LAUSR

Copying/pasting, note-forwarding, and templating are common practices in the electronic medical record (EMR) even though early observations indicated a widespread belief that such behaviours would be rare [1]. Recent surveys indicate much broader acceptance and existence of copying/pasting, and other purportedly efficiency-producing behaviours than initially was predicted [2]. Medical educators and clinicians have raised concerns about the impact on notes, which may be rendered bloated or meaningless [3, 4], as well as the impact on the patient-physician relationship, the physicianlearner relationship, and the ability of learners to interact with patients [3, 5, 6]. Learners (and providers) engaging in copying/pasting and other EMR-based efficiency measures may have less in-depth knowledge about their patients [7]. Whether there is any causation in this correlation is not well studied, but studies in other fields suggest that technological multitasking may overwhelm individuals’ ability to attend to detail [8]. Educational impact of the EMR, particularly that of interpersonal and communication skills, has been discussed by previous authors [9, 10]. Of concern to us is the possibility that critically important aspects of learning (including direct patient care, professionalism and accountability) and patient care are suffering as metrics and efficiency measures are increasingly prioritized [11].