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Open Notes in Teaching Clinics: A Multisite Survey of Residents to Identify Anticipated Attitudes and Guidance for Programs. J Grad Med Educ 2018 Jun;10(3):292-300



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Scopus ID

2-s2.0-85054961138   1 Citation


Background : Clinicians are increasingly sharing outpatient visit notes with patients through electronic portals. These open notes may bring about new educational opportunities as well as concerns to physicians-in-training and residency programs.

Objective : We assessed anticipatory attitudes about open notes and explored factors influencing residents' propensity toward note transparency.

Methods : Residents in primary care clinics at 4 teaching hospitals were surveyed prior to implementation of open notes. Main measures included resident attitudes toward open notes and the anticipated effect on patients, resident workload, and education. Data were stratified by site.

Results : A total of 176 of 418 (42%) residents responded. Most residents indicated open notes would improve patient engagement, trust, and education but worried about overwhelming patients, residents being less candid, and workload. More than half of residents thought open notes were a good idea, and 32% (56 of 176) indicated they would encourage patients to read these notes. More than half wanted note-writing education and more feedback, and 72% (126 of 175) indicated patient feedback on residents' notes could improve communication skills. Attitudes about effects of open notes on safety, quality, trust, and medical education varied by site.

Conclusions : Residents reported mixed feelings about the anticipated effects of sharing clinical notes with patients. They advocate for patient feedback on notes, yet worry about workload, supervision, and errors. Training site was correlated with many attitudes, suggesting local culture drives resident support for open notes. Strategies that address resident concerns and promote teaching and feedback related to notes may be helpful.

Author List

Crotty BH, Anselmo M, Clarke D, Elmore JG, Famiglio LM, Fossa A, Flier L, Green J, Klein JW, Leveille S, Lin CT, Lyon C, Mejilla R, Moles M, Stametz RA, Thompson M, Walker J, Bell SK


Bradley H. Crotty MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Attitude of Health Personnel
Education, Medical, Graduate
Electronic Health Records
Internal Medicine
Internship and Residency
Patient Access to Records
Physician-Patient Relations
Surveys and Questionnaires
jenkins-FCD Prod-409 d1e206b0be345926047b0d9c353c78a4cce4058b