Electronic health records in outpatient clinics: Perspectives of third year medical students

Abstract Background United States academic medical centers are increasingly incorporating electronic health records (EHR) into teaching settings. We report third year medical students' attitudes towards clinical learning using the electronic health record in ambulatory primary care clinics. Methods In academic year 2005–06, 60 third year students were invited to complete a questionnaire after finishing the required Ambulatory Medicine/Family Medicine clerkship. The authors elicited themes for the questionnaire by asking a focus group of third year students how using the EHR had impacted their learning. Five themes emerged: organization of information, access to online resources, prompts from the EHR, personal performance (charting and presenting), and communication with patients and preceptors. The authors added a sixth theme: impact on student and patient follow-up. The authors created a 21-item questionnaire, based on these themes that used a 5-point Likert scale from "Strongly Agree" to "Strongly Disagree". The authors emailed an electronic survey link to each consenting student immediately following their clerkship experience in Ambulatory Medicine/Family Medicine. Results 33 of 53 consenting students (62%) returned completed questionnaires. Most students liked the EHR's ability to organize information, with 70% of students responding that essential information was easier to find electronically. Only 36% and 33% of students reported accessing online patient information or clinical guidelines more often when using the EHR than when using paper charts. Most students (72%) reported asking more history questions due to EHR prompts, and 39% ordered more clinical preventive services. Most students (69%) reported that the EHR improved their documentation. 39% of students responded that they received more feedback on their EHR notes compared to paper chart notes. Only 64% of students were satisfied with the doctor-patient communication with the EHR, and 48% stated they spent less time looking at the patient. Conclusion Third year medical students reported generally positive attitudes towards using the EHR in the ambulatory setting. They reported receiving more feedback on their electronic charts than on paper charts. However, students reported significant concerns about the potential impact of the EHR on their ability to conduct the doctor-patient encounter.Peer Reviewe

Adoption and attachment: a study of attachment in young adult adoptees

Bibliography: p. 87-97Extrapolating from the central tenets of attachment theory and research, the present study investigated the implications for the adoption experience on the developing security and pattern of attachment relationships. Differences between adoptee and non-adoptee attachment classifications were explored, and classification differences were analyzed based on their relationship with demographic and theoretically relevant variables. A sample of 34 late adolescent to young-adult adoptee volunteers (20 females, 14 males), ranging from 17 to 32 years of age, were recruited. They were administered the Adult Attachment Interview, the Adult Attachment Projective, and asked questions relating to their adoptions. The sample's distribution of Adult Attachment Projective classifications was compared to norms of community and clinical samples. Consistent with the implications from attachment theory and research, the adoptee distribution differed significantly from that expected for a non-adopted, non-clinical sample (p:S.0001). Furthermore, several features of the distribution pattern were also consistent with projections from attachment theory and research. First, the rate of secure or Autonomous attachment is significantly lower than expected (E) (15%, E = 52%). Second, Dismissing attachment, the most common form of insecurity in normative samples, is nearly absent in this sample (6%, E = 18%). Third, both the Preoccupied (47%, E = 11 %) and the atypical Unresolved/Disorganized (32%, E = 19%) attachment classifications are overrepresented in this sample relative to the comparison norms. These adoptees resembled a clinical sample in their distribution of attachment patterns. Between classification group differences were analyzed by examining their relationship with the following variables: age, gender, age at adoption, professional status, relationship status, parenting status, search for birth family/outcome, counseling experience, and subsequent threats to attachm~nt (loss, trauma, abuse, rejection, and separation). None of these analyses supported an association between any of the independent variables and classification group differences. The findings from this study support the theory that adoptees are at greater risk for insecure attachments than their non-adopted counterparts. It is recommended that future studies make further attempts to identify the source/s of these differences

Web-based ehealth to support counseling in routine well-child Care: Pilot study of e-health4uth home safety

Background: Providing safety education to parents of young children is important in the prevention of unintentional injuries in or around the home. We developed a Web-based, tailored safety advice module to support face-to-face counseling in the setting of preventive youth health care (E-health4Uth home safety) in order to improve the provision of safety information for parents of young children. Objective: This pilot study evaluated a Web-based, tailored safety advice module (E-health4Uth home safety) and evaluated the use of E-health4Uth home safety to support counseling in routine well-child care visits. Methods: From a preventive youth health care center, 312 parents with a child aged 10-31 months were assigned to the E-health4Uth home safety condition or to the care-As-usual condition (provision of a generic safety information leaflet). All parents completed a questionnaire either via the Internet or paper-And-pencil, and parents in the E-health4Uth condition received tailored home safety advice either online or by a print that was mailed to their home. This tailored home safety advice was used to discuss the safety of their home during the next scheduled well-child visit. Parents in the care-As-usual condition received a generic safety information leaflet during the well-child visit. Results: Mean age of the parents was 32.5 years (SD 5.4), 87.8% (274/312) of participants were mothers; mean age of the children was 16.9 months (SD 5.1). In the E-health4Uth condition, 38.4% (61/159) completed the online version of the questionnaire (allowing Web-based tailored safety advice), 61.6% (98/159) preferred to complete the questionnaire via paper (allowing only a hardcopy of the advice to be sent by regular mail). Parents in the E-health4Uth condition evaluated the Web-based, tailored safety advice (n=61) as easy to use (mean 4.5, SD 0.7), pleasant (mean 4.0, SD 0.9), reliable (mean 4.6, SD 0.6), understandable (mean 4.6, SD 0.5), relevant (mean 4.2, SD 0.9), and useful (mean 4.3, SD 0.8). After the well-child visit, no significant differences were found between the E-health4Uth condition and care-As-usual condition with regard to the satisfaction with the information received (n=61, P=.51). Health care professionals (n=43) rated the tailored safety advice as adequate (mean 4.0, SD 0.4) and useful (mean 3.9, SD 0.4). Conclusions: Less than half of the parents accepted the invitation to complete a Web-based questionnaire to receive online tailored safety advice prior to a face-to-face consultation. Despite wide access to the Internet, most parents preferred to complete questionnaires using paper-And-pencil. In the subgroup that completed E-health4Uth home safety online, evaluations of E-health4Uth home safety were positive. However, satisfaction scores with regard to tailored safety advice were not different from those with regard to generic safety information leaflets