Open Notes in Teaching Clinics: A Multisite Survey of Residents to Identify Anticipated Attitudes and Guidance for Programs.

Background: Clinicians are increasingly sharing outpatient visit notes with patients through electronic portals. These open notes may bring about new educational opportunities as well as concerns to physicians-in-training and residency programs.

Objective: We assessed anticipatory attitudes about open notes and explored factors influencing residents' propensity toward note transparency.

Opening Residents' Notes to Patients: A Qualitative Study of Resident and Faculty Physician Attitudes on Open Notes Implementation in Graduate Medical Education.

Purpose: OpenNotes is a growing national initiative inviting patients to read clinician progress notes (open notes) through a secure electronic portal. The goals of this study were to (1) identify resident and faculty preceptor attitudes about sharing notes with patients, and (2) assess specific educational needs, policy recommendations, and approaches to facilitate open notes implementation.

Method: This was a qualitative study using focus groups with residents and faculty physicians who supervise residents, representing primary care, general surgery, surgical and procedural specialties, and nonprocedural specialties, from Beth Israel Deaconess Medical Center and Geisinger Health System in spring 2013.

Considering the clinical context of medical education.

The article by Chen and colleagues in this issue suggests that the context in which clinical medical education is executed matters, especially if we intend to meet the projected future physician workforce needs in the United States. Placing learners in the highest-performing medical settings seems intuitive, but this can be disruptive to the patient care interface, especially in high-performing health care delivery systems. Simply placing learners in a well-functioning, highly reliable health care delivery system focused on systems of care and directed at improving quality and safety is not enough for learners.