Sometimes determination and compromise thwart success: lessons learned from an effort to study copying and pasting in the electronic medical record

Assessing the quality of electronic medical records as a platform for resident education

BACKGROUND

Previous studies have assessed note quality and the use of electronic medical record (EMR) as a part of medical training. However, a generalized and user-friendly note quality assessment tool is required for quick clinical assessment. We held a medical record writing competition and developed a checklist for assessing the note quality of participants' medical records. Using the checklist, this study aims to explore note quality between residents of different specialties and offer pedagogical implications.

METHODS

The authors created an inpatient checklist that examined fundamental EMR requirements through six note types and twenty items. A total of 149 records created by residents from 32 departments/stations were randomly selected. Seven senior physicians rated the EMRs using a checklist. Medical records were grouped as general medicine, surgery, paediatric, obstetrics and gynaecology, and other departments. The overall and group performances were analysed using analysis of variance (ANOVA).

RESULTS

Overall performance was rated as fair to good. Regarding the six note types, discharge notes (0.81) gained the highest scores, followed by admission notes (0.79), problem list (0.73), overall performance (0.73), progress notes (0.71), and weekly summaries (0.66). Among the five groups, other departments (80.20) had the highest total score, followed by obstetrics and gynaecology (78.02), paediatrics (77.47), general medicine (75.58), and surgery (73.92).

CONCLUSIONS

This study suggested that duplication in medical notes and the documentation abilities of residents affect the quality of medical records in different departments. Further research is required to apply the insights obtained in this study to improve the quality of notes and, thereby, the effectiveness of resident training.

The utility of failure: a taxonomy for research and scholarship

INTRODUCTION

Health professions education (HPE) research and scholarship utilizes a range of methodologies, traditions, and disciplines. Many conducting scholarship in HPE may not have had the opportunity to consider the value of a well-designed but failed scholarly project, benefitted from role-modelling of the value of failure, nor have engaged with the common nature of failure in research and scholarship.

METHODS

Drawing on key concepts from philosophy of science, this piece describes the necessity and benefit of failure in research and scholarship, presents a taxonomy of failure relevant to HPE research, and applies this taxonomy to works published in the Perspectives on Medical Education failures/surprises series.

RESULTS

I propose three forms of failure relevant to HPE scholarship: innovation-driven, discovery-oriented, and serendipitous failure. Innovation-driven failure was the most commonly represented type of failure in the failures/surprises section, and discovery-oriented the least common.

CONCLUSIONS

Considering failure in research and scholarship, four conclusions are drawn. First, failure is integral to research and scholarship-it is how theories are refined, discoveries are made, and innovations are developed. Second, we must purposefully engage with the opportunities that failure provide-understanding why a particular well-designed project failed is an opportunity for further insight. Third, we must engage publicly with failure in order to better communicate and role model the complexities of executing scholarship or innovating in HPE. Fourth, in order to make failure truly an opportunity for growth, we must, as a community, humanize and normalize failure as part of a productive scholarly approach.