Postgraduate Master of Medicine student perspectives on data access and record-keeping for research
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Abstract
Background. Registrars in specialisation training programmes encounter numerous difficulties in completing the research component of the Master of Medicine degree. Poor patient record-keeping hinders the research process.
Objectives. To investigate current types of medical patient record-keeping systems (electronic v. paper) in training health facilities, and the effect data accessibility has on specialist training and research.
Methods. This was a mixed-methods study that included both descriptive and analytical components. Of 610 postgraduate students enrolled in the University of KwaZulu-Natal College of Health Sciences Master of Medicine programme, 168 completed a cross-sectional survey to collect data and 11 did follow-up interviews. The survey and interviews explored issues related to medical record-keeping in the participants’ department or hospital, emphasising their experiences with data access while conducting research. The quantitative data were analysed using descriptive statistics, and the qualitative data were analysed thematically. Ethical approval was obtained from the institution’s Biomedical Research Ethics Committee.
Results. Of the 168 participants, 94 (56%) reported that problems with data access hindered their research, while 56 (33%) indicated that data access did not affect their research. Only 30 participants (18%) had no difficulty in obtaining data for their research, while the rest (n=138; 82%) experienced varying degrees of difficulty. A total of 110 participants (65%) indicated that paper-based record-keeping was mainly being used in their department or hospital, while electronic record-keeping was reported by the rest (n=58; 35%). Many (n=125; 74%) expressed the need to improve hospital data management practices, and 39 (23%) reported that plans were being implemented to improve these practices. Participants expressed frustration with regard to accessing data even in departments that used electronic systems, and they raised concerns regarding data security.
Conclusion. The migration to electronic patient record-keeping has not yet been implemented in many hospitals, with poor patient record-keeping affecting training and research.
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References
Smith LJ. How to survive as a medical registrar. Br J Hosp Med (Lond) 2012;73(7):C104-C108. https://doi. org/10.12968/hmed.2012.73.sup7.c104
Walters L, Laurence CO, Dollard J, Elliott T, Eley DS. Exploring resilience in rural GP registrars – implications for training. BMC Med Educ 2015;15:110. https://doi.org/10.1186/s12909-015-0399-x
Patel N, Naidoo P, Smith M, Loveland J, Govender T, Klopper J. South African surgical registrar perceptions of the research project component of training: Hope for the future? S Afr Med J 2016;106(2):169-171. https://doi. org/10.7196/SAMJ.2016.v106i2.10310
Szabo CP, Ramlall S. Research competency and specialist registration: Quo vadis? S Afr Med J 2016;106(12):1183- 1185. https://doi.org/10.7196/SAMJ.2016.v106.i12.11217
Biccard BM, Dyer RA, Swanevelder JL, Coetzee JF, Shafer SL. Is the HPCSA requirement for a research dissertation for specialist registration the best option? South Afr J Anaesth Analg 2017;23(4):4-6.
Grossman ES. How long does it take a registrar to complete the compulsory research project enabling specialist registration? S Afr Med J 2019;109(4):254-258. https://doi.org/10.7196/SAMJ.2019.v109i4.13377
Costello A, Filippi V, Kubba T, Horton R. Research challenges to improve maternal and child survival. Lancet 2007;369(9569):1240-1243. https://doi.org/10.1016/S0140-6736(07)60574-1
Patel N, Leusink AL, Singh N, Koto MZ, Luvhengo T. Registrar perceptions on general surgical training in South Africa: A report by the South African Society of Surgeons in Training (SASSiT). S Afr J Surg 2018;56(2):10-14. 9. Singh E. Clinical registrars’ perceptions of their specialist training on the University of Witwatersrand training
circuit. MMed (Comm Health) thesis. Johannesburg: University of the Witwatersrand, 2010. http://hdl.handle.
net/10539/7750 (accessed 15 February 2023).
Swart HA, Archer E. ‘We communicate poorly with each other’ – registrars’ perceptions of communication skills
training. MedEdPublish 2021;10:119. https://doi.org/10.15694/mep.2021.000119.1
Kleinitz A, Campbell D, Walters L. General practice registrar perceptions on training medical students. Aust Fam
Physician 2014;43(1):64-67.
