The Button Project: Using Chart Rounds for Teaching Clinical Ophthalmology with an Electronic Medical Record

Objective: Chart rounds have traditionally been used effectively for clinical teaching in ophthalmology. The introduction of the electronic health record has altered practice patterns and some evidence suggests interference with resident education. The purpose of this study was to investigate the use of chart rounds in our ophthalmology department and to see if a simple intervention, an "education button", could positively impact clinical teaching. Design: We used a cross-sectional survey, and pre- and post-intervention surveys to assess the utility of an intervention - an "education button". Setting: Department of Ophthalmology at Duke University, a tertiary care academic ophthalmology practice, in Durham, North Carolina. Participants: Ophthalmology trainees (37), including residents and clinical fellows, and clinical faculty (50) in the department were surveyed anonymously. The overall response rate for the cross-sectional survey was 83% (72/87). The overall response rate for the educational study was 53% for the first time-point and 59% for the second time-point. Results: For the cross-sectional survey, trainees found chart rounds to be useful and would like to increase their frequency. Most faculty reported doing them regularly, although not having enough time was the most common barrier (76% of the faculty). In the pre- and post-assessment of the "education button" (overall response rate 53%), the overall impression was positive with the button easy to use, but the implementation of the button did not appear to change the quality or frequency of chart rounds; nor did it appear to have an effect on covering learning objectives. Conclusion: While the "education button" could help with communication between the faculty and trainees during a busy clinic session to identify cases for discussion, it did not address the most common barrier identified by faculty members, that of not having enough time.