning. They provide examples of benefits and challenges to use of EHR to this purpose, for evaluation and assessment of individuals, as well as trends within the health system or training program, gaps in trainee exposure to certain health conditions or patient populations, and wellness related issues such as work hours.
Why should you read the article?
Refining competency-based assessment is an ongoing and evolving process. This article summarizes prior work that has explored EHR data mining for the purpose of competency assessment and provides a map of work already accomplished and highlights areas of success and opportunity. As the EHR is an untapped or underutilized resource that already exists for evaluating learners’ clinical competency, readers can use this article to identify their own opportunities and approaches to implementation. The reader will see how the EHR can provide a novel perspective into competency assessment which can augment or enhance more traditional methods such as direct observation of clinical care, simulation, and standardized patients.
How can you use this article?
Medical educators should consider piloting the implementation of similar approaches to use of EHR data in evaluation of undergraduate medical education (UME). Educators should also consider developing longitudinal partnerships with informaticists as the ideal way in which they can explore EHR data to improve learner assessment. Additionally, this approach underscores the necessity of allowing health professions learners, including medical students, to have EHR access and an appropriate allowable level of engagement with the medical record, such as writing billable student notes, so that they may practice, develop, and be assessed in competencies from multiple perspectives. Accessing and data mining the EHR at the UME level is a potentially untapped area of interest that should be further explored.
Review Author: Mark Olaf, D.O., Associate Professor of Emergency Medicine and Vice Chair of Emergency Medicine Education; Associate Regional Dean, Geisinger Commonwealth School of Medicine, Danville, PA. Organization: Clerkship Directors in Emergency Medicine