The Impact of Technology on the Development of Core Entrustable Professional Activities (EPAs)

Abstract

Advances in technology have benefited clinical practice as well as medical education in many ways. Information technologies have been used to improve health care quality through several approaches. For example, breakdowns in communication, particularly, during transitions of care, are among the most common factors contributing to adverse events. Technology has provided the opportunity to implement computerized coverage systems for Bhand offs^as well as wireless access to electronic health records (EHR). Information systems have been developed to standardize symptom and diagnosis specific order sets, monitor trends and aberrancies in laboratory data, and to assist in identification of potential drug interactions and medication reconciliation to enhance quality care. Furthermore, information technology has offered health care providers and students accessibility to reference information through online textbooks and evidence-based clinical decision support resources such as UpToDate® and DynaMed® [1]. Educational technologies such as the mannequins found in simulation laboratories have provided controlled environments that create safer contexts for learning and assessment by reducing risks to patients. However, it is important to consider the integration of technology and its effect on professional skills from a developmental standpoint.There are potential unintended consequences to these technological advances in medical education such as the Bflipped patient,^a term describing the first clinical encounter for a learner as an electronic visit with the EHR or the BiPatient^ [2]. For the student, this virtual encounter reveals the chief complaint, history of present illness, physical exam, and often a defined assessment and plan before actually meeting the patient. This virtual encounter with pre-populated data and reasoning has essentially become the student's first Breal^encounter resulting in less critical thinking by the learner. In addition, clinical reasoning by residents and attending occurs independently during the electronic Bpre-rounding^of the medical record prior to team rounds. This solo mental exercise that occurs in the minds of the preceptors during review of the EHR excludes the learner from the conversation that previously occurred during rounds when charts were reviewed together [3]. This diminishes teachable moments for learners at varying levels of training and affects the development of clinical reasoning skills. Furthermore, technology has proven to be an essential component of health care and millennials have embraced it as their generation not only views it as part of the norm, but sees inefficiencies in its absence. However, with more time at the computer and less time at the bedside coupled with decreased critical thinking being modeled, practiced, and taught, medical educators need to evaluate more formally the true impacts of technology on the learner. With a move toward integrating competency-based assessments of students into the context of clinical practice to determine attainment of ...

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