Learning from Reflection on Patient Outcomes Data: How EHR Can Support Trainees in Graduate Medical Education on Inpatient Rotations

INTRODUCTION: As healthcare evolves into interdisciplinary, complex, team-based care that often includes shiftwork and sub-specialization, patient outcomes data has become necessary for trainees to engage in reflective practice in clinical environments. However, current practices around collecting and distributing such data to trainees are not effective. Specifically, it is not clear what patient data are significant and compelling to trainees for reflective practice. The goal of our study was to characterize trainee perspectives on what data are meaningful to promote reflective activities for learning in the clinical work environment.

METHODS: From 2020-2021, we conducted a longitudinal cross-sectional study to assess trainee interest in clinical outcomes data. Over 14 days, pediatrics and internal medicine residents doing inpatient work at the University of California San Francisco completed surveys corresponding to recently opened patient charts.

RESULTS: 958 surveys were completed by 41 participants (average 23 unique patient encounters per participant). Trainees expressed interest in follow-up for 32.9% of encounters (n = 315/958), most often to 'learn if something significant or unexpected happened.' Trainees most often desired follow-up patient data when they had made significant decisions or felt responsible.

DISCUSSION: Trainees were interested in clinical outcomes data for a limited number of patient encounters, highlighting challenges with current strategies to promote reflective practice using clinical outcomes data. While refinement of such approaches continues through consideration of what trainees find meaningful in data, understanding motivating and demotivating factors in trainees' outcomes data-seeking behaviors will also be crucial for success in using such data for learning opportunities.