Effective Resident EHR Training Hinges on Personal Initiative

According to a study published in JAMIA, a willingness to learn on the job by asking questions was important for resident development in EHR use and clinical documentation.  

Researchers conducted qualitative semi-structured interviews with 32 residents and 13 clinic personnel at an internal medicine residency program.

Enhanced EHR training during residency programs can improve EHR efficiency, allowing residents to spend more time developing clinical knowledge and improving patient care quality.

However, increasing documentation requirements from payers and regulators impose significant time and effort costs on residents. Therefore, the authors emphasized that resident EHR training must include general EHR use skills development and documentation skills development.

While research on resident EHR training practices is scarce, with a recent literature review finding just four studies on training residents to leverage EHR systems properly, one challenge is balancing time demands to provide specific learning events.

Through their qualitative study, the researchers found that learning effective EHR use is a combination of planned interventions on the part of residency programs and personal initiative to learn on the part of residents.

“Specifically, while onboarding training can provide an entry base of knowledge, ongoing opportunities for learning are essential to effective clinical skills development; opportunities that include formalized mentoring relationships between senior and junior residents and creating a culture where residents feel comfortable asking questions from any clinic personnel,” the researchers wrote.

For instance, medical assistants (MAs) and residents in the study noted that MAs have direct visibility into challenges that residents experience with completing EHR documentation requirements.

“Clinic rotations in residency programs should therefore foster closer relationships between MAs and residents to enable the MAs to guide and train residents as these issues are evidenced,” the authors suggested.

Encouraging residents to engage with one another to share EHR best practices can also lead to skill gains and increased initiative to share knowledge with peers.

With most hospitals and physician’s offices leveraging EHRs to manage patient health data and payers moving to performance and outcome-based compensation models, documentation requirements for physicians have increased significantly in recent years.

For residents, this means reduced clinical skill development time, less patient engagement, and longer workdays, potentially contributing to burnout.

“Given that EHR systems are here to stay, actionable solutions for residency programs are necessary to address these challenges,” the authors emphasized.

They suggested that one option would be to empower patients to take a more active role in their care.

Residents in the study often felt overwhelmed by EHR alerts to document quality measures during patient visits for acute problems. Ideally, providers should address quality measures during annual wellness visits. Prompting patients to schedule and keep annual wellness visits would allow residents to stay focused on the focal problem for acute care visits.

“That would also have the added benefit of giving the resident time to develop personalized preventive care plans for more of their patients, which could improve health outcomes for those patients and further develop the resident’s clinical skills,” the researchers pointed out.

“Enabling and prompting patients to provide information for quality measures documentation ahead of visits would be another way to shift some documentation burden from residents as well as empower patients to take more ownership of their care,” they added.

Providers could leverage patient portals for this purpose by sending patients a pre-visit questionnaire that included quality measures questions with a video explaining how to complete the documentation and why there is value in that activity.