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Women's health care has evolved significantly since it was first acknowledged as an integral part of internal medicine training more than two decades ago. To update and clarify core competencies in sex- and gender-based women's health for general internists, the Society of General Internal Medicine (SGIM) Women and Medicine Commission prepared the following Position Paper, approved by the SGIM council in 2023. Competencies were developed using several sources, including the 2021 Accreditation Council for Graduate Medical Education Program Requirements for Internal Medicine and the 2023 American Board of Internal Medicine Certification Examination Blueprint. These competencies are relevant to the care of patients who identify as women, as well as gender-diverse individuals to whom these principles apply. They align with pivotal advances in women's health and acknowledge the changing context of patients' lives, reaffirming the role of general internal medicine physicians in providing comprehensive care to women.

BackgroundPrimary care practices are responding to calls to incorporate patients' social risk factors, such as housing, food, and economic insecurity, into clinical care. Healthcare likely relies on the expertise and resources of community-based organizations to improve patients' social conditions, yet little is known about the referral process.ObjectiveTo characterize referrals to community-based organizations by primary care practices.DesignQualitative study using semi-structured interviews with healthcare administrators responsible for social care efforts in their organization.ParticipantsAdministrators at 50 diverse US healthcare organizations with efforts to address patients' social risks.Main measuresApproaches used in primary care to implement social needs referral to community-based organizations.ResultsInterviewed administrators reported that social needs referrals were an essential element in their social care activities. Administrators described the ideal referral programs as placing limited burden on care teams, providing patients with customized referrals, and facilitating closed-loop referrals. We identified three key challenges organizations experience when trying to implement the ideal referrals program: (1) developing and maintaining resources lists; (2) aligning referrals with patient needs; and (3) measuring the efficacy of referrals. Collectively, these challenges led to organizations relying on staff to manually develop and update resource lists and, in most cases, provide patients with generic referrals. Administrators not only hoped that referral platforms may help overcome some of these barriers, but also reported implementation challenges with platforms including inconsistent buy-in and use across staff; integration with electronic health records; management and prioritization of resources; and alignment with other organizations in their market.Conclusion and relevanceReferrals to community-based organizations were used in primary care to improve patients' social conditions, but despite strong motivations, interviewees reported challenges providing tailored and up-to-date information to patients.

As part of an investment by the Bill & Melinda Gates Foundation to support the Government of Bihar to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide, BBC Media Action implemented multiple communication tools to support front-line worker (FLW) outreach. We analyse the impacts of a package of mHealth audio messaging and paper-based job aids used by FLWs during government-sponsored village health, sanitation and nutrition days (VHSNDs) on knowledge and practices of childbearing women across the RMNCHN continuum of care. Data from two surveys collected between July and September 2016 were analysed using logistic regression to compare health-related knowledge and behaviours between women who had been exposed at VHSNDs to the mHealth GupShup Potli (GSP) audio recordings or interpersonal communication (IPC) tools versus those who were unexposed. Exposure to GSP recordings (n=2608) was associated with improved knowledge across all continuum-of-care domains, as well as improved health-related behaviours in some domains. The odds of having taken iron-folic acid (IFA) tablets were significantly higher in exposed women (OR 1.5, 95% CI 1.1 to 2.2), as was contraceptive use (OR 2.0, 95% CI 1.2 to 3.2). There were no differences in birth preparedness or complementary feeding practices between groups. Exposure to IPC paper-based tools (n=2002) was associated with a twofold increased odds of IFA consumption (OR 2.3, 95% CI 1.7 to 3.2) and contraceptive use (OR 1.8, 95% CI 1.2 to 2.8). Women exposed to both tools were generally at least twice as likely to subsequently discuss the messages with others. BBC Media Action's mHealth audio messaging job aids and paper-based IPC tools were associated with improved knowledge and practices of women who were exposed to them across multiple domains, suggesting their important potential for improving health outcomes for beneficiaries at scale in low-resource settings. NCT02726230.

