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Medical education in an electronic health record-mediated worldc

Medical education in an electronic health record-mediated world. Ellaway, R. H., Graves, L. & Greene, P. S. Med Teach 35, 282–286 (2013).


This paper reflects on the extent to which we are preparing learners for practice in an EHR-mediated world. The paper finds changes in perception and practice must occur to link medical education and e-health.


Deliberate instruction, guidance, & modeling around the use of EHRs is needed. Learners will not develop the necessary skills passively – they are seldom the self-directed digital natives one may expect.

  • Development of e-health competences depends on leadership and direction from others. Preceptors must find ways to teach EHR skills that follow principles of patient-centered care

EHRs need to accommodate learners’ workflows and data alongside those of their teachers – including procedure tracking, adding patient notes, and preceptor reviews.

  • EHR initiatives tend to focus on technology adoption - often failing to accommodate the critical educational dimension for clinicians and their students.

All aspects of e-health need to be addressed in common competency frameworks and accreditation standards for medical education.

  • The absence of accreditation or competency frameworks promoting EHR competencies means there is little top–down momentum for EHR integration into medical education

Further research is required into the profile of EHRs within medical education at all levels.


Leaders in medical education should establish a vision for the optimal use of EHRs in terms of professional frameworks and practices. More research is needed, along with practical exemplars of integrating ehealth into medical education, particularly in ways that enable rather than diminish compassionate and patient-centered care.


This paper gives a good and recent overview of medical education in the context of EHRs. The barriers in effective EHR use and the limitations of our knowledge are expounded. The key of this paper is a focus on the perceptions and practices of medical educators around e-health and HER use. The paper brings up the excellent point that without addressing these factors, the connection between MedEd and e-health will continue to be tenuous and problematic. To that end, practice points and recommendations are issued around that theme. This paper tackles the issue e-health in MedEd from a novel perspective and offers practice points for consideration. 5/5 checks.v