Interventions to Mitigate EHR and Documentation Burden in Health Professions Trainees: A Scoping Review

Area of Science:

• Medical Education
• Health Informatics
• Human Factors Engineering

Background:

• Health professions trainees (trainees) uniquely navigate electronic health records (EHRs) during their education.
• Existing efforts to reduce EHR burden primarily focus on experienced health professionals (HPs), with less understanding of trainee-specific challenges.
• Trainee EHR burden, or documentation burden, impacts learning and clinical practice, though EHR use varies among trainees and HPs.

Purpose of the Study:

• To develop the Trainee EHR Burden Model, a framework for understanding how interventions can mitigate EHR burden within the trainee workflow.
• To systematically review interventions aimed at reducing EHR burden experienced by trainees.
• To adapt an existing workflow model by integrating findings from studies on trainee EHR interventions.

Main Methods:

• Conducted a scoping review across four databases following PRISMA-ScR guidelines to identify studies measuring trainee experiences with EHR burden interventions.
• Performed concept clarification to categorize and map included studies to elements of a workflow model.
• Adapted an existing workflow model to pinpoint specific, intervenable stages within the trainee EHR workflow.

Main Results:

• Identified 11 studies evaluating interventions for trainee EHR burden, including curriculum, training, coaching, scribe utilization, technology aids, and communication strategies.
• Interventions demonstrated varied impacts on EHR burden, primarily assessed via surveys and less frequently through direct observation.
• Most studies featured small sample sizes, focused on inpatient settings, and concentrated on physician trainees.

Conclusions:

• Limited research exists on trainee perspectives regarding interventions to alleviate EHR burden.
• Many studies employed quasi-experimental designs and were confined to inpatient environments.
• The developed Trainee EHR Burden Model provides a foundational framework for situating interventions within trainee workflows, highlighting the need for further research across diverse clinical settings.