I’m pretty comfortable giving advice on scribing since I used to teach scribes. And I’m comfortable talking about my experiences in medical school. Although I will let you decide on how helpful they are.
What I would like to discuss today is how scribing has (or hasn’t) helped me in medical school (so far). I’m writing this on the last few days of my winter break before I dive head first into my second semester of my first year. So that definitely means it will be posted way later… It also means I have many more semesters to go to see how scribing has helped me. But we will stick to what has helped me so far.
In general, we hope that our pre-med experiences help us out in some way, shape, or form by the time we get to medical school. Or nursing school. Or PA school. We are hoping to not have to start from square one or get thrown into a situation head first without any context to draw from. Because let’s be real: as humans, we react to situations, especially new situations, by drawing off of previous experiences. So we hope as medical students that we have some context to help us out. Mostly because we have no idea what we are doing most of the time anyways. So a little bit of help is amazing!
I’m also hoping for this post to be much shorter than some of my other, very lengthy posts. I really like to talk, and surprisingly when I think I have nothing to write about, I still end up with a long post. So if you aren’t in the mood to read a lengthy post today, you are in luck!
How it as helped: Anything related to interacting like a future doctor
In general, I would say my scribe experience has helped me the most in my PCM course (or Principals of Clinical Medicine/How to be a doctor course). Mostly because doing charting and seeing interactions between patients and physicians or physician-extenders was something that would occur multiple times a day, all day, for many years for me.
I’m comfortable here. I’ve seen how a physician asks questions, helps guide their patients along during their conversation, and they types of exams to choose for their complaints. I’ve even thankfully had some interaction with medical decision-making and ordering certain things for certain issues. It’s very different being on the other side though, so that part does make me a bit nervous. But overall, I’m definitely a lot more chill than some of my other classmates when it comes to this part of our education.
Here are some more specific points for you:
Knowing how to write notes. They don’t really give you a great grasp on how to do this in medical school. But they do teach you all of the necessary components of the chart and how to get information for those parts.
You are more comfortable with being in a room with a patient
You know and are comfortable with so.many.terms!
You are comfortable with the outline of how to do an exam. You may not know how to do something specifically, but you are learning why you do it in medical school and how to actually do it. But from being as scribe, you’ve seen your physicians run through this like the back of their hand. You could probably give a run down of how to do one or a good order to perform one in before they actually teach you. (Doesn’t mean you are good at it though).
You will utilize that same “on the fly” learning ability to quickly pick up things/research them. Remember when you had to do so much searching and figuring out on your own to get the information you needed? Same thing applies here. Use it. You can thank me later.
This “on the fly” learning transfers to other courses; not just in your ‘how to be a doctor’ course.
Trouble-shooting. This one is interesting for me. I would do this all the time as a scribe and then try to figure out the best way to fix my problem before asking for help from the doctor. But turns out it works great here too when you are learning so many things.
What I’m expecting it to help with in the future:
Mostly in my rotations. I expect to feel pretty at home in a variety of clinics. My last scribe job had me starting up clinics and I would work in several different clinics throughout the week. I’m hoping that having to be thrown in and learn my way around different clinics will help me feel more comfortable.
Putting my ability to ask other staff for resources in my rotations. This one was hella helpful as a scribe. I fully intend to utilize every resource possible during my rotations.
Charting on new EMRs. Well using an EMR in general.
And I will see how much more I can come up with in the years to come!
What it hasn’t helped with:
I’m still a little nervous. Check out my “What Still Makes Me Nervous” post from last week to see more in-depth and specifics on this!
It doesn’t mean I will pass on everything I do. Especially skills wise. I failed a few things my first semester. One of them being a competency for taking vital signs. To be fair, I wasn’t allowed to touch patients as a scribe… so handling patients is definitely a new skill I’m learning!
Multitasking isn’t as helpful. What I mean by this is multitasking is needed and very helpful with scribing. But honestly, in medical school you are learning difficult concepts at lightening speed. So it’s actually easier to pull all your focus on that one concept than trying to spread yourself thin.
And that’s all I’ve been able to come up with! If you are thinking about scribing and want to know the benefits and pitfalls to your future in medicine, hopefully this helps. Also, check out my scribing section on my blog if you are interested in scribing. Lots of information on there.
As always, let me know what you liked, didn’t like, and what you would like to see next in the comments!
As a trainer scribe, you’ve had the experience of being a scribe for quite some time and are now ready to take on the leadership role.
Not only do you have to train a new scribe while you are on the floor seeing patients, but you also need to make sure you can pick up the slack of your trainee as they still don’t know what they are doing.
This means double the work.
Which sounds horrible.
Actually it can be pretty brutal especially if you don’t like teaching or you have a terrible attitude. But, it can be an amazing experience for you as you learn and grow personally and as a scribe, test your limits. Maybe you decide that you like teaching (like me) and it’s great to put down on resume’s and medical school applications as well. Also, the added benefit is if you have new blood there, you aren’t constantly being contacted by your chief scribe or upper boss to cover a shift because you don’t have enough scribes. More scribes = less being called into shifts = more days off.
