How Case Western is Prioritizing Epic EHR Training for Medical Students

EHR use has become closely intertwined with the practice of medicine, with a staggering 96 percent of hospitals leveraging the technology. However, hands-on EHR training remains rare in early medical student education.

While some medical students may have EHR experience from working in clinics, others do not use EHR systems until the beginning of their third-year clerkship, according to Anastasia Rowland-Seymour, MD, associate professor of medicine at Case Western Reserve University (CWRU) School of Medicine.

"There isn't any education about how to use the EHR until they get onto the wards, so they're thrown into this new situation with a new EHR and have to do all of that adjusting at the same time," Rowland-Seymour, who also serves as assistant dean for longitudinal clinical education at the School of Medicine, explained to EHRIntelligence in an interview.

However, that will no longer be the case for CWRU medical students. The institution is the first medical school to use Lyceum, a new platform from EHR vendor Epic that aims to introduce first-year medical students to EHR platforms.

CWRU began using Lyceum with its medical student class in July 2023. The system provides students and faculty access to an EHR training environment, including dozens of test patients with diverse backgrounds and clinical case histories, as well as online learning modules and training materials.

The platform is set to prepare students for using EHRs during their third-year clinical rotation at one of CWRU's four teaching hospital affiliates, three of which use Epic systems.

"If there was a way for us to prepare our students a little bit better for their time in the clerkships by giving them exposure to the EMR, we saw that as a desirable thing that we'd like to provide," Rowland-Seymour said.

She noted that since the Lyceum platform is separate from the EHR training environments attached to the teaching hospitals, students do not have to go through the credentialing required by the hospitals.

Additionally, the EHR training environments at the hospitals are not necessarily at the right level for a medical student, Rowland-Seymour pointed out.

"All of the hospital EHR training materials are for clinicians, people who are actually in the trenches taking care of patients, not people learning how to think about providing care for patients, so it's a different vantage point," she explained.

With Lyceum, Case Western faculty will create lesson plans that focus on teaching students how to document high-quality information in the EHR.

"We want to make sure students understand that if you put in bad data, you're not going to have a lot of success in manipulating that data to get answers to your clinical questions and improve patient care," Rowland-Seymour said. "If you put in discrete pieces of data that are correct, that directly aids your ability to provide care for your patient and large populations of patients in the future."

Case Western faculty will also use the platform to help educate students on the skills necessary to interact with patients while using the EHR.

"It's a huge learning curve for clinicians to be able to talk to a patient, provide compassionate care, and be an active listener while they are documenting things in the EHR or retrieving information from the EHR," Rowland-Seymour emphasized.

"Doing all of that at the same time as being present for the patient is hard," Rowland-Seymour continued. "It takes a lot of practice to get there, so the sooner we can start our students on that journey, the better they are going to be when they are clinicians."

She also noted that integrating Lyceum into the medical school's curriculum will introduce students to the use of large data sets in clinical research. Most medical schools have a research program as part of their required training. Rowland-Seymour noted that she clearly remembers sifting through paper charts and extracting data from up to a hundred paper charts when she was a medical student.

Now, students can extract data for clinical research through the EHR, she explained.

"Teaching the students how they might extract the data from a dataset of patients in the EMR can help them begin to think about their research projects and how they might frame clinical questions based on a particular patient question that they can extrapolate to a larger dataset," Rowland-Seymour said.

Additionally, she emphasized the value of the platform for simulation-based education due to its diverse test patients and clinical case histories.

While the CWRU curriculum uses standardized patients for simulation-based medical education, Rowland-Seymour noted that the medical school is limited in terms of who they are able to recruit to portray patients.

"Our cohort of standardized patients doesn't reflect the depth and breadth of diversity of our patient population that our students see," she explained.

For instance, researchers have noted the importance of hiring transgender individuals to fill the role of a transgender standardized patient, given the historical marginalization of the transgender community.

"We are limited in terms of the number of transgender patients we might be able to expose students to using standardized patients, but if we use the EMR, we can create a transgender case that students have the opportunity to go through and practice some of their communication skills using the EMR," Rowland-Seymour said.

In the same way that physical diagnosis is a skill that clinicians must master, being able to use the EHR proficiently is a skill, she emphasized. Early exposure to these systems could go a long way in preparing future clinicians to deliver patient-centered care.