Clinicians need efficient, effective and responsible methods of communicating with their peers and trainees . Previous reports have shown that most residents and staff prefer text messaging due to its ease of use and effectiveness [10, 14, 15]. Additionally, as we work as educators to balance patient privacy and autonomy with the inclusion of medical students in direct patient care, we are challenged to find innovative ways to use information technology to achieve these goals. Our mixed-methods study suggests that integrated EMR secure messaging is a promising way to improve team engagement of medical students as well as improve their education. Most medical students use personal smartphones for clinical work, and the built-in secure messaging is a great alternative to other email systems that can pose privacy issues. [5, 10, 13,14,15].
Our simple interventions in the present study allowed students to perceive benefits for their education and involvement in patient care. Specifically, students reported a better quality of communication with faculty and ancillary staff during their internal medicine rotation compared to previous rotations. Additionally, they noted that Secure Chat specifically helped improve the quality and ease of communication on their internal medicine rotation, which was true for communication with faculty and ancillary staff. Over 75% of students said Secure Chat improved their educational experience.
Reviewing message content provided insight into how students were included in Secure Chat communications. More than 50% of message threads contained information related to patient care, including day-to-day management, admissions information, and discharge planning. These are conversations in which students may not have been directly included in the past. During the acting internships, many students had strong message threads with the participants regarding patient management issues. Other types of communications of interest included peer-to-peer communication regarding procedures as well as a communication from a resident highlighting a quality improvement issue.
The current study has several limitations, including the partial survey format. Additionally, many students (7/24) had not worked on services with residents in the past, which could be a significant confounder for perceived quality of communication. The number of students involved in the study was also relatively low as we only selected one study site and data collection ended prematurely due to the COVID-19 pandemic.
In future studies, additional interventions should be undertaken to promote the use of embedded secure messaging among medical students. Specifically, more can be done to promote the inclusion of medical students on secure messaging threads among faculty and residents. Direct integration into clerkship could be improved by interventions such as weekly questions on specific cases and the encouragement of peer-to-peer teaching. As embedded secure messaging becomes more commonplace and is increasingly adopted in institutions around the world, faculty can be creative in integrating it as an additional tool for medical education and the active participation of students in patient care.