Majola N. The ophthalmology postgraduate training programme in South Africa: The registrars’ perspective. Afr
Vision Eye Health 2019;78(1):a493. https://doi.org/10.4102/aveh.v78i1.493
Pezzi CM. Big data and clinical research in oncology: The good, the bad, the challenges, and the opportunities.
Ann Surg Oncol 2014;21(5):1506-1507. https://doi.org/10.1245/s10434-014-3519-7
Katurura MC, Cilliers L. Electronic health record system in the public health care sector of South Africa: A systematic literature review. Afr J Prim Health Care Fam Med 2018;10(1):1746. https://doi.org/10.4102/phcfm.
v10i1.1746
Dadipoor S, Ramezankhani A, Aghamolaei T, Safari-Moradabadi A. Barriers to research activities as perceived by medical university students: A cross-sectional study. Avicenna J Med 2019;9(1):8-14. https://doi.org/10.4103/ ajm.AJM_121_18
Kabirpanthi V, Gupta V, Chavan PV. Barriers perceived by researchers in pursuing medical research in an evolving medical college of tribal Madhya Pradesh, India. J Fam Med Prim Care 2022;11(2):701‐707. https://doi. org/10.4103/jfmpc.jfmpc_1706_21
Nabeiei P, Mousavinezhad H, Amini M. Barriers that prevent implementation of research in medical education. J Adv Med Educ 2017;1(1):7-14.
Andronikou S. ‘Board exams’ for South African radiology registrars – level the playing field. SA J Radiol 2012;16(1):a221. https://doi.org/10.4102/sajr.v16i1.221
Jenkins LS, von Pressentin K. Family medicine training in Africa: Views of clinical trainers and trainees. Afr J Prim Health Care Fam Med 2018;10(1):1638. https://doi.org/10.4102/phcfm.v10i1.1638
Nolte KB. Research issues in forensic pathology: A survey of academic institutions employing forensic pathologists. Hum Pathol 2004;35(5):532-535. https://doi.org/10.1016/j.humpath.2004.01.010
Bots SH, Groenwold RHH, Dekkers OM. Using electronic health record data for clinical research: A quick guide. Eur J Endocrinol 2022;186(4):E1-E6. https://doi.org/10.1530/EJE-21-1088
Vos JFJ, Boonstra A, Kooistra A, Seelen M, van Offenbeek M. The influence of electronic health record use on collaboration among medical specialties. BMC Health Serv Res 2020;20(1):676. https://doi.org/10.1186/s12913- 020-05542-6
Honeyford K, Expert P, Mendelsohn EE, et al. Challenges and recommendations for high quality research using electronic health records. Front Digit Health 2022;4:940330. https://doi.org/10.3389/fdgth.2022.940330
Keshta I, Odeh A. Security and privacy of electronic health records: Concerns and challenges. Egypt Informatics J 2021;22(2):177-183. https://doi.org/10.1016/j.eij.2020.07.003
YanamadalaS,MorrisonD,CurtinC,McDonaldK,Hernandez-BoussardT.Electronichealthrecordsandqualityof care: An observational study modeling impact on mortality, readmissions, and complications. Medicine (Baltimore) 2016;95(19):e3332. https://doi.org/10.1097/MD.0000000000003332
Weeks RV. Electronic health records: Managing the transformation from a paper-based to an electronic system, J Contemp Manage 2013;10:135-155.
Sandhu D. Postgraduate medical education – challenges and innovative solutions. Med Teach 2018;40(6):607- 609. https://doi.org/10.1080/0142159X.2018.1461997
University of KwaZulu-Natal. Internal Medicine: Research methodology module. https://medicine.ukzn.ac.za/ registrar/researchmethodologymodule/ (accessed 15 February 2023).