BackgroundBrucellosis, as a serious zoonotic infectious disease, has been recognized as a re-emerging disease in the developing countries worldwide. In china, the incidence of brucellosis is increasing each year, seriously threatening the health of humans as well as animal populations. Despite a quite number of diagnostic methods currently being used for brucellosis, innovative technologies are still needed for its rapid and accurate diagnosis, especially in area where traditional diagnostic is unavailable.Methodology/principal findingsIn this study, a total of 22 B cell linear epitopes were predicted from five Brucella outer membrane proteins (OMPs) using an immunoinformatic approach. These epitopes were then chemically synthesized, and with the method of indirect ELISA (iELISA), each of them displayed a certain degree of capability in identifying human brucellosis positive sera. Subsequently, a fusion protein consisting of the 22 predicted epitopes was prokaryotically expressed and used as diagnostic antigen in a newly established brucellosis testing method, nano-ZnO modified paper-based ELISA (nano-p-ELISA). According to the verifying test using a collection of sera collected from brucellosis and non-brucellosis patients, the sensitivity and specificity of multiepitope based nano-p-ELISA were 92.38% and 98.35% respectively. The positive predictive value was 98.26% and the negative predictive value was 91.67%. The multiepitope based fusion protein also displayed significantly higher specificity than Brucella lipopolysaccharide (LPS) antigen.ConclusionsB cell epitopes are important candidates for serologically testing brucellosis. Multiepitope fusion protein based nano-p-ELISA displayed significantly sensitivity and specificity compared to Brucella LPS antigen. The strategy applied in this study will be helpful to develop rapid and accurate diagnostic method for brucellosis in human as well as animal populations.

An objective structured clinical examination (OSCE) has been recognised as a reliable but workload-intensive assessment method across health sciences studies. Though a variety of digital marking tools have been employed to improve marking and feedback provision for OSCEs, many of these require specialist software or maintenance. This pilot study examines the development and trialling of Microsoft Forms as a marking and feedback instrument for an OSCE within a Sport and Exercise Therapy module. This study aims to assess whether the use of a non-specialist digital tool, such as Microsoft Forms, might be able overcome limitations in current assessment procedures and ultimately provide a more effective method for marking and feedback provision for an OSCE. Results from OSCE examiners (N = 8) and students (N = 30) who participated in the pilot indicate that Microsoft Forms does have the potential to provide a more effective experience for examiners and ultimately improve upon feedback provision for students when compared with a paper-based marking tool. However, concerns around the form's ease-of-use may ultimately influence its adoption as a marking instrument above current paper-based methods.

The use of misidentified and contaminated cell lines continues to be a problem in biomedical research. Research Resource Identifiers (RRIDs) should reduce the prevalence of misidentified and contaminated cell lines in the literature by alerting researchers to cell lines that are on the list of problematic cell lines, which is maintained by the International Cell Line Authentication Committee (ICLAC) and the Cellosaurus database. To test this assertion, we text-mined the methods sections of about two million papers in PubMed Central, identifying 305,161 unique cell-line names in 150,459 articles. We estimate that 8.6% of these cell lines were on the list of problematic cell lines, whereas only 3.3% of the cell lines in the 634 papers that included RRIDs were on the problematic list. This suggests that the use of RRIDs is associated with a lower reported use of problematic cell lines.

"The viscosity of the blood in narrow capillary tubes" by Robin Fahraeus and Torsten Lindqvist ("Am J Physiol" 96: 562--568, 1931) can be a valuable opportunity for teaching basic hemorheological principles in undergraduate cardiovascular physiology. This classic paper demonstrates that a progressive decline in apparent viscosity occurs when blood flows through glass capillary tubes of diminishing radius, which was later designated as the "Fahraeus-Lindqvist effect." Subsequent studies have shown that apparent viscosity continues to decline at diameters that correspond to the arteriolar segments of the systemic vascular tree, where the majority of the total peripheral resistance resides and is actively regulated in vivo. The Fahraeus-Lindqvist effect thus reduces microvascular resistance, thereby maintaining local tissue perfusion at a relatively lower blood pressure. The paper by Fahraeus and Lindqvist can be used as a platform for a plenary discussion of these concepts as well as of the relationships among hematocrit, vessel diameter, red blood cell deformability, and resistance to blood flow and how these factors may affect the work of the heart. (Contains 2 tables and 3 figures.)

