The Effect of Computerized Provider Order Entry on Medical Student Clerkship Experiences
- Affiliations of the authors: Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD. Dr. Harper is currently at the Department of Medicine, University of California, San Francisco, San Francisco, CA
- Correspondence and reprints: Amy M. Knight, MD, CIMS Division, ASC Building, Room 262, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224; e-mail: <aknight{at}jhmi.edu>
- Received 31 March 2005
- Accepted 9 May 2005
Abstract
Objective To describe medical students' attitudes toward placing orders during training, and the effect of computerized provider order entry (CPOE) on their learning experiences.
Design Prospective, controlled study of all 143 Johns Hopkins University School of Medicine students who began the Basic Medicine clerkship between March 2003 and April 2004 at one of three teaching hospitals: one using CPOE, one paper orders, and one that began using CPOE midway through this study.
Measurements Survey of students at the start and after the first month of the clerkship.
Results Ninety-six percent of students responded. Students expressed a desire to place 100% of orders for their patients. Ninety-five percent of students believed that placing orders helps students learn what tests and treatments patients need. Eighty-four percent reported that being unavailable due to conferences and teaching sessions was a significant barrier to participating in the ordering process. Students at hospitals using CPOE reported placing significantly fewer of their patients' follow-up orders compared to students at hospitals using paper orders (25% vs. 50%, p < 0.01) and were more likely to report that their resident or intern did not want them to enter orders (40% vs. 16%, p < 0.01). Comparisons of students at hospitals using CPOE to each other showed that these differences were attributable to one of the hospitals. Thirty-two percent of students at both hospitals using CPOE reported that the extra length of time required for housestaff to review their orders in the computer was a significant barrier.
Conclusion Hospitals need to ensure that the educational potential of medical students' clinical experiences is maximized when implementing CPOE.
Footnotes
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Informatics and statistics support provided by the Johns Hopkins Bayview Medical Center General Clinical Research Center, grant M01-RR-02719. We are grateful for the assistance of Ms. Debbie Hill with survey design, the late Dr. Matthew Tayback with statistical analysis, and for manuscript review by and helpful suggestions from Dr. Scott Wright, Dr. Roy Ziegelstein, and Dr. David Hellmann.
Presented in part at the Society of General Internal Medicine Annual Meeting, May 15, 2004, and at Medinfo: The 11th World Congress of Medical Informatics, September 10, 2004.
