Appl Clin Inform 2019; 10(03): 479-486
DOI: 10.1055/s-0039-1692402
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Copy-and-Paste in Medical Student Notes: Extent, Temporal Trends, and Relationship to Scholastic Performance

Ken Monahan
1  Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Cheng Ye
2  Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Edward Gould
3  Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Meng Xu
4  Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Shi Huang
4  Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Anderson Spickard III
2  Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
5  Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
S. Trent Rosenbloom
2  Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
5  Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
6  Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Joseph Coco
2  Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Daniel Fabbri
2  Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Bonnie Miller
7  Office of Health Sciences Education–School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Institutsangaben
Funding None.
Weitere Informationen

Publikationsverlauf

21. März 2019

29. April 2019

Publikationsdatum:
03. Juli 2019 (online)

Abstract

Background Medical students may observe and subsequently perpetuate redundancy in clinical documentation, but the degree of redundancy in student notes and whether there is an association with scholastic performance are unknown.

Objectives This study sought to quantify redundancy, defined generally as the proportion of similar text between two strings, in medical student notes and evaluate the relationship between note redundancy and objective indicators of student performance.

Methods Notes generated by medical students rotating through their medicine clerkship during a single academic year at our institution were analyzed. A student–patient interaction (SPI) was defined as a history and physical and at least two contiguous progress notes authored by the same student during a single patient's hospitalization. For some students, SPI pairs were available from early and late in the clerkship. Redundancy between analogous sections of consecutive notes was calculated on a 0 to 100% scale and was derived from edit distance, the number of changes needed to transform one text string into another. Indicators of student performance included United States Medical Licensing Exam (USMLE) scores.

Results Ninety-four single SPIs and 58 SPI pairs were analyzed. Redundancy in the assessment/plan section was high (40%) and increased within individual SPIs (to 60%; p < 0.001) and between SPI pairs over the course of the clerkship (by 30–40%; p < 0.001). Students in the lowest tertile of USMLE step II clinical knowledge scores had higher redundancy in the assessment/plan section than their classmates (67 ± 24% vs. 38 ± 22%; p = 0.002).

Conclusion During the medicine clerkship, the assessment/plan section of medical student notes became more redundant over a patient's hospital course and as students gained clinical experience. These trends may be indicative of deficiencies in clinical knowledge or reasoning, as evidenced by performance on some standardized evaluations.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the Vanderbilt Medical Center Institutional Review Board.