Implementation of Changes to Medical Student Documentation at Duke University Health System: Balancing Education With Service.

Gagliardi, Jane P; Bonanno, Brian; McPeek Hinz, Eugenia R; Musser, R Clayton; Knudsen, Nancy W; Palko, Michael; McNair, Felice; Lee, Hui-Jie; Clay, Alison S

Implementation of Changes to Medical Student Documentation at Duke University Health System: Balancing Education With Service.

dc.contributor.author	Gagliardi, Jane P
dc.contributor.author	Bonanno, Brian
dc.contributor.author	McPeek Hinz, Eugenia R
dc.contributor.author	Musser, R Clayton
dc.contributor.author	Knudsen, Nancy W
dc.contributor.author	Palko, Michael
dc.contributor.author	McNair, Felice
dc.contributor.author	Lee, Hui-Jie
dc.contributor.author	Clay, Alison S
dc.date.accessioned	2022-10-28T19:24:48Z
dc.date.available	2022-10-28T19:24:48Z
dc.date.issued	2021-06
dc.date.updated	2022-10-28T19:24:46Z
dc.description.abstract	Purpose When the Centers for Medicare and Medicaid Services (CMS) changed policies about medical student documentation, students with proper supervision may now document their history, physical exam, and medical decision making in the electronic health record (EHR) for billable encounters. Since documentation is a core entrustable professional activity for medical students, the authors sought to evaluate student opportunities for documentation and feedback across and between clerkships. Method In February 2018, a multidisciplinary workgroup was formed to implement student documentation at Duke University Health System, including educating trainees and supervisors, tracking EHR usage, and enforcing CMS compliance. From August 2018 to August 2019, locations and types of student-involved services (student-faculty or student-resident-faculty) were tracked using billing data from attestation statements. Student end-of-clerkship evaluations included opportunity for documentation and receipt of feedback. Since documentation was not allowed before August 2018, it was not possible to compare with prior student experiences. Results In the first half of the academic year, 6,972 patient encounters were billed as student-involved services, 52% (n = 3,612) in the inpatient setting and 47% (n = 3,257) in the outpatient setting. Most (74%) of the inpatient encounters also involved residents, and most (92%) of outpatient encounters were student-teaching physician only.Approximately 90% of students indicated having had opportunity to document in the EHR across clerkships, except for procedure-based clerkships such as surgery and obstetrics. Receipt of feedback was present along with opportunity for documentation more than 85% of the time on services using evaluation and management coding. Most students (> 90%) viewed their documentation as having a moderate or high impact on patient care. Conclusions Changes to student documentation were successfully implemented and adopted; changes met both compliance and education needs within the health system without resulting in potential abuses of student work for service.
dc.identifier	00001888-202106000-00049
dc.identifier.issn	1040-2446
dc.identifier.issn	1938-808X
dc.identifier.uri	https://hdl.handle.net/10161/26111
dc.language	eng
dc.publisher	Ovid Technologies (Wolters Kluwer Health)
dc.relation.ispartof	Academic medicine : journal of the Association of American Medical Colleges
dc.relation.isversionof	10.1097/acm.0000000000003729
dc.subject	Humans
dc.subject	Education, Medical, Undergraduate
dc.subject	Clinical Clerkship
dc.subject	Students, Medical
dc.subject	Feedback
dc.subject	Documentation
dc.subject	Adult
dc.subject	United States
dc.subject	North Carolina
dc.subject	Female
dc.subject	Male
dc.subject	Electronic Health Records
dc.subject	Centers for Medicare and Medicaid Services, U.S.
dc.title	Implementation of Changes to Medical Student Documentation at Duke University Health System: Balancing Education With Service.
dc.type	Journal article
duke.contributor.orcid	Gagliardi, Jane P\|0000-0003-4667-6607
duke.contributor.orcid	McPeek Hinz, Eugenia R\|0000-0003-3759-9806
duke.contributor.orcid	Musser, R Clayton\|0000-0002-7528-0970
duke.contributor.orcid	Clay, Alison S\|0000-0003-3191-5345
pubs.begin-page	900
pubs.end-page	905
pubs.issue	6
pubs.organisational-group	Duke
pubs.organisational-group	School of Medicine
pubs.organisational-group	Clinical Science Departments
pubs.organisational-group	Anesthesiology
pubs.organisational-group	Anesthesiology, Critical Care Medicine
pubs.organisational-group	Medicine
pubs.organisational-group	Psychiatry & Behavioral Sciences
pubs.organisational-group	Surgery
pubs.organisational-group	Medicine, General Internal Medicine
pubs.organisational-group	Medicine, Pulmonary, Allergy, and Critical Care Medicine
pubs.organisational-group	Medical Education
pubs.organisational-group	Psychiatry & Behavioral Sciences, Adult Psychiatry & Psychology
pubs.publication-status	Published
pubs.volume	96