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Medical education in the electronic medical record (EMR) era: benefits, challenges, and future directions

Medical education in the electronic medical record (EMR) era: benefits, challenges, and future directions. Tierney, M. J., Pageler, N. M., Kahana, M., Pantaleoni, J. L. & Longhurst, C. A. Acad Med 88, 748–752 (2013).


The authors review what has been documented about the effect of EMR use on medical learners. They examine acknowledged benefits and educational risks to use of EMRs, consider factors that promote their successful use when implemented in academic environments, and identify areas of future research of EMRs’ role in medical education.


Clinical decision support poorly implemented can have negative effects on learners such as “alert fatigue”, feeling overwhelming etc. Properly used, they can allow context-relevant education.

  • Further research efforts should evaluate the influence of CDS not on trainee behaviour and on their underlying fund of knowledge.

Decision makers can ensure EMR use favourably affects trainees’ workflow by, for example, ensuring strategic placement of computer hardware and making key decisions about personnel for data entry.

  • Medical educators and program directors must advocate for decisions that optimize trainee workflow.

EMRs can enhance or impair the development of effective written communication skills: in some setting students are prohibited from adding documentation to the EMR, and concerns have arisen over reliance on templates/copy-pasting.

  • Formalizing EMR-specific written & oral comm. competencies by training level is vital. Strategies for mitigating some learning & training concerns come from the RIME/EMR scheme.

EMRs offer potential for teaching effective integration of a network of care providers, but have not yet reached full maturity to support this kind of multidisciplinary collaboration.

  • EMR systems in training should fulfill the needs of learners to operate effectively in the realm of a patient-centered medical home.


Fostering the development of professionalism and patient-physician communication in an EMR world requires development of EMR-specific skills and curriculum development. Appropriate use of the EMR and related technologies in medicine can offer clinical educators and trainees a rich and promising platform to use in pursuit of a positive and effective educational experience.


This paper aptly highlights key issues of EMR use around the ACGME, along with benefits and future directions. This article manages to cover a wide variety of issues and offer practical solutions across settings. This article is a very valuable resource. 5/5 Checks.