Packed with crucial test results and messages that directly shape patient care, the EHR inbox can consume a resident physician’s day.
What can residents do to ensure patient safety and health care quality while trying not to get bogged down by what can be a burdensome volume of clerical work? In an interview with the AMA, Brianna E. Vaa Stelling, MD, MHPE, offered her expert perspective on the question.
Don’t hesitate to escalate
In both her work in the clinic and research—including a study she co-wrote that appeared in the Journal of Graduate Medical Education on how residency programs educate, monitor, and supervise inbox work —Dr. Vaa Stelling has focused on EHR inbox optimization.
Dr. Vaa Stelling—director of the ambulatory clinic rotation for the internal medicine residency at Mayo Clinic in Rochester, Minnesota—and her colleagues surveyed internal medicine program directors and about three quarters of the 267 respondents indicated that their programs have some resident inbox supervision, 51% of programs required faculty supervision of inbox messages for all residents Still, that supervision can take on many different forms.
“Some residents might be hesitant to show that they don’t have the answer to a test result or need help,” she said. “If you are unsure about what to do from a medical decision-making standpoint, need help navigating a challenging patient relationship or identifying resources within the system, those would all be situations where it would be appropriate to loop in” a supervising faculty.”
The study also found that 28% of internal medicine residency programs do not require supervision of resident inbox work.
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Ensure coverage
About 20% of program directors were aware of a patient-safety incident occurring due to an unsupervised resident inbox-related patient care decision, the study says. In most instances—save for 28% of internal medicine residency programs the study identified that do not require supervision of resident inbox work—oversight isn’t the resident’s responsibility.
Ensuring coverage of their EHR inbox when they are out, however, is another patient-safety hazard that residents can help abate.
“On a high level, a program is going to provide the scaffolding or the structure in terms of how they want to approach coverage of the inbox,” Dr. Vaa Stelling said. “In some instances, the onus is probably going to be on the individual resident to inform their co-resident team of the coverage plan.”
Dive deeper:
- The do’s and don’ts of EHR use for new resident physicians
- 9 steps to reduce the EHR inbox—and stress—at the system level
- 5 tips to help resident physicians shift from intern to PGY-2
- Do you have “feedback literacy”? For residency, it’s a must.
Programs understand the burden
According to the 2023 national comparison report based on survey responses from more than 2,000 resident physicians across 22 organizations using the AMA Organizational Biopsy®, about 20% of residents spend six-plus hours per week on EHR activities outside of work. Residency programs understand the problem, Dr. Vaa Stelling said.
“There's a relationship between inbox burden and burnout,” she said. “I can speak for our program and say that we are very mindful of that. We proactively monitor inbox burden by doing a cross-sectional analysis every month of all the residents’ inboxes. Mainly, we are looking for numbers of messages that haven't been addressed and the time it took to address high priority messages. It can be a harbinger of burnout, so we’ll make an effort to ask those residents: How are you?”
What if a resident is feeling overmatched by the inbox or the EHR?
“That’s natural—it can be overwhelming,” said Dr. Vaa Stelling. Her advice; “Reach out to a colleague, whether it’s a fellow resident, chief or attending; they can help. We want residents to utilize all the resources at their disposal, and people are a part of that.”
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.
That includes resources such as AMA Steps Forward® toolkit, “A System-Level Approach to EHR Inbox Reduction.” The nine-step process offers guidance for reducing and streamlining the inbox to ease the burden on doctors, one of the stressors that contribute to physician burnout.
Dive deeper:
- How programs can address the five top resident physician stressors
- One driver of resident physician burnout: Too little time at bedside
- 3 trends in resident physician burnout that demand action