Background: Treatment burden is an emerging concept in health care literature. It can complicate the patients’ condition and perhaps result in poor adherence to treatment, which is linked to worse clinical outcomes. However, until now there is no definition for treatment burden recognized by all stakeholders. This review was prepared in order to find what available definitions for treatment burden are present in the literature. Methods: A systematic review of the literature was prepared looking for definitions of treatment burden in adult patients. Articles about adults aged 18 years or older from both genders with one or more medical conditions that contained a (new) definition of treatment burden were included. The search approach consisted of conventional systematic review database searching of multiple resources including Embase, Medline, PsycINFO, and CINAHL. Two independent reviewers screened the titles and abstracts, and full papers. Results: The searches resulted in 8045 records, of which 16 articles were included. Based on quality appraisal criteria, we decided that two definitions had better evaluations than the rest of the definitions, the first one defining it as the impact of the ‘work of being a patient’ on functioning and well-being, the second as the actions and resources they devote to their healthcare. Conclusion: We consider the definition concentrating on actions and resources patients devote to their healthcare, including difficulty, time, and out-of-pocket costs dedicated to the healthcare tasks such as adhering to medications, dietary recommendations, and self-monitoring as the one probably comprising most domains of Treatment Burden that we have found in our search in the existing literature. However, adding even more domains to this definition and differentiating explicitly between patient's perception and caregiver's perception in the definition could in our opinion result in an improved definition. Also patients' evaluation of this definition is commendable.

Through a previous review of high impact practices at our institution, we identified that health science students have very few opportunities to engage in experiential learning (EL) in the current curriculum. This paper describes our work to transform an existing volunteer opportunity at an allied health clinic, into a meaningful, student-driven, co-curricular EL opportunity. Specifically, we incorporated critical EL elements (i.e. reflection, feedback) into the existing volunteer program and developed five program specific learning outcomes (LO). We then tracked volunteers' self-selected participation in a variety of activities and collected volunteers' and practitioners' assessment of LO achievement. This paper presents LO data from the first offering of this EL opportunity and discusses the challenges we faced and lessons learned through this process so that it may inform other institutions considering implementing co-curricular EL opportunities.

Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.

Peer-assisted learning (PAL) is a long-standing educational concept in higher education (HE) and has been subjected to ongoing development and ultimate implementation into so-called 'high-risk' programmes. Substantial literature and evidence are available to confirm that PAL is an effective tool for unlocking active learning in medical education. This paper focusses on the effects of same-year/level PAL implementation on the academic performance of tutors and tutees in a health sciences' extended curriculum programme (ECP) at a University of Technology (UoT) in South Africa (SA). A retrospective, longitudinal and quantitative analysis of pre- and post-intervention results of three consecutive ECP student cohorts (2017-2019) was conducted to determine whether same-year/level PAL implementation enhanced academic performance. A total of 138 ECP students participated in this study and a statistically significant difference (p-value <0.05) was found with the overall comparison between the pre- and post-intervention results. Although not all ECP students benefited from this same-year/level PAL intervention, the findings of the study suggest that for the majority of ECP students, same-year/level PAL can be considered as an innovative educational intervention to improve academic success and preparedness for future studies.

In health sector, the academics require the faculty members to publish their scientific or scholarly work to contribute to the ever-evolving knowledge and understanding. It also develops connections with people of same field to promote learning and knowledge as a part of continuing education. Due to lack of formal coaching and instruction at the undergraduate level, regarding research methodology, including hypothesis development, sample size calculation, data collection and ethical approvals, the poorly constructed articles are often rejected by the reviewers. Thorough understanding of manuscript writing makes it potentially strong to be accepted by the editorial team. A quality article is a positive addition to the vast field of scientific research. Thus, to ensure the accuracy of scientific knowledge, the manuscripts have to be evaluated intricately. By addressing the issues responsible for rejections, one can maximize the rate at acceptance. [ABSTRACT FROM AUTHOR]

Inquiry-based learning (IBL) provides students with an opportunity to take ownership of their learning while developing important higher-order skills necessary for designing innovative solutions to complex modern health problems. In our undergraduate health sciences program, critical thinking, creativity, research skills and innovative thinking are core program learning outcomes, and thus IBL is an important pillar of our curriculum. We have taken a staged approach, integrating IBL into each year of a four-year undergraduate degree program that scaffolds structure and independence to suit undergraduate student needs from the first to third years; this culminates in an independent, student-driven honours thesis in the fourth year. In this paper, we share practical IBL strategies that pair with student needs throughout the four-year continuum and highlight strategies to address challenges at each stage of learning.

