Using a Qualitative Interview to Evaluate Pediatric Interns Use of EMR in Simulation (1090-003622) (Research Abstract Professor Rounds: Group 5)
Start time: Friday, January 29, 2021, 10:00 AM End time: Friday, January 29, 2021, 11:00 AM Session Type: Research Abstracts (Completed Studies)
The ubiquity of electronic medical records (EMR) makes training inclusive of their use important for medical education. Various approaches to this education have been utilized, but most of them rely on passive learning methods such as instructor-led didactics and online learning modules (1,2). The amount of training learners receive is also inadequate (3,4). Providers have performed poorly when asked to utilize the EMR to identify patient safety issues using the EMR (5). Recent studies showed that simulation-based training was effective in improving pediatric trainees use of EMR, however little is known about its utility in the clinical setting and its impact on the process of care (2,5). Therefore, we aim to explore the benefit of and the perceived challenges of utilizing the EMR in the evaluation of a simulated pediatric patient with sepsis through qualitative interviews and a post-simulation survey among a sample of pediatric interns.
This was a mixed-methods study using qualitative and quantitative data to evaluate EMR use among pediatric interns in a simulated setting. Each session used a standardized information sheet to introduce the research team, describe the rationale of the study, and communicate the rules and expectations related to the participants. To mirror the actual clinical team, each team was composed of a bedside nurse and a pediatric intern. Participants were oriented to the functionality of the simulator, SimJunior (Laerdal Medical, Wappinger Falls, NY). Following the simulation, a standardized debriefing was conducted by the study’s main facilitator (principal investigator). Each intern and nurse completed a brief 6-item survey to evaluate their experience of the simulation session. Structured interviews with the interns were analyzed for emergent themes, drawing on thematic analysis and grounded theory.
Surveys showed that interns and nurses felt the simulation was reflective of a patient they would care for and that the simulation was relevant to their daily practice. Both groups also felt they would be more likely to utilize the EMR in a similar clinical scenario and that their comfort utilizing the EMR increased. During the simulation, no intern correctly performed all of the tasks required for caring for a patient with sepsis (e.g. starting IV, giving fluids, starting antibiotics), with a significant variation in time to achievement between participants. In interviews, the interns reported learning about the EMR through simulation, especially through the hands-on practice required during the simulation or debriefing. They reported either being unaware of data visualization tools within the EMR, or re-learning about these tools. They also reported that incorporation of the EMR enhanced the realism of the simulation, making it a better approximation of a real-life patient encounter.
EMR utilization among first year pediatric interns in the evaluation of a simulated pediatric patient with sepsis is variable. Interview responses supported that current training methodologies for the EMR and its clinical use are only partially effective, and some of that effect is lost over time. Incorporation of the EMR into simulation also improves the realism of the simulation and has the potential to increase the duration that learning and knowledge is maintained. Our study highlights the need for continued and improved training around EMR and its use in the evaluation of acutely changing patients and supports the use of simulation as an important mode of EMR education.