Perceptions of the Educational Value of the Electronic Health Record: A Qualitative Study

BACKGROUND: Electronic health record (EHR) adoption at academic medical institutions has impacted patient care and trainee education; however, limited studies have examined its potential as an educational tool. OBJECTIVE: To explore attending and resident perceptions of current and potential impacts of EHR-based documentation as an education tool. METHODS: Using a constructivist approach and thematic analysis methods, an interview was developed through expert discussion and literature review. Purposive sampling of 15 pediatric and medicine-pediatrics residents and 7 pediatric hospitalist attendings promoted diverse responses. Reflexivity was managed using coders of different levels and backgrounds, with regular meetings for discussion and reflection. Interview analysis proceeded with multiple rounds of iterative coding, and underlying themes were constructed and analyzed. RESULTS: Three themes were constructed: (1) Writing and reviewing documentation facilitates learning clinical reasoning and building skills; (2) viewing documentation as service, with missed educational opportunities and inefficiencies, limits educational benefit; and (3) appreciating cultural perceptions of documentation in training promotes educational opportunities and may reduce low-yield activities. These themes, combined with existing literature, suggest areas for documentation-based educational interventions to improve quality, better direct effort, and incorporate documentation feedback into resident education. Similarly, reducing inefficiency in the EHR allows for more educational opportunities within the EHR and elsewhere, including bedside teaching. Finally, recognizing the impact of culture around documentation may improve awareness of educational opportunities. CONCLUSIONS: Resident and attending perceptions highlighted areas of educational potential in EHR documentation. Combined with existing literature, these themes suggest interventions can increase educational value.