Automated Procedure Logs for Cardiology Fellows: A New Training Paradigm in the Era of Electronic Health Records

Anyanwu, Emeka; Mor‐Avi, Victor; Ward, R. Parker

doi:10.4300/jgme-d-20-00642.1

Cited by 6 publications

(14 citation statements)

References 11 publications

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“…Researchers consistently showed that manual procedure logging was markedly incomplete, inaccurate, or both when compared with EHR-derived logs. All articles that compared EHR-measured procedures with manual logs demonstrated incomplete capture (5 of 5 [100%]), with manual logs capturing between 50% and 76% of procedures performed, 23,25,26,28,30 despite efforts to improve manual logging through targeted reminders. 28 Three studies compared the accuracy of manually entered procedure codes with EHR codes, with rates ranging from 47% to 87%.…”

Section: Resultsmentioning

confidence: 99%

Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review

Lees

Beni²,

Lee³

et al. 2023

Academic Medicine

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Purpose This study systematically reviews the uses of electronic health record (EHR) data to measure graduate medical education (GME) trainee competencies. Method In January 2022, the authors conducted a systematic review of original research in MEDLINE from database start to December 31, 2021. The authors searched for articles that used the EHR as their data source and in which the individual GME trainee was the unit of observation and/or unit of analysis. The database query was intentionally broad because an initial survey of pertinent articles identified no unifying Medical Subject Heading terms. Articles were coded and clustered by theme and Accreditation Council for Graduate Medical Education (ACGME) core competency. Results The database search yielded 3,540 articles, of which 86 met the study inclusion criteria. Articles clustered into 16 themes, the largest of which were trainee condition experience (17 articles), work patterns (16 articles), and continuity of care (12 articles). Five of the ACGME core competencies were represented (patient care and procedural skills, practice-based learning and improvement, systems-based practice, medical knowledge, and professionalism). In addition, 25 articles assessed the clinical learning environment. Conclusions This review identified 86 articles that used EHR data to measure individual GME trainee competencies, spanning 16 themes and 6 competencies and revealing marked between-trainee variation. The authors propose a digital learning cycle framework that arranges sequentially the uses of EHR data within the cycle of clinical experiential learning central to GME. Three technical components necessary to unlock the potential of EHR data to improve GME are described: measures, attribution, and visualization. Partnerships between GME programs and informatics departments will be pivotal in realizing this opportunity.

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Section: Resultsmentioning

confidence: 99%

Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review

Lees

Beni²,

Lee³

et al. 2023

Academic Medicine

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“…Fellows self-reported femoral CVC placement attempts in MedHub which may lead to both underreporting and potential inaccuracy in the date the procedure was performed. 36 37 We did not include CVC placement attempts at other anatomic sites in our study, which likely provided additional opportunities for experiential learning in shared aspects of the procedure. HMA measurements were performed during CVC placement on a simulation task trainer rather than on actual patients, which likely led to higher levels of performance given the relatively larger vessel size and controlled environment.…”

Section: Discussionmentioning

confidence: 99%

Central Venous Catheter Placement Skill Acquisition Through Apprenticeship Training in Clinical Context during Pediatric Critical Care Medicine Fellowship: A Longitudinal Study

Good,

Miller,

Kendall

et al. 2023

J Pediatr Intensive Care

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Pediatric critical care medicine (PCCM) fellows must develop competence in central venous catheter (CVC) placement. The impact of experiential learning opportunities in the clinical context on PCCM fellow CVC placement skill acquisition remains unknown. We sought to measure femoral CVC placement skill acquisition during fellowship and compare fellow to attending skill. We performed a prospective observational cohort study of PCCM fellows at the University of Colorado from 2019 to 2021. Femoral CVC placement skill was measured by attending evaluation of level of the supervision (LOS) required for the fellow, and hand motion analysis (HMA) on simulation task trainer. Competence in femoral CVC placement was defined as LOS ≥ 4 (can perform this skill independently) on a 5-point Likert scale. We compared fellow skill in femoral CVC placement to years of training and number of femoral CVCs placed. We also compared third-year fellow and attending HMA measurements. We recruited 13 fellows and 6 attendings. Fellows placed a median of 8 (interquartile range 7, 11) femoral CVCs during the study period. All fellows who reached third-year of fellowship during the study period achieved competence. Longitudinal analysis demonstrated improvement in CVC placement skill by both LOS and HMA as years of fellowship and number of femoral CVCs placed increased. Few third-year fellows achieved attending level skill in femoral CVC placement as measured by HMA. PCCM fellows acquired skill in CVC placement during fellowship and achieved competence in the procedure, but most did not reach attending level of skill.

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“…For example, one approach was described in which the metadata needed to link a procedure were added to the documentation completed by cardiology fellows. 12 This type of approach could be expanded to record trainee involvement in a standardized way, but a concern to be addressed is the inclusion of non-clinical data (eg, the specific role of trainees involved in a case) to clinical notes.…”

Section: Discussionmentioning

confidence: 99%

“…2,10,11 Past studies identified multiple factors that resulted in increased administrative time for residents, including the ambiguity in categorizing a surgery into multiple component procedures and determining resident role for a case. 2,5 Other work has proposed automated procedure logs or clinical registries to reduce manual documentation, 12,13 but these approaches have not addressed a key issue-linking a procedure to a trainee and then transmitting the data to the ACGME. The difficulty to determine from the electronic health record (EHR) which cases are performed by a resident surgeon also makes it challenging to assess resident case log initiatives.…”

Section: Introductionmentioning

confidence: 99%

Implementation and Evaluation of Integrating an Electronic Health Record With the ACGME Case Log System

Xiao

Sikder

Woreta

et al. 2022

Journal of Graduate Medical Education

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Background It is essential to log resident-performed procedures to assess training programs and fulfill specialty requirements, but resident case numbers are often underreported. Current systems require inefficient data entry steps, and residents and fellows report that user interfaces and administrative burden contribute to logging inaccuracy. Objective To determine the accuracy, feasibility, and acceptability of a single logging approach for resident case logging. Methods In 2018, we implemented a case logging system integrated with the institutional electronic health record (EHR) and the Accreditation Council for Graduate Medical Education (ACGME) case log system to record procedures performed by ophthalmology residents. We compared the proportion of resident-performed cataract extractions in the EHR that were reported to ACGME for 3 periods: before the deployment of the new system (6 months), during the transition (6 months), and after the change (2 years). Resident satisfaction with the new system was evaluated using surveys. Results An analysis of resident cataract surgeries showed that the percentage of resident cases logged increased from 85% prior to implementation to 91% after implementation. The integrated system became the preferred case logging method, with 100% of all logged cases being entered using the new platform. Surveys showed that the percentage of trainees who were moderately or very satisfied with the case log process increased from 55% before implementation to 100% after implementation. Conclusions A resident case log system integrated with an EHR more accurately reflects resident operative volume and increases trainee satisfaction with the logging process.

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Automated Procedure Logs for Cardiology Fellows: A New Training Paradigm in the Era of Electronic Health Records

Cited by 6 publications

References 11 publications

Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review

Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review

Central Venous Catheter Placement Skill Acquisition Through Apprenticeship Training in Clinical Context during Pediatric Critical Care Medicine Fellowship: A Longitudinal Study

Implementation and Evaluation of Integrating an Electronic Health Record With the ACGME Case Log System

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