Training the Next Generation of Clinicians in the EHR

How EHR Training Has Evolved

Dr. Joel Boggan, associate professor of medicine at Duke University School of Medicine, explains that students now begin clinical encounters and related EHR work during their first year, where residents complete formal new-user and specialty-specific modules.

“There has been a general trend toward earlier exposure and use of the tools, meaning students can accrue more time working in these environments,” he says.

Simulated EHRs allow students to navigate records, review and add documentation and enter orders before performing those tasks in patient-care settings. During clinical rotations, professional activities give faculty a framework for reviewing students’ documentation and providing feedback.

Dr. Deepak Pradhan, co-director of AI education at NYU Grossman School of Medicine’s Institute for Innovations in Medical Education and a pulmonary and clinical care specialist, says EHR competency now extends beyond learning where to click.

“EHR competency is really a clinical competency issue now as well,” he says.

RELATED: EHR optimization uses data to improve clinical workflows.

Who Actually Needs EHR Certification (and Who Doesn't)      

Dr. Salim Saiyed, chief medical informatics officer at the University of Texas at Austin Dell Medical School, explains that while basic training and competency cover most learners and physicians, a growing group of future leaders, researchers and informaticists need more.

“Programs to upskill will be key for the future,” he says.

He points out that vendors are responding. Epic’s Physician Builder and Informatics tracks are becoming the credentialing path for physicians who will help design EHR systems, not just operate them. 

Boggan adds that certifications, such as the National Healthcareer Association’s Certified Electronic Health Records Specialist (CEHRS) credential are primarily intended for EHR analysts, clinical informaticists and revenue cycle professionals, not most frontline physicians.

“Residents have to complete new-user orientation and train in their specialty environments, but those don’t typically come with a certification,” he says. “Those are the basic elements for use as a frontline clinician.”

The EHR Training Gap: What New Clinicians Aren’t Learning

Saiyed says one key gap in education regards “the business and platforms” behind the screen.

“We teach residents to chart, but not to see the platforms that they’re charting into,” he says.

He points to revenue cycle, scheduling, referral management, analytics, population health and a variety of integrations.

“Future physicians need to see those ripples before they act, not after,” he explains.

Dr. Gabrielle Mayer, co-director of AI education at NYU Grossman School of Medicine’s Institute for Innovations in Medical Education and an internist, says the gap is managing the EHR under clinical time pressure.

“One thing you can’t improve until you get to residency is understanding how time interacts with your EHR use,” she says.

She explains that residents must learn to treat EHR use as a complement to the clinical examination rather than a separate, sequential task.

Ambient Listening AI Is Transforming Documentation Skill Sets

Saiyed calls ambient listening AI “the biggest shift in a generation,” explaining that physicians are shifting from entering notes to serving as their editor, auditor and final medical decision-maker.

“That means validating AI-generated narratives for accuracy, catching subtle bias or omissions, and preserving nuances AI can’t hear,” he says. “Typing speed and note templates are out; clinical judgment and AI oversight are in.”

Boggan adds that ambient AI shifts documentation training toward verification and accountability.

“Clinicians need to critically review the output, detect hallucinations, identify omitted findings and verify and edit it so that it is accurate,” he says.

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What AI-Assisted Charting Means for Training Curricula

Saiyed says students must learn the skills of creating a medical note before they learn to edit an AI-generated one. Otherwise, AI becomes a crutch instead of an accelerant.

“Beyond documentation, curricula need real fluency in responsible AI use, bias mitigation, data governance and human oversight — the literacy every physician will need in the future,” he says.

From Mayer’s perspective, students should master unaided documentation before progressing to AI-assisted charting.

“We think about writing a note without the assistance of ambient AI and developing that skill,” she says.

Assessment rubrics can then determine whether a learner’s notes demonstrate sufficient clinical reasoning to introduce AI augmentation and verification.

WATCH: Phoenix Children’s optimized its EHR to enhance patient care.

What Makes EHR Training Actually Stick      

Mayer says the most effective EHR training often happens when learners encounter a real workflow problem.

“That’s the moment that the learning is best,” she says.

Pradhan points out that faculty development is equally important because attending physicians supervise EHR and AI use in clinical settings.

“You need somebody to really interrogate, investigate and reflect in a safe environment about how we can do better,” Pradhan says.