Preparing Residents for Future Practice
Preparing Residents for Future Practice
Objectives Patients frequently use secure web portals to access their medical record and communicate with their doctors, though few institutions currently train residents for electronic communication. We sought to develop a curriculum for secure messaging between patients and resident physicians, and to assess resident attitudes before and after the curriculum.
Methods In 2011, we developed a curriculum for patient–doctor secure messaging using a web-based patient portal within an internal medicine residency programme. We asked all residents to perform a self-assessment of skills, and report attitudes toward electronic communication at the beginning and end of the experience (9 months apart). We enrolled residents who practiced at the hospital-based clinic site into the patient portal, and recorded usage statistics.
Results The completed survey response rate was 108/159 (68%). At baseline, 57% of residents had used traditional email with patients, and most residents felt that the portal would increase work for providers but benefit patients. Postintervention questionnaires demonstrated no significant changes among all respondents, but residents who used the portal perceived improvements in care. Most residents were concerned about professional liability. More residents felt comfortable writing electronic messages to patients after the curriculum (80% to 91%, p=0.01).
Conclusions Implementing a patient web portal and secure messaging in a residency clinic is feasible and may improve the work and educational experience of trainees. Residents were initially sceptical of secure messaging being an additional burden to their work, but this was not realised among residents who used the portal.
Over the past decade, patients and doctors have increasingly supplemented their office visits with electronic communication via e-mail or patient portals. Many electronic health records (EHRs) allow patients to view parts of their medical record, to request appointments and prescription refills, and to send secure messages to their physicians. Physicians have been reluctant to offer these services in part because of the time commitment and lack of reimbursement under the current fee-for-service reimbursement system. Despite physician hesitancy, patients and health systems increasingly expect providers to offer this service, and electronic access is part of the criteria for the patient-centred medical home.
In the USA, passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 has led to accelerated adoption of these systems by offering incentive payments to practices that meet criteria for the 'meaningful use' of EHRs. These criteria include providing patients with timely electronic access to their health information and allowing for secure messaging between patients and physicians. Recent studies have shown an improvement in care process measures, patient engagement, and health outcomes with patient portals and clinical messaging.
Despite the rise in EHRs and patient portal adoption, few institutions provide formal training to medical students and residents related to electronic communication. In many practices, physicians are expected to use secure messaging with patients outside of visits, and must learn best practices 'on the job'. The majority of communication skills training throughout medical education emphasises synchronous communication modalities, not the asynchronous communication of electronic messaging. To prepare residents for future practice, medical educators should integrate electronic communication into resident practices and ambulatory medicine curricula.
We sought to develop a curriculum for teaching secure messaging within a large US-based internal medicine residency training programme. Our assessment included evaluation of attitudes toward electronic communication with patients before and after the curriculum, which included experiential learning on the patient portal. We hypothesised that current residents who are 'digital natives', meaning, they grew up with e-mail and the internet, would be more embracing of secure messaging with patients than older faculty have historically been, and that the portal would be an efficient means of patient–doctor communication for residents. In this paper, we describe the curriculum, present portal usage data, and examine the effect on resident attitudes (Box 1 and Box 2).
Abstract and Introduction
Abstract
Objectives Patients frequently use secure web portals to access their medical record and communicate with their doctors, though few institutions currently train residents for electronic communication. We sought to develop a curriculum for secure messaging between patients and resident physicians, and to assess resident attitudes before and after the curriculum.
Methods In 2011, we developed a curriculum for patient–doctor secure messaging using a web-based patient portal within an internal medicine residency programme. We asked all residents to perform a self-assessment of skills, and report attitudes toward electronic communication at the beginning and end of the experience (9 months apart). We enrolled residents who practiced at the hospital-based clinic site into the patient portal, and recorded usage statistics.
Results The completed survey response rate was 108/159 (68%). At baseline, 57% of residents had used traditional email with patients, and most residents felt that the portal would increase work for providers but benefit patients. Postintervention questionnaires demonstrated no significant changes among all respondents, but residents who used the portal perceived improvements in care. Most residents were concerned about professional liability. More residents felt comfortable writing electronic messages to patients after the curriculum (80% to 91%, p=0.01).
Conclusions Implementing a patient web portal and secure messaging in a residency clinic is feasible and may improve the work and educational experience of trainees. Residents were initially sceptical of secure messaging being an additional burden to their work, but this was not realised among residents who used the portal.
Introduction
Over the past decade, patients and doctors have increasingly supplemented their office visits with electronic communication via e-mail or patient portals. Many electronic health records (EHRs) allow patients to view parts of their medical record, to request appointments and prescription refills, and to send secure messages to their physicians. Physicians have been reluctant to offer these services in part because of the time commitment and lack of reimbursement under the current fee-for-service reimbursement system. Despite physician hesitancy, patients and health systems increasingly expect providers to offer this service, and electronic access is part of the criteria for the patient-centred medical home.
In the USA, passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 has led to accelerated adoption of these systems by offering incentive payments to practices that meet criteria for the 'meaningful use' of EHRs. These criteria include providing patients with timely electronic access to their health information and allowing for secure messaging between patients and physicians. Recent studies have shown an improvement in care process measures, patient engagement, and health outcomes with patient portals and clinical messaging.
Despite the rise in EHRs and patient portal adoption, few institutions provide formal training to medical students and residents related to electronic communication. In many practices, physicians are expected to use secure messaging with patients outside of visits, and must learn best practices 'on the job'. The majority of communication skills training throughout medical education emphasises synchronous communication modalities, not the asynchronous communication of electronic messaging. To prepare residents for future practice, medical educators should integrate electronic communication into resident practices and ambulatory medicine curricula.
We sought to develop a curriculum for teaching secure messaging within a large US-based internal medicine residency training programme. Our assessment included evaluation of attitudes toward electronic communication with patients before and after the curriculum, which included experiential learning on the patient portal. We hypothesised that current residents who are 'digital natives', meaning, they grew up with e-mail and the internet, would be more embracing of secure messaging with patients than older faculty have historically been, and that the portal would be an efficient means of patient–doctor communication for residents. In this paper, we describe the curriculum, present portal usage data, and examine the effect on resident attitudes (Box 1 and Box 2).
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