Using the Electronic Health Record to Identify Educational Gaps of Internal Medicine Interns

Are interns exposed to common clinical diagnoses? A study examined just this question by looking at PGY-1 notes from 10022 different hospitals. This question is particularly important to me considering in a few months I will be an internal medicine intern.  The study analyzed 53066 clinical notes covering 10022 hospitalization with 1436 different ICD-9 diagnoses spanning 216 CCS diagnostic categories. 31% of PGY1 had experience with fewer than 5 of the top 10 diagnoses and only 17% of PG1Y01 saw all top 10 CCS diagnoses and 5% had exposure to fewer than 5 CCS diagnoses. The results of this study are interesting.  However, limitations of this study include that using billing diagnoses may and probably does not fully represent the intern experience. What is useful to know is that the EMR can help AGME and tracking what type of patients interns are seeing. It was also surprising that interns are exposed to so few of the most common diagnoses are seen in their first few months of residency. Programs can use this information to identify gaps in their training. It would be interesting to know if EMR can be used track what procedures residents have performed as well. This is both useful in tracking the progress of intern training but it can be useful in minimizing the paperwork interns have to do in recording both the procedures they do and the diagnoses they’ve seen.


  1. Alvin Rajkomar,Sumant R. Ranji, and Bradley Sharpe (2017) Using the Electronic Health Record to Identify Educational Gaps for Internal Medicine Interns. Journal of Graduate Medical Education: February 2017, Vol. 9, No. 1, pp. 109-112.

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