Association Between Centers for Medicare and Medicaid Services Student Note Policy Implementation and Physician Note...

Documentation in the electronic medical record (EMR) is a core Entrustable Professional Activity for medical students, yet opportunities for participation remain limited. Following a policy change allowing physicians to bill using medical student documentation, our institution integrated student note writing into the daily workflow. This study evaluates the impact on resident and attending physician documentation time.

Daily progress notes as well as history and physicals from a pediatric hospital medicine service from January 2017 to March 2023 were included. The length of time each provider spent accessing the note, as recorded by the EMR, was used to quantify editing time differences. Linear mixed effects models with random effects for student and either resident or attending (depending on the analysis) and a fixed effect for group compared time spent editing notes.

Forty six thousand eight hundred and fifty notes from 32 attending physicians, 345 residents, and 552 medical students were analyzed. Attendings did not spend significantly different amounts of time editing notes originating from residents, third-year (M3), or fourth-year (M4) medical students (9.2 vs 8.7 vs 9.0 minutes, P = .26). Residents spent less time editing M3 notes compared to authoring their own notes (17.3 vs 40.2 minutes, P < 0.0001).

Incorporating medical student note writing into clinical practice did not increase EMR documentation time for attending physicians. Residents spent less time editing student notes, suggesting efficiency benefits. These findings support integration of student documentation as a sustainable educational practice that enhances student engagement without adding documentation time burden for resident and attending physicians.