The electronic health record as a teaching and learning tool in residency training: A scoping review

Purpose: While electronic health records (EHRs) are a critical tool for clinical care in academic medical centers, there is a gap in the literature regarding utilization of EHRs for teaching and learning, outside of descriptions on EHR training or use for quality improvement projects. The research question for this scoping review is: How is the EHR purposefully used in educational interventions for teaching and learning in graduate medical education?Methods: We searched all publications in PubMed, SCOPUS, CINAHL, ERIC, Cochrane and MedEdPORTAL databases from 2010 to 2022 that met our search criteria. Using Arksey and O'Malley's framework, the abstracts were reviewed by three team members, and the full text was reviewed by all authors using a standardized data extraction sheet.Results: Of the 2431 records, 19 met inclusion criteria and were reviewed in full. All studies were set in North America, 79% at teaching hospitals, and 42% in Internal Medicine programs. The EHR was used purposefully to improve learning in sepsis, diabetes, asthma, critical care, post- and peri-operative care, and it was used to provide feedback about clinical performance, test utilization, costs of care, and errors. The educational interventions included simulation, direct feedback using EHR data, and workshops with pre-post knowledge and skills testing.Conclusions: This scoping review identifies how the EHR is being used as a teaching and learning tool for trainees. There is a need for more purposeful use of the EHR in designing educational interventions for residents.

Purpose: 电子健康记录（Electronic Health Records, EHRs）是学术医疗中心临床诊疗的核心工具，但现有文献中，除针对电子健康记录培训或其用于质量改进项目的相关描述外，其在教学与学习场景中的应用研究存在显著空白。本次范围综述的研究问题为：电子健康记录（EHRs）如何被有目的地应用于毕业后医学教育（Graduate Medical Education）的教学相关教育干预实践？
Methods: 我们检索了2010年至2022年间PubMed、SCOPUS、CINAHL、ERIC、Cochrane及MedEdPORTAL数据库中符合检索标准的全部文献。基于Arksey与O'Malley的研究框架，由3名研究小组成员对文献摘要进行初筛，全体作者采用标准化数据提取表对符合纳入标准的全文文献进行复评。
Results: 在检索获得的2431条记录中，共有19篇符合纳入标准并被纳入全文评审。所有研究均开展于北美地区，其中79%的研究依托教学医院实施，42%的研究面向内科住院医师培训项目。电子健康记录（EHRs）被有目的地用于提升脓毒症、糖尿病、哮喘、重症监护、围手术期及术后护理相关的学习效果，同时被用于反馈临床诊疗表现、检验项目应用情况、医疗成本及诊疗失误相关信息。纳入的教育干预手段包括模拟训练、基于电子健康记录（EHRs）数据的直接反馈，以及设置前后测知识与技能测评的专题工作坊。
Conclusions: 本次范围综述明确了电子健康记录（EHRs）作为教学工具应用于受训者培养的具体路径。当前仍需在住院医师教育干预的设计环节，更具针对性地运用电子健康记录（EHRs）。