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The Israeli Patient-Doctor-Computer communication study: an educational intervention pilot report and its implications for person-centered medicine

Shmuel Reis, Hilla Cohen-Tamir, Leora Eger-Dreyfuss, Orit Eisenburg, Aviv Shachak, Dalia Hasson-Gilad, Amitai Ziv


Background:Electronic Medical Records (EMRs) are presently ubiquitous, transforming the dyadic patient-doctor relationship into a triadic patient-doctor-computer one. Nevertheless, there is a paucity of theoretical and empirical work in the field. The authors’ previous work provides a framework for clinical encounters in the computerized setting and enabled the development of a simulation-based educational intervention (one day workshop with extensive simulated exercises and debriefing) fostering the incorporation of computerized records into consultations. The pilot trial of the intervention and its evaluation is reported.

Methods: Scenarios simulating patient-doctor encounters with Simulated Patients (SPs) have been developed based on a blueprint. A high–fidelity customized EMR system was installed at MSR - Israel Center for Medical Simulation. An evaluation package comprised of observation scales for physician-observers, SPs and learners’ self–evaluation was developed. The intervention and post-test were pilot tested on 12 Family Medicine residents.

Results:The intervention workshop and post-test were rated highly for quality, relevance, logistics, authenticity and impact. Eight paired self-evaluation surveys were available for interpretation. The average score for self-evaluation performance in the four domain skills (communication, technical use of computer, cross cultural, and error prevention) increased 1.5 points on the average (SD 1.2, range 9-13). A statistically significant increase was computed by the Wilcoxon Signed Ranks Test (Z=-2.4 p<.05). Chronbach’s alpha values were 0.604 for the SPs and 0.529 for the observers’ scales (12 records for each observer).

Conclusions: The developed module of an educational intervention for enhancing Primary Care Physicians (PCPs) skills in the computerized setting has been successfully piloted. The simulation, evaluation and debriefing tools developed for the study perform adequately and were found to be acceptable and feasible. A trend towards positive educational impact exists. The study provides a framework of insights and tools for upgrading PCPs performance in the computerized setting. These insights and tools have a real potential to advance the quality, safety and effectiveness of healthcare. This module is ready for final, rigorous testing as well as for serving as a benchmark for future leaner, portable interventions. Potentially, pending the necessary empirical evidence, it may profoundly impact upon quality of care and patient safety and has implications for the development of person-centered medicine.

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