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

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