This paper aims to validate the English Language Entrance Test for King Saud bin Abdulaziz University for Health Science (hereafter KSAU-ET). It supports the argument regarding using specially designed in-house entrance tests at health universities by showcasing the test's development, administration, and validation process. It presents a new framework for test validation that is informed by various existing frameworks such as Messick (1996), Sireci (1998) and, Weir (2005), with a specific focus on the notions of unitary and practicality. The proposed framework treats validity as a pre-, during, and post-test process that collects evidence from each phase to support the test's overall validity. The data were collected using different tools and through the three stages of the validation process. The test was taken by 474 candidates who applied to join KSAU-HS Stream II medical program. The data confirmed that the test was reliable (alpha > 7) and reasonably meet the university's needs to select the program's top prospective candidates. Nevertheless, the study highlighted the importance of collecting further evidence in future studies and including more selection criteria in the regression model of analysis. Using this framework, the study contributes to the existing body of research that investigate English entrance test validation. It shows that exam validity is a context-sensitive process strongly associated with the purpose for which the exam is used. Finally, the paper discusses pedagogical implications that may help educators at health science universities develop in-house entrance tests in place of standardized tests, which often do not address context, curriculum, or program objectives.

The faculty at Massachusetts College of Pharmacy and Health Sciences (MCPHS) recognized the potential benefits for collaborative teaching and learning across disciplines. Research and development of an Interprofessional Case Learning Project (ICLP) laid the foundation for the creation and implementation of a problem-based learning course. This course, Interdisciplinary Perspectives of an Infectious Disease--Malaria, introduced innovative interdisciplinary pedagogy into the curriculum of the MCPHS School of Arts & Sciences. Designed by biologists, chemists, historians, and public health faculty, this course introduced senior pre-medicine majors to varied methods and theories as they worked in groups to solve problems related to the incidence, prevention, and treatment of an infectious disease. Students' deliverables included journal-quality research papers and posters presented at the MCPHS School of Arts & Sciences Undergraduate Research Conference.

Background: Mentorship is essential for education and career development in health-related fields, yet Sub-Saharan African universities often lack structured programs. To address this, the MedXMentor program was established at Mbarara University of Science and Technology (MUST) to provide structured mentorship to undergraduate health sciences students in Uganda. This paper outlines insights gained from implementing the MedXMentor hybrid mentorship program. Methods: Using a mixed-methods approach, the study employed the Kirkpatrick Model of Evaluation to assess mentees' reactions, learning, behavior, and goal achievement. Data were collected via Google Form surveys, feedback forms, mentoring logs, and session attendance records. Descriptive statistics and thematic analysis provided a comprehensive understanding of the program's impact. Results: The program served 80 mentees, with 48 participating in one-on-one mentorship and 32 in group sessions. It enlisted 24 mentors, mainly from the medical field. Between April and September 2022, eight online group sessions were held, with an average attendance rate of 52%. These sessions focused on project planning, grant writing, and soft skills development, resulting in improved mentee comprehension and skill acquisition. Mentees reported an enhanced understanding of project planning, grant writing, communication, leadership, and teamwork. Their experiences were categorized into four themes: Mentor Engagement, Goal-Oriented Study, Skills and Professional Development, and High-Yield Mentor-Mentee Engagements. Conclusion and recommendations: Implementing the MedXMentor program proved effective in providing crucial mentorship and equipping students with vital academic and professional skills. The program highlighted its potential to bridge the mentorship gap in low-resource settings. By empowering future healthcare professionals in Africa, MedXMentor exemplifies how mentorship initiatives can drive significant advancements in healthcare education and practice.

Virtual Reality (VR) is a computer-generated environment with noteworthy didactic applications in different educational levels and areas of knowledge. The study of the perceptions of the agents involved about the use of VR in lectures is a fruitful line of research because it has implications in terms of the measures to be taken to improve the training and competence of professors in its use. In this paper, a quantitative, descriptive, and correlational research is carried out on the assessments of a sample of 1638 Latin American university professors on both (i) the didactic use of VR and (ii) the influence of the professors' area of knowledge on these assessments. For this purpose, a validated questionnaire was used, the responses to which were subjected to statistical analysis. As a result, it was found that the ratings of VR are very high, but professors believe that their digital skills for its use are insufficient. In addition, the professors' area of knowledge significantly influences their ratings, being higher in the areas of knowledge in which professors have a better self-concept of their digital skills. Furthermore, gender gaps have also been identified in the answers given, which behave differently according to the area of knowledge. Finally, some conclusions, implications, and recommendations are drawn from the results obtained.

