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
Date
06/28/2018Pubmed ID
29946386Pubmed Central ID
PMC6008043DOI
10.4300/JGME-D-17-00486.1Scopus ID
2-s2.0-85054961138 (requires institutional sign-in at Scopus site) 11 CitationsAbstract
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 SKAuthor
Bradley H. Crotty MD Associate Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAttitude of Health Personnel
Communication
Education, Medical, Graduate
Electronic Health Records
Feedback
Female
Humans
Internal Medicine
Internship and Residency
Male
Patient Access to Records
Physician-Patient Relations
Physicians
Surveys and Questionnaires
