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Rationale In their future practices, medical students will see patients in technology-enhanced clinical settings, but unfortunately, they are inadequately trained for this type of practice. To use this technology effectively, students must learn to find and integrate new information while they are seeing patients. Fortunately, personal digital assistants and wireless tablet PCs with Internet capabilities provide rapid access to clinical resources. This technology allows just-in-time learning which was previously impractical. The purpose of this project was to improve medical students' abilities to find and integrate clinical information during patient encounters. We redesigned a highly rated required Family Medicine course, based on the changing landscape of medical practice, to provide students with the tools and experiences needed to improve their abilities to find and integrate clinical information.
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Implementation (pedagogy) The Family Medicine clerkship is a 6-week course where junior medical students see patients under supervision, have didactic lectures, and attend case-based discussions. We provide students the opportunity to access Internet-based resources, such as DynaMed, UpToDate, the US Preventative Services Task Force, and the Center for Disease Control, during live patient care, with an expert faculty member. We redesigned case-based discussions to include exercises that required students to find and integrate new information in order to manage the patient case. For example, when studying coronary artery disease, students access a risk calculator to guide their recommendations for specific patients. We designed a standardized patient case to evaluate students' abilities to find and integrate new information during a patient visit and are studying how our educational interventions effect this set of skills.
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Implementation (technology) Security (privacy of patients' health information) was the most challenging barrier to implementation. At Kansas University Medical Center, we utilize Bluesocket wireless security to protect private patient information. Used in conjunction with the Meetinghouse Aegis Client, students can authenticate wirelessly from any enabled tablet, allowing access to patient information via our Centricity electronic health record. Students gain access to Centricity via Microsoft terminal services so that no confidential information remains on the devices.
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Impact on Teaching Our teaching strategies changed to take advantage of mobile access to medical information in the classroom and clinics. We redesigned our didactic series to include cases that required students to find and integrate new information to solve clinical problems. In the clinic, faculty taught students to use an electronic health record and share electronic information with patients in an examination room. The culture in our student clinic changed to one that encouraged inquiry and sharing of knowledge between students and knowledge because we had the tools to find information quickly.
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Impact on Student Learning One Year Ago - We had inadequate hardward and technology infrastructure. Students had limited access to Internet-based resources in our clinical practice and classroom. We had no instruments to measure if students were able to find and integrate information in real time. Today - We have adequate hardware and technology infrastructure. Students have access to patient information and medical resources. Students practice finding and integrating information during real patient sessions and case-based discussions. We created a standardized patient exercise to assess these skills. One Year From Now - We plan to adapt our real time instructional methods to highlight the importance of using technology for every patient at every encounter. We hope to see >80% of students find and integrate new information during standardized assessments. Five Years From Now - We plan to use our continued research as information for licensing and testing bodies to ensure that information technology skills are taught and assessed in all medical schools.
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Medical student Quanita Crable is using the HP Tablet PC to document an office visit under the direction of course co-director, Dr. John Delzell.
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"We prepare students for technology-enhanced medical practice. We strive to use technology with every patient at every encounter to improve patient care and student learning." ---Dr. Heidi Chumley
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Contact Us Primary Investigator: Heidi Chumley, MD Kansas University School of Medicine 3901 Rainbow Blvd. Kansas City, Kansas 66160 (913) 588-1996 [email protected] Co-Investigators: Dr. John Delzell; Michael Karr; and Dr. Hannah Maxfield; Kansas University School of Medicine
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References & Publications Publications Rouf I, Chumley H, Dobbie A. Student's view of the Electronic Health Record. BMC Medical Education, submitted/under review. Dobbie A, Chumley H, and Delzell J. Case-based exercises fail to improve medical students' information management skills: a controlled trial. BMC Medical Education 2006;6:14-20. Chumley H, Pollock M, and Dobbie A. Your practice, students, and an electronic health record. The Teaching Physician: Information technology and teaching in the office. 4(3): 3-4, 2005. Presentations Primary Care Skills for Future Physicians: Finding and Incorporating Information at the Point of Care, Slice of Life Annual Meeting, July, 2006, Lausanne, Switzerland The road to a paperless medical school curriculum, Slice of Life Annual Meeting, July, 2006, Lausanne, Switzerland Students and the Electronic Health Record: Challenges and Solutions for Ambulatory Settings; The Central Group on Educational Affairs Spring Meeting, March 2006 in Kansas City, Kansas Medical Students and your Electronic Health Record: challenges and solutions; The Society for Teachers of Family Medicine Predoctoral Meeting, February 2006, Charleston, South Carolina Residents, Medical Students and your Electronic Health Record: challenges and solutions; The Society for Teachers of Family Medicine Annual Meeting, April, 2006, San Francisco, California Learners and your Electronic Health Record: challenges and solutions; Annual Workshop for Directors of Family Medicine Residencies, June, 2006, Kansas City, Missouri And submitted for presentation The Impact of an Electronic Health Record on Outpatient Learning: A pilot study of students' perceptions; Society of General Internal Medicine Annual Meeting, April 2006 in Los Angeles, California
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Quick Facts Dept: Family Medicine, Kansas University School of Medicine Courses Impacted: Family Medicine 950 # Students Impacted: Approximately 120/year # Faculty Involved: 4
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