In multilingual Australian classrooms, one of the biggest challenges for culturally and linguistically diverse (CALD) learners is mastering the academic language they need to succeed at school. Unlike everyday language, academic language refers to the abstract, complex and challenging language that students need to understand, evaluate, synthesise and report on ideas that they learn in the classroom. It may include, for example, discipline-specific vocabulary, or textual conventions typical for a content area. As Goldenberg (2008) says: "If we want students to think like mathematicians, read like historians, write like scientists, we need to teach them these ways of thinking reading and writing" (p. 9). For CALD students in Australian mainstream classrooms, who learn subject content through English, mastery of academic language can prove particularly challenging if they are restricted to "English only" approaches to show what they know and can do. In contrast, a translanguaging approach can enable students to utilize any of the features in their full linguistic repertoires to demonstrate what they know and can do in relation to classroom content (Garcia, Johnson & Seltzer, 2017). This paper reports on an empirical research project that investigated the role of translanguaging (Garcia, 2009) in teaching academic language to CALD students, by setting up collaborative activities in which students worked together to draw upon all of their language and cultural knowledge. During this project, the first author, an academic researcher, collaborated with two classroom teachers (both of whom co-authored this paper) to explore various ways in which teachers could mobilise multilingual teaching pedagogies to support the students' access to and engagement with language and literacy learning. In providing a finely grained account of how a translanguaging approach was applied to literacy and oracy work in a Health Sciences unit, this article demonstrates clearly how CALD students' linguistic resources are fundamental to their cultural identities, and that enabling students to access all of these resources can lead to deeper and richer learning experiences.

This paper proposes social living labs for informed learning as an innovative approach to interprofessional and community education. It presents a new conceptual model and practice framework suited to rapidly changing, information-intensive work and social environments. The proposed approach is theoretically informed and evidence based. It integrates concepts from three complementary fields: Informed learning as information literacy pedagogy that enables using information critically and creatively to learn (information science); interprofessional education as a professional learning model with a cross-disciplinary and community reach (health sciences/medicine); and social living labs as informal learning context and problem-solving process (community development). After reviewing relevant literature, the paper introduces the concepts and research that underpin social living labs for informed learning. Then it presents a new conceptual model and a practice framework to guide their design and implementation. To illustrate the practical application of this approach, a hypothetical scenario envisages health practitioners, librarians and community members collaborating in a social living lab to address health and social challenges related to child obesity. The paper concludes by discussing anticipated benefits and limitations of the approach and possible wider application. As a contribution to theory, the paper uncovers a previously unrecognised synergy between the principles of informed learning, social living labs and interprofessional education. Supporting information literacy research and practice, the paper identifies a significant role for informed learning in community and professional education, and a novel strategy for health information literacy development. The paper is of interest to educators, researchers, and practitioners across information literacy, community development, healthcare, and other professional fields.

This paper describes a study, in the form of multiple field tests, designed to help students in an environmental health science course express and understand the subjective perspectives that they and their classmates hold on important course topics. This study is part of a project using the Q sorting technique found in Q methodology as the basis for a classroom activity, an approach we term Q pedagogy. Q methodology is a research methodology designed to study people's subjectivity and was first formulated by William Stephenson in the 1930s. Results show that the Q pedagogy activity was effective in promoting individual reflection and group discussion among students in the class. Q pedagogy adapts the rich, mixed methods research approach of Q methodology for instruction to advance the Scholarship of Teaching and Learning (SoTL).

This case presents the design and implementation process of multimedia case-based learning modules for a Sex and Gender Specific Health (SGSH) education curriculum. The learning modules were designed to advance understanding of sex and gender differences, increase awareness of gender-specific health issues, and improve clinical knowledge of sex and gender evidence-based medicine. This paper describes the three phases of the project. In the first phase of planning, five diseases actively examined in the medical field were chosen to address sex and gender differences, and the instructional development team specifically adapted a case-based learning framework to provide more authentic and interprofessional learning opportunities for health science trainees. In the second phase, learning modules were structured with multiple revisions incorporating multimedia case-based learning strategies, such as case movie trailers, expert guides, and case solutions. In the third phase, a number of decisions regarding module interface, case videos, and server management were made. Throughout the phases, the instructional designers resolved a number of issues, such as communication with subject matter experts (SMEs), consistency of learning materials, copyright, case movie production tool, closed captioning, server configuration, and dissemination. The design process and challenges described in this paper would be useful for others developing similar instructional materials in a healthcare environment.

