Student Competency in Outpatient Documentation: Insights From the 2025 CERA Clerkship Directors Study

BACKGROUND AND OBJECTIVES: Competency in clinical documentation is a core entrustable professional activity expected of graduating medical students, and multiple national organizations have established expectations for documentation training and assessment. However, limited guidance exists on how these competencies are operationalized and assessed in clinical settings, and little is known about current educational practices. This study aimed to characterize how family medicine clerkships teach and assess outpatient documentation competency. METHODS: We conducted a cross-sectional analysis using five documentation-related items embedded in the 2025 Council of Academic Family Medicine Educational Research Alliance clerkship directors survey. The survey was distributed to 174 US and Canadian family medicine clerkship directors. Descriptive statistics summarized the responses. RESULTS: The response rate was 57.4% (100/174). Most directors (78.7%) rated assessing documentation competency as important or very important. At clerkship entry, 60.2% of students required intermittent prompting, while 32.3% needed repeated direction. Teaching methods varied: 33.3% reported no formal instruction, and only 19.4% used a common rubric. Informal assessment predominated (56.4%), and 8.5% reported no formal process. Regarding accuracy and integrity, 37.6% had no formal evaluation, while 25.8% used direct observation and 22.6% employed standardized patients or simulations. CONCLUSIONS: Teaching and assessment of outpatient documentation competency in family medicine clerkships are highly variable, with many programs lacking structured approaches. These findings underscore the need for standardized guidelines and curricular integration to ensure that all students achieve competency prior to residency.