Stakeholder-Informed Needs Assessment for Open Notes Curriculum in Inpatient Pediatrics

The 21st Century Cures Act mandates real-time patient access to clinical notes, introducing challenges in medical education, particularly in inpatient pediatrics, where issues of confidentiality, proxy access, and sensitive topics are common. Despite this shift in practice, medical students receive little formal preparation in writing notes that patients and caregivers can read, known as Open Notes. The objective of this study was to conduct a stakeholder-informed needs assessment to inform curricula for medical student documentation in inpatient pediatrics in the Open Notes era.

We conducted a multisite qualitative study using focus groups with key stakeholders involved in medical student documentation and supervision; third- and fourth-year medical students, Pediatrics residents, and pediatric hospital medicine fellows and faculty, across 4 US academic institutions. Transcripts were analyzed using inductive thematic analysis by a research team representing multiple levels of medical training.

Seventy-six participants across 12 focus groups identified 4 core content domains for Open Notes curricula as follows: 1) adapting documentation for diverse audiences; 2) using respectful, patient-centered language; 3) documenting diagnostic uncertainty and differing perspectives among stakeholders; and 4) managing confidentiality and proxy access. Participants supported a longitudinal curriculum beginning prior to clerkships that is reinforced throughout clinical training, with low-stakes practice opportunities, structured feedback, institutional guidance, and use of electronic health record tools to support learning.

Medical students require intentional training to document effectively in the Open Notes era. This study provides a stakeholder-informed framework to guide the development of undergraduate medical education curricula for inpatient pediatrics documentation.