In this paper, we critically evaluate the use of a weekly "rapid responses (RR) to learning" process in the context of teaching a graduate course on research methods over a three-year period. The RR process involved use of a short set of open-ended questions about key moments in learning that students complete, in writing, during the last five minutes of each class. The questions asked students to identify salient take-away messages, note when they felt the most and least engaged, name actions taken by anyone that were affirming or confusing, and consider specific "aha" moments. Our specific aim was to assess the following questions: What was the pedagogic value of the RR process? How did it inform our teaching and to what extent were there direct benefits of the process for students as well as for us as teachers? We found that the systematic feedback we obtained in this way supported weekly monitoring of student learning, facilitated response to trouble spots, and assisted in assessment of student engagement and classroom climate. It also provided insight into the efficacy of pedagogic strategies, such as student engagement in metacognitive learning, and models a process of instructors receiving feedback and being flexible to change. For instructors, the process enhanced motivation and professional development; plus, we found benefits in documenting instructor leadership and development. Finally, it facilitated deeper appreciation of the need to better integrate student self-assessment and the development of metacognitive skills as core components of the course.

This paper presents the findings of a study on a fully online Bachelor's level course in Health Sciences at a European University conducted to explore the influence of learning design on the formation and evolution of different types of communities of learning. The impetus for the study came from the well-established effectiveness of community-based learning, a need for understanding learning design and analytics within networked structures and, the lack of theoretical grounding for social network analysis (SNA) in previous literature. Our study uses the Integrated Methodological Framework (IMF) which employs SNA as the key methodology for exploring community-based learning in light of the Communities of Practice (CoP) and Community of Inquiry (CoI) frameworks. The course comprised of three differently designed successive discussion forums spanning three weeks each. Network diagrams and SNA measures clearly showed the impact of the different learning designs on student engagement in the discussion forums. Based on CoP and CoI structural components within the IMF, a comparative analysis of whole-network properties of the three networks indicated the formation of a CoP, initiated and mediated by the tutor in discussion 1, sustained by the students in discussion 2, and disintegrated due to lack of guidance and facilitation in discussion 3. Qualitative analysis on the content of discussion posts revealed the importance of group oriented messages in the formation of the CoP. The paper discusses findings in terms of implications for learning design and analytics in online learning and the role of the tutor in community formation.

ObjectiveElectronic health records (EHRs) are widely adopted, but the time demands of EHR use on ophthalmology trainees are not well understood. This study evaluated ophthalmology trainee time spent on clinical activities in an outpatient clinic undergoing EHR implementation.DesignProspective, manual time-motion observations of ophthalmology trainees in 2018.ParticipantsEleven ophthalmology residents and fellows observed during 156 patient encounters.MethodsProspective time-motion study of ophthalmology trainees 2 weeks before and 6 weeks after EHR implementation in an academic ophthalmology department. Manual time-motion observations were conducted for 11 ophthalmology trainees in 6 subspecialty clinics during 156 patient encounters. Time spent documenting, examining, and talking with patients were recorded. Factors influencing time requirements were evaluated using linear mixed effects models.Main outcome measuresTotal time spent by ophthalmology residents and fellows per patient, time spent on documentation, examination, and talking with patients.ResultsSeven ophthalmology residents and four ophthalmology fellows with mean (standard deviation) postgraduate year of 3.7 (1.2) were observed during 156 patient encounters. Using paper charts, mean total time spent on each patient was 11.6 (6.5) minutes, with 5.4 (3.5) minutes spent documenting (48%). After EHR implementation, mean total time spent on each patient was 11.8 (6.9) minutes, with 6.8 (4.7) minutes spent documenting (57%). Total time expenditure per patient did not significantly change after EHR implementation (+0.17 minutes, 95% confidence interval [CI] for difference in means: -2.78, 2.45; p = 0.90). Documentation time did not change significantly after EHR implementation in absolute terms (+1.42 minutes, 95% CI: -3.13, 0.29; p = 0.10), but was significantly greater as a proportion of total time (48% on paper to 57% on EHR; +9%, 95% CI: 2.17, 15.83; p = 0.011).ConclusionTotal time spent per patient and absolute time spent on documentation was not significantly different whether ophthalmology trainees used paper charts or the recently implemented EHR. Percentage of total time spent on documentation increased significantly with early EHR use. Evaluating EHR impact on ophthalmology trainees may improve understanding of how trainees learn to use the EHR and may shed light on strategies to address trainee burnout.