Enhancing Student Empathetic Engagement, History-Taking, and Communication Skills During Electronic Medical Record Use in Patient Care.

PURPOSE: To examine whether an intervention on proper use of electronic medical records (EMRs) in patient care could help improve medical students' empathic engagement, and to test the hypothesis that the training would reduce communication hurdles in clinical encounters. METHOD: Seventy third-year medical students from the Sidney Kimmel Medical College at Thomas Jefferson University were randomly divided into intervention and control groups during their six-week pediatric clerkship in 2012-2013. The intervention group received a one-hour training session on EMR-specific communication skills, including discussion of EMR use, the SALTED mnemonic and technique (Set-up, Ask, Listen, Type, Exceptions, Documentation), and role-plays. Both groups completed the Jefferson Scale of Empathy (JSE) at the clerkship's start and end. At clerkship's end, faculty and standardized patients (SPs) rated students' empathic engagement in SP encounters, using the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and their history-taking and communication skills. RESULTS: Faculty mean ratings on the JSPPPE, history-taking skills, and communication skills were significantly higher for the intervention group than the control group. SP mean ratings on history-taking skills were significantly higher for the intervention group than the control group. Both groups' JSE mean scores increased pretest to posttest, but the changes were not significant. The intervention group's posttest JSE mean score was higher than the control group's, but the difference was not significant. CONCLUSIONS: The findings suggest that a simple intervention providing specialized training in EMR-specific communication can improve medical students' empathic engagement in patient care, history-taking skills, and communication skills.

Are medical students being taught invasive skills using simulation?

INTRODUCTION: Basic invasive procedural skills are traditionally taught during clerkships. Using simulation to teach invasive skills provides students the opportunity to practice in a structured environment without risking patient safety. We surveyed incoming interns at Thomas Jefferson University Hospital to assess the prevalence of simulation training for invasive and semi-invasive procedural skills during medical school. METHODS: From 2008 to 2010, we surveyed 357 incoming interns at Thomas Jefferson University Hospital. The questionnaire asked incoming interns if they received formal instruction or procedural training with or without a simulation component for 34 procedures during medical school. Interns indicated their number of attempts and successes for each procedure in clinical care. RESULTS: All 357 incoming interns completed the survey. Experience in 28 procedures is reported in this article. For all but three basic procedures, more than 75% of interns received formal didactic instruction. Only 3 advanced procedures were formally taught to most interns. The prevalence of simulation training for the basic and advanced procedures was 46% and 23%, respectively. For the basic procedures, the average number of attempts and successes was 6.5 (range, 0-13.9) and 6.2 (range, 0-13.4), respectively. For the advanced procedures, the average number of attempts and successes was 1.5 (range, 0-4.8) and 1.3 (range, 0-4.7), respectively. CONCLUSIONS: Although most medical students receive formal instruction in basic procedures, fewer receive formal instruction in advanced procedures. The use of simulation to complement this training occurs less often. Simulation training should be increased in undergraduate medical education and integrated into graduate medical education.