PROVIDENCE, RI – Students at the Warren Alpert School of Medicine at Brown University believe that healthcare IT can contribute greatly to the future of medical care, as do many of their fellow medical students around the United States.
But do U.S. medical schools do enough to train students how to use IT?
Results from the 2007 “Future Physicians of America” survey, released this summer by San Mateo, Calif.-based Epocrates, revealed that more than 75 percent of medical students think formal courses in healthcare IT would be of great value to America’s future physicians. These same students also rated electronic medical records as the healthcare initiative most likely to reduce errors and improve patient safety.
“The willingness of young physicians to use IT won’t be a problem,” said Rushabh Modi, a fourth-year medical student at Brown. “But a lot of schools don’t offer formal training to students, especially in the first two years.”
Modi said one of the big obstacles to IT training for medical students were persistent “romantic notions” about how medicine should be practiced. Many experienced physicians think the recordkeeping should be done “by hand and on paper,” said Modi.
Neel Shah, another fourth-year Brown medical student, explained the belief in paper-based recordkeeping at some medical schools relies on the notion that students will learn better if they hand-write notes and prescriptions rather than being prompted by a computer system.
“We’re trained to have a very systematic way of keeping records and writing orders,” Shah said. “There are long lists of things that need to be done, and many physicians believe that if you do things by hand, you will learn better.”
Shah said advanced students at Brown do get regular exposure to electronic records at the local hospitals where they see patients. But this experience only reinforces the fact that there is little consistency to EMR systems across healthcare institutions.
“There are three different proprietary systems at each of the hospitals where we see patients,” Shah noted. “One hospital has CPOE but uses paper records, and another has electronic records but handwritten prescriptions. And then there’s the VA system, which is unique. We even encounter different recordkeeping systems on different floors of the same hospital.”
Brown has made efforts to introduce its students to healthcare IT. The medical school offers a required course in “Doctoring,” that is intended to teach professional development skills in a community-based setting.
Students were initially required to have a personal digital assistant, or PDA, that included software with a patient-encounter template. The data collected on the devices allowed faculty to see what students learned at the approximately 200 different community practices where students worked as part of the Doctoring course.
This year, however, Brown no longer requires that students use PDAs, said Arthur Frazzano, MD, associate dean of medicine at Brown.
“PDA technology is actually pretty difficult to use in medicine,” said Frazzano. “It’s labor-intensive, the screens are small, there are lots of drop-down menus, and they don’t allow for very good manipulation of data. Believe it or not, we’re going back to a paper-and-pencil method, and putting the data we collect on the Web.”
Frazzano added that the Brown faculty does not discourage medical students from using PDAs, but said the technology doesn’t mesh well with the “bedside” training that the school wants to emphasize.
“All of the medical schools are having trouble adapting their training regimen to information technology,” Frazzano said. “The truth is that there needs to be a broader effort toward use of IT, but the physicians can’t do it alone. Piecemeal efforts don’t really work.”
Shah believes broad adoption of IT among U.S. physicians will ultimately depend less on formal training in medical schools than on the presence of IT “champions” among the residents on hospital staffs.
“Our exposure is really dictated by what’s available in the hospitals, and the encouragement we get from the residents who we learn from,” Shah said. “There really has to be more traction in the physician community at large before students are affected.”