THE ELECTRONIC HEALTH RECORD AND DEVELOPMENT OF MEDICAL STUDENTS' MENTAL PATIENT MODELS.

Medical practitioners routinely use dual process clinical reasoning: pattern recognition, termed system 1 thinking, and system 2 thinking or analytic reasoning. System 1 thinking, a hallmark of expertise developed through experience with multiple similar patients and deliberate practice, is rapid and automatic. For decades, the structured written medical write-up and progress notes served an educational as well as a patient care role. The introduction of electronic health records (EHRs) potentially hinders the development of the cognitive models upon which system 1 thinking is predicated. Using a vignette-based extended matching chief complaint examination, we investigated the effects of introducing an inpatient EHR on three classes of third-year medical students before and after the EHR implementation. While some subsection scores were significantly different, there was no overall change in performance. Based on this assessment, the development of cognitive models of patient presentations is not impeded by the introduction of an EHR.