Development, implementation, and evaluation of the use of electronic health record simulation in health professions education

Introduction Electronic health records (EHRs) are central to healthcare delivery, yet opportunities for learners to develop EHR proficiency in realistic, standardized educational settings remain limited. We describe the development, implementation, and evaluation of a longitudinal EHR curriculum using simulated patient records across health professions programs at a large academic health system. Methods From June 2023 through June 2025, Duke University School of Medicine used ACE5, a parallel Epic training environment, to develop simulated patient cases embedded within existing curricula. Eleven simulated patient records (5 pediatric, 6 adult) were incorporated into clinical skills courses, problem-based learning, physician assistant orientation, clerkships, and fourth-year capstone training. Activities taught chart review, documentation, order entry, clinical decision support, preventive care, and patient handoffs. Student perceptions were assessed by anonymous survey and faculty feedback qualitatively. Results A total of 670 medical and physician assistant students participated. Among 25 survey respondents from a nested cohort of 126 medical students, perceived confidence was higher for using the training environment (76%) and chart review tools (72%) than for advanced tasks such as order entry and flowsheet management. About half (52%) reported moderate to substantial perceived knowledge gains, and 96% perceived they were somewhat or extremely likely to use these skills in future practice. Students valued realistic EHR practice and requested more exposure; faculty recognized educational benefit but noted implementation challenges. Conclusions Longitudinal simulated EHR training is feasible and potentially valuable for developing practical EHR competencies. Sustained exposure, institutional support, and curricular alignment are critical for successful implementation.