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Abstract: SA-PO016

The Impact of the Electronic Medical Record (EMR) on Nephrology Fellowship Training

Session Information

  • Educational Research
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

  • 800 Educational Research


  • Yuan, Christina M., Walter Reed National Military Medical Center, Laurel, Maryland, United States
  • Little, Dustin J., AstraZeneca, Gaithersburg, Maryland, United States
  • Raghavan, Rajeev, Baylor College of Medicine, Houston, Texas, United States
  • Nee, Robert, Walter Reed National Military Medical Center, Laurel, Maryland, United States

Group or Team Name

  • Nephrology Education Research and Development Consortium (NERDC)

A potential unintended consequence of EMR use is the impact on physician training. We surveyed U.S. Nephrology fellows to assess perceived burdens and benefits of the EMR on fellow education.


Using the ACGME 2018-2019 public list of nephrology programs, we contacted 148 program directors (PDs) by email requesting completion of an anonymous on-line survey on EMR impact on fellow education. PDs were asked to forward an anonymous survey link to their clinical fellows, and indicate to how many they forwarded the link. Surveys were open for 2 months, with reminders sent to PDs every 2 weeks.


PD response rate was 34% (51/148 programs). 22% (33 PDs) forwarded the link to their fellows (n=216; 26% of U.S. nephrology fellows). Median fellows/program was 6 (range 2-20).

72 fellows (33%) responded. 39 were 1styear; 33 were 2nd/3rdyear fellows. 42% indicated that their institution’s EMR functionality was “slowed, disrupted, or completely lost” monthly or more.

51% of fellows agreed/strongly agreed that the EMR contributed positively to their education. The 3 most frequently cited positive effects were: access to EMR from home/mobile device (81%); efficient laboratory result trending (70%); and efficient determination of patient medications (47%). The 3 most frequently cited negative effects were: more time spent with the EMR than the patient (75%); excessive/irrelevant documentation (67%); and preventing fellows from learning the minimal essential evaluation for a given disease (42%).

More than 50% of fellows agreed/strongly agreed they were “often reluctant” to do procedures (52%), participate in conferences (57%), prolong patient interactions (74%), and do independent case-directed literature review (55%), because of the competing time demands of EMR completion. 65% “sometimes” or “often” exceeded work hours limits because of time spent on EMR documentation. 54% “sometimes” or “often” made mistakes in the EMR due to the use of “copy forward”.


Although the nephrology fellows surveyed indicated that the EMR had positive impacts on their education, the time demands of data entry appear to interfere with educational opportunities and may contribute to work hours violations.

The views expressed are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or the US Government.