• Paul M Wallach, Lauren M Foster, Monica M Cuddy, Maya M Hammoud, Kathleen Z Holtzman, and David B Swanson.
• Indiana University School of Medicine, Indianapolis, IN, USA. pwallach@iu.edu.
• J Gen Intern Med. 2019 May 1; 34 (5): 705-711.

BackgroundAs electronic health records (EHRs) became broadly available in medical practice, effective use of EHRs by medical students emerged as an essential aspect of medical education. While new federal clinical documentation guidelines have the potential to encourage greater medical student EHR use and enhance student learning experiences with respect to EHRs, little is known nationally about how students have engaged with EHRs in the past.ObjectiveThis study examines medical student accounts of EHR use during their internal medicine (IM) clerkships and sub-internships during a 5-year time period prior to the new clinical documentation guidelines.DesignAn online survey about EHR use was administered to medical students immediately after they completed USMLE Step 2 CK.ParticipantsThe sample included 16,602 medical students planning to graduate from US medical schools from 2012 to 2016.Main MeasuresDescriptive statistics were computed to determine the average percentage of students engaged in various health record activities during their IM educational experiences by graduation year.Key ResultsThe vast majority (99%) of medical students used EHRs during IM clerkships or sub-internships. Most students reported that they entered information into EHRs during the inpatient component of the IM clerkship (84%), outpatient component of the IM clerkship (70%), and the IM sub-internship (92%). Yet, 43% of the students who graduated in 2016 never entered admission orders and 35% of them never entered post-admission orders.ConclusionsMedical school graduates ought to be able to effectively document clinical encounters and enter orders into EHR systems. Although most students used and entered information into EHRs during their IM clinical training, many students appear to have received inadequate opportunities to enter notes or orders, in particular. Implications for graduate medical education preparedness are considered. Future research should address similar questions using comparable national data collected after the recent guideline changes.

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