Harvard Medical School educators, working in close collaboration with OpenNotes, will guide medical students and their core faculty in adopting open and transparent communication with a broad variety of patients and their families.
Project description
Open notes present novel ethical and practice dilemmas. Words matter, and descriptions of social determinants of health, medical vernacular (e.g., “patient denies”) and medical terms (e.g., “obesity”) may offend patients. Accompanied by important repercussions for trust in providers, stigmatizing language or insensitive notes may also especially affect persons from sexual/gender, cultural, ethnic, or religious minorities. Other dilemmas arise in complex family dynamics, where some individuals may expect to access their family member’s notes.
Studies show that many clinicians report being less candid in documentation after the implementation of open notes. Upholding accuracy in clinical record-keeping remains a clear imperative. Strategies intended to avert harm, worry, or offense are understandable, yet such practices may inadvertently pose a greater risk to patients by undermining the quality of clinical documentation and true transparency.
In this project, the educators in charge of the first two years of clinical education for Harvard medical students will work in close collaboration with OpenNotes to guide the students and their core faculty in balancing benefits with risks of transparent communication across a range of practical dilemmas.
Supported by a three-year grant from the Macy Foundation and a matching donation by Kate and Arnold Schmeidler, the principal goals of the project are:
- To devise a checklist of best practices for writing clinical notes addressing difficult ethical issues and the needs of diverse populations of patients. The checklist will be developed in collaboration with medical educators, OpenNotes faculty and consultants, and patients who will together create a rubric for teaching students and faculty.
- To teach medical students to compose sensitive and thoughtful notes that build trust and communicate the patient’s experience with illness, while also accurately communicating clinical data, and to develop students’ skills in talking to patients about their clinical notes.
- To share educational material and experiences beyond Harvard Medical School with students and other health professionals nationally and internationally. With the advice of a national advisory committee of medical educators, the team will create tool kits of educational materials, videos, webinars, podcasts, case discussions, checklists, and assessments for other institutions to use and implement within their institutional curricula.
Project Team
Principal Investigators
Katherine T. Johnston, MD, MA., MSc, FACP
Assistant Professor of Medicine, Harvard Medical School. Former Co-Director, Practice of Medicine course, Harvard Medical School. Associate Site Director, Core 1 Medicine Clerkship and primary care internist, Massachusetts General Hospital
Anita Vanka, MD, FHM, FACP
Assistant Professor of Medicine, Harvard Medical School. Course Director, Practice of Medicine course, Harvard Medical School. Associate Site Director, Core 1 Medicine Clerkship and hospitalist, Beth Israel Deaconess Medical Center
Co-Investigators
Charlotte Blease, BSc, MA, PhD
Keane Visiting Scientist, OpenNotes, Beth Israel Deaconess Medical Center
Tom Delbanco, MD, MACP
Co-Founder, OpenNotes. John F. Keane & Family Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center
Cait DesRoches, DrPH
Executive Director, OpenNotes. Associate Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center
Collaborators
Sigall K. Bell, MD, Director of Patient Safety and Discovery, OpenNotes, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center
Fabienne Bourgeois, MD, MPH, OpenNotes lead for Pediatrics, Assistant Professor of Pediatrics, Harvard Medical School. Pediatric hospitalist and Physician Lead of Consumer Informatics, Boston Children’s Hospital
Sara Fazio, MD, FACP, Professor of Medicine, Harvard Medical School. Advisory Dean and Director, The Walter Bradford Cannon Society, Harvard Medical School. Primary care internist, Beth Israel Deaconess Medical Center
Leonor Fernandez, MD, Assistant Professor of Medicine, Harvard Medical School. Director, Patient Engagement, Healthcare Associates. Primary care internist, Beth Israel Deaconess Medical Center
Karla Kendrick, MD, Fellow in general medicine, Harvard Medical School, Beth Israel Deaconess Medical Center
Barbara Lam, MD, Fellow in hematology and oncology, Harvard Medical School, Beth Israel Deaconess Medical Center
Daniele Olveczky, MD, MSc, Assistant Professor of Medicine, Harvard Medical School. Co-Chair, Harvard Medical School Academy Cross Cultural Interest Group. Hospitalist, Beth Israel Deaconess Medical Center
Stephen O’Neill, LICSW, BCD, JD, OpenNotes Mental Health liaison. Faculty member, Center for Bioethics, Harvard Medical School. Former Social Work Manager for Psychiatry, Primary Care, Pain Management and Infectious Disease, Beth Israel Deaconess Medical Center
Jennifer Potter, MD, Professor of Medicine, Harvard Medical School. Advisory Dean, William B. Castle Society, Harvard Medical School. Co-Chair, the Fenway Institute. Primary care internist, Beth Israel Deaconess Medical Center
Liz Salmi, Senior Strategist, OpenNotes, Beth Israel Deaconess Medical Center. Leader, Brain Cancer Quality of Life Collaborative
Jan Walker, RN, MBA, Co-Founder, OpenNotes. Associate Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center
Funding provided by
Josiah Macy Jr. Foundation and a matching gift from Kate and Arnold Schmeidler
The Josiah Macy Jr. Foundation is the only national foundation dedicated solely to improving the education of health professionals. Our guiding principle is that health professional education has at its core a strong social mission: to serve the public’s needs and improve the health of the public. We foster innovation in clinical learning environments by investing in promoting diversity, equity, and belonging, increasing collaboration among future health professionals, and preparing future health professionals to navigate ethical dilemmas. Our aim is to prepare future health professionals to meet the needs of the 21st century.