Background: Despite widespread mandated use of Electronic Health Records (EHR), many residency programs struggle to find the best strategy to conduct EHR training. Traditional EHR training sessions are typically led by non-clinical IT staff and are often structured around software functionalities rather than clinical workflow. Furthermore, EHR training is often not customized to the needs of the different clinical specialty areas. 

Purpose: The aim of this study is to create, implement, and evaluate the effectiveness of a physician led and specialty focused EHR training through the use of clinical vignettes.


A series of live EHR training sessions, tailored to each specialty, were offered to incoming interns and fellows from all departments during orientation. Participants were grouped according to clinical specialty and the live sessions were run by physicians in that specialty. All trainees were given 12 pre-training video modules and a post-video quiz to prepare for the live training sessions. During the live training sessions, trainees were given clinical vignettes and access to a mock EHR domain and mock patient. Trainees completed mock admissions, discharge processes, medical reconcilliations and entered orders related to their clinical specialty area and workflow. Trainees also completed a post training satisfaction survey at the end of the final training session. A total of 206 trainees participated in the study. A total of  146 completed the survey (response rate of 70%). 77% of the participants ‘strongly agreed’ or ‘agreed’ that the EHR workflow based vignettes were effective in enhancing their training.


Our study suggests that EHR training should minimize computer based, passive didactic teaching of software functionalities and rather should focus on case-based clinical vignettes that are tailored to each clinical subspecialty area to accommodate for the different types of workflow. An EHR training model centered on a specialty based workflow approach can be used as an important training technique to teach residents the core principles of EHR use.