Alhefzi AA, Alsaleem SA, Al Humayed RS, et al. Challenges and difficulties in research facing by Saudi board postgraduate residents in Aseer region. J Fam Med Prim Care 2021;10(3):1485-1488. https://doi.org/10.4103/ jfmpc.jfmpc_1721_20
De Pietro C, Francetic I. E-health in Switzerland: The laborious adoption of the federal law on electronic health records (EHR) and health information exchange (HIE) networks. Health Policy 2018;122(2):69-74. https://doi. org/10.1016/j.healthpol.2017.11.005
Khubone T, Tlou B, Mashamba-Thompson TP. Electronic health information systems to improve disease diagnosis and management at point-of-care in low and middle income countries: A narrative review. Diagnostics (Basel) 2020;10(5):327. https://doi.org/10.3390/diagnostics10050327
Wilson K, Khansa L. Migrating to electronic health record systems: A comparative study between the United States and the United Kingdom. Health Policy 2018;122(11):1232-1239. https://doi.org/10.1016/j.healthpol.2018.08.013 33. Yang J, Li Y, Liu Q, et al. Brief introduction of medical database and data mining technology in big data era. J Evid Based Med 2020;13(1):57-69. https://doi.org/10.1111/jebm.12373
Barfod C, Lauritzen MM, Danker JK, et al. The formation and design of the ‘Acute Admission Database’ – a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital. Scand J Trauma Resusc Emerg Med 2012;20:29. https://doi.org/10.1186/1757-7241-20-29
The value and importance of health information privacy. In: Nass SJ Levit LA, Gostin LO, eds. Beyond the HIPAA Privacy Rule: Enhancing Privacy, Improving Health Through Research. Washington, DC: National Academies Press, 2009. https://www.ncbi.nlm.nih.gov/books/NBK9579/ (accessed 15 February 2023).
Stevenson F. The use of electronic patient records for medical research: Conflicts and contradictions. BMC Health Serv Res 2015;15(1):124. https://doi.org/10.1186/s12913-015-0783-6
Cowie MR, Blomster JI, Curtis LH, et al. Electronic health records to facilitate clinical research. Clin Res Cardiol 2017;106(1):1-9. https://doi.org/10.1007/s00392-016-1025-6
Madhavan S, Bastarache L, Brown JS, et al. Use of electronic health records to support a public health response to the COVID-19 pandemic in the United States: A perspective from 15 academic medical centers. J Am Med Inform Assoc 2020;28(2):393-401. https://doi.org/10.1093/jamia/ocaa287
Kaewkungwal J, Adams P, Sattabongkot J, Lie RK, Wendler D. Issues and challenges associated with data- sharing in LMICs: Perspectives of researchers in Thailand. Am J Trop Med Hyg 2020;103(1):528-536. https:// doi.org/10.4269/ajtmh.19-0651
RepublicofSouthAfrica.ElectronicCommunicationsandTransactionsAct,No.25of2002.https://www.gov.za/ sites/default/files/gcis_document/201409/a25-02.pdf (accessed 17 February 2024).
Watney M. Admissibility of electronic evidence in criminal proceedings: An outline of the South African legal position. J Inf Law Technol 2009(1). http://go.warwick.ac.uk/jilt/2009_1/watney (accessed 17 February 2024). 42. Van Tonder GP. The admissibility and evidential weight of electronic evidence in South African legal proceedings:
A comparative perspective. LLM thesis. Cape Town: Faculty of Law, University of the Western Cape. 2013. http:// etd.uwc.ac.za/xmlui/bitstream/handle/11394/4833/VanTonder_gp_llm_law_2013.pdf ?sequence=1&isAllowed=y (accessed 17 February 2024).
Fischer F, Kleen S. Possibilities, problems, and perspectives of data collection by mobile apps in longitudinal epidemiological studies: Scoping review. J Med Internet Res 2021;23(1):e17691. https://doi.org/10.2196/17691
Prahladh S, van Wyk J. South African and international legislature with relevance to the application of electronic documentation in medicolegal autopsies for practice and research purposes. Egypt J Forensic Sci 2022;12:1. https://doi.org/10.1186/s41935-021-00261-3
Republic of South Africa. Protection of Personal Information Act, No. 4 of 2013. https://www.gov.za/documents/ protection-personal-information-act (accessed 8 March 2024).