The Effect of Computerized Provider Order Entry on Medical Students’ Ability to Write Orders

Knight, Amy M.; Kravet, Steven J.; Kiyatkin, Dmitry; Leff, Bruce

doi:10.1080/10401334.2012.641490

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…In a previous study, order sets also increased residents’ comfort level with symptom management in palliative care [ 8 ]. In the undergraduate setting, pneumonia admission order-writing skills among medical students trained at hospitals using computerized provider order-entry (CPOE) compared to those using handwritten orders were no different [ 9 ]. However, the effect of order sets on resident knowledge and order-writing skills has not previously been reported.…”

Section: Introductionmentioning

confidence: 99%

The effect of patient care order sets on medical resident education: a prospective before-after study

Stephenson

Gupta

2013

BMC Med Educ

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BackgroundPatient care order sets are increasingly being used to optimize care. While studies have evaluated the impact of order sets on provider performance and patient outcomes, their impact on postgraduate medical trainee knowledge remains unknown. We sought to evaluate the impact of order sets on respirology knowledge, order-writing skills, and self-reported learning.MethodsWe conducted a prospective before-after study. Postgraduate trainees completing a Respirology rotation at a quaternary-care hospital 6 months before (no order set period) and 12 months after (order set period) order set introduction. Guideline-based admission order sets with educational prompts detailing recommended management of cystic fibrosis and chronic obstructive pulmonary disease were implemented on the respirology ward. Each resident completed a test before and after the rotation assessing knowledge and order-writing. Residents in the order set period additionally completed a questionnaire regarding the impact of order set use on their learning. Analysis: The primary outcome, the difference between pre and post rotation scores was compared between residents in the no order set period and residents in the order set period, using univariate linear regression. Test validity was assessed with a 2-sample t-test, analysis of variance and Pearson’s correlation coefficient. Self-reported impact of order set use were descriptively analyzed, and written responses were collated and coded.ResultsInvestigators consecutively recruited 11 subjects before and 28 subjects after order set implementation. Residents in the order set period had a greater improvement in post-rotation test scores than residents in the no order set period (p = 0.04); after adjustment for baseline scores, this was not significant (p = 0.3). The questionnaire demonstrated excellent convergent, discriminant and construct validity. Residents reported that order sets improved their knowledge and skills and provided a systematic approach to care.ConclusionsOrder sets do not appear to impair resident education, and may impart a benefit. This will require validation in larger studies and across diseases.

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Section: Introductionmentioning

confidence: 99%

The effect of patient care order sets on medical resident education: a prospective before-after study

Stephenson

Gupta

2013

BMC Med Educ

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“…However, students in the CPOE groups reported less occasions to place orders as their supervisors either placed the orders before them or didn’t let them by lack of time. [ 17 , 18 ] In our study design, as the software was already part of the routine workflow in the hospital, CRs were keener on letting students place orders using CPOE. Moreover we used a randomized cross-controlled design to avoid the bias of getting the most motivated students and CRs in the case group as well as a method of analysis taking account of the various uncontrollable factors.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 – 6 ] Although CPOE can facilitate medical prescription and reduce serious medication error rates by more than half [ 7 – 12 ], few studies have addressed the impact of CPOE on the students’ medical training and ability to place sound orders, despite the indication that it could be useful, particularly through the immediate feedback about the placed order. [ 13 – 18 ] These trials yielded negative results, yet they provide insights on the possible causes of failure: lack of randomization, of time and investment from the supervisors, focus on a specialty, factors of confusion such as the addition of learning material in both groups, or a method of evaluation which did not capture the beneficial effect of the intervention.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Impact of Computerized Provider Order Entry on Medical Students Training at Bedside: A Randomized Controlled Trial

et al. 2015

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ObjectiveTo evaluate the impact of computerized provider order entry (CPOE) at the bedside on medical students training.Materials and MethodsWe conducted a randomized cross-controlled educational trial on medical students during two clerkship rotations in three departments, assessing the impact of the use of CPOE on their ability to place adequate monitoring and therapeutic orders using a written test before and after each rotation. Students’ satisfaction with their practice and the order placement system was surveyed. A multivariate mixed model was used to take individual students and chief resident (CR) effects into account. Factorial analysis was applied on the satisfaction questionnaire to identify dimensions, and scores were compared on these dimensions.ResultsThirty-six students show no better progress (beginning and final test means = 69.87 and 80.98 points out of 176 for the control group, 64.60 and 78.11 for the CPOE group, p = 0.556) during their rotation in either group, even after adjusting for each student and CR, but show a better satisfaction with patient care and greater involvement in the medical team in the CPOE group (p = 0.035*). Both groups have a favorable opinion regarding CPOE as an educational tool, especially because of the order reviewing by the supervisor.ConclusionThis is the first randomized controlled trial assessing the performance of CPOE in both the progress in prescriptions ability and satisfaction of the students. The absence of effect on the medical skills must be weighted by the small time scale and low sample size. However, students are more satisfied when using CPOE rather than usual training.

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“…Since the advent of EHRs, students’ opportunities to work with patient medical records have been influenced by rotations at sites with different EHR platforms, by supervising physicians’ differing levels of comfort with and ability to use EHRs, and by policies that restrict student EHR use. 6,7 A 2009 survey of clerkship directors showed that many students lack full EHR access. To illustrate, only about a fourth of directors (27%) reported that students could use the EHR to view patient records, write notes, and enter orders (which a supervising physician had to cosign); less than half (41%) allowed students to view the EHR and write notes; and a nearly a third (32%) allowed students view-only access.…”

Section: Problemmentioning

confidence: 99%

The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record

et al. 2017

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Problem Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety. Approach Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills. Outcomes The authors collected performance data for students (n = 71) at the first institution during academic years 2011–2013 and for students (n = 211) at the second institution during academic year 2013–2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students’ EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals. Next Steps Cross-institutional data comparisons will help determine whether differences in curricula affect students’ EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice.

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The Effect of Computerized Provider Order Entry on Medical Students’ Ability to Write Orders

Abstract: When admission order completeness and quality for medical students who trained at hospitals using CPOE were compared to those who trained using handwritten orders, no important differences were found.

Cited by 10 publications

References 22 publications

The effect of patient care order sets on medical resident education: a prospective before-after study

The effect of patient care order sets on medical resident education: a prospective before-after study

Evaluating the Impact of Computerized Provider Order Entry on Medical Students Training at Bedside: A Randomized Controlled Trial

The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record

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