Walk-Through of My Day
I’m going to walk you through (roughly) what I did as a trainer scribe so you have an idea of how the schedule/day goes. I will be choosing more of a specialty view of it (as in what I experienced while training for ENT) as this is what I did right before I stopped scribing. I’ll even throw in some tips as a trainer so when you become a trainer, you can show everyone up with your fancy schmancy new skills. Please refer to my infographic above for my mock schedule while following along below!
Day 1, 7:30 AM I’ll start at the beginning. Training takes weeks, but the first shift is always the most important. If clinic doesn’t start until 8 AM (see picture above), then I will have my new scribble arrive at 7:30. This way I can give them a full tour of the clinic, show them where their laptop is, help them sign in, and show them any other necessary things/areas without the constraint of patients being there or the physician hovering.
7:45 AM If I have time, I will also show them (again) how to navigate the chart and what is going to specifically be helpful for their clinic and their physician during their shift. If I didn’t have them download their templates or smart phrases (we used EPIC, this was a HUGE timesaver by this EMR), I would have them download it and show them how to get more or start new ones that they could make on their own. By this time, we should have 2 laptops pulled out and ready to go. Remember, even though your new trainee just spent 2 weeks in classroom training, they are now on the floor seeing real patients. You are going to have to walk them through a lot all over again because their nerves will get the best of them.
8:00 AM The first patient should be on their way to being seated and the physician should be arriving if they are not already there. I would prep the chart with my trainee looking over my shoulder, explaining why I was doing what I was doing. Then we would go in and see the patient. During this time, I would be writing the note and explaining (softly if I could) to my trainee why information was going where it was going and pointing out why I was moving to different areas of the chart as the physician was progressing with their visit. If it was a type of visit or my provider didn’t enjoy me talking/teaching, I would just have them watch me without explaining. When we would leave the room, I would clean up the note on my end and answer any questions (if I could right in the moment).
8:15 AM I would always see 2-3 patients first on the first day. This was so they could get a feel for how to write a note. Tip: it’s kind of like monkey see, monkey do. So letting them shadow you for a period is good. Also, they are hella nervous so giving them some time to be there without the pressure of doing something will help them relax.
Since RV’s (return visits) are easier to grasp (less information) than NP’s (new patients), I would generally start the newbie on an RV note as it is overall easier and slightly less stressful. So I’d be seeing this patient with my new scribble in tow.
8:30 AM Ah! A NP note. The newbie isn’t doing this one yet, but they can watch as I fill out a more detailed note.
9:00 AM Time for my new scribble to give this a shot! Usually, they don’t want to do it. A gentle push and reassuring them that I would be writing down the information in case they missed anything (believe me they will miss A TON) will usually be enough to get them to do it. You will usually have to help walk them through how to open a note again during this stage because they will be freaking out even though they just watched you do a couple….
Tip: Bring a pad of paper/notebook and pens/pencils to write on. You can also use a clipboard if you would like. If your clinic has enough room, then just bring the laptop and do it in a word note. Since you cannot save the information or email it to yourself (for HIPAA reasons) this is the best way to save your information on the laptop without fear of losing it. But you do need a way to write down everything that was said/occurred during the visit (as if you were going to write the note) because your new scribble is still very fresh. They are gunna need help.
9:15 AM Okay. I would then have new scribble sit this one out and work on the note they just saw. They are going to need to time to move things around, figure out their shorthand, and try to make sense of the mess of the note they just nervously wrote. I tell them to finish the note as if I wasn’t going to look at it, and instead as if the next person seeing it was the physician. Meaning it needed to be done to the best of their ability. So I will go in with the physician for this next patient and leave my scribble in the dictation room to work.
9:30 AM If le scribble is doing well and ready to see another one I will let them go in and do this note while I take secondary notes. If not, then I would have them stay and work out their nerves. I’m a hard trainer, but it’s usually with good purpose. Tip: you need to be able to gauge your new trainee and the schedule. If they are super nervous or royally struggling then give them another patient. If not, throw them in. Most of the time on the first day they would do one patient and then sit about 2 out unless the note we saw was super easy or they are doing fantastic.
9:45 AM Alright, making the new scribble see this one. Same thing as the prior one they saw. I’m taking secondary notes and helping them through the visit on the chart, they are actually writing the note.
10:00 AM They sit this one out. This one is also a new patient, and I don’t think I’m going to have them try a new patient yet this morning. I instruct them that if they are done with the note they just saw, to take the time and review both notes to fix anything if I’m still not out of the room yet. Gotta start teaching them to be constantly reviewing, so they can catch their own mistakes before the provider reviews the note.
10:30 AM If they are done with their RV note from earlier, I will have them tag along for the NP note. They will be shadowing for this one.
#trying to learn to write like a scribe. (Courtesy of giphy.com)
And basically the rest of the day will go they see one, and have 1-2 off. They may need an additional patient off if they are really struggling with a note. That’s okay, just make sure you continue to gently push where it counts. If they are all caught up by the last few patients (or what they think is caught up) I may have them try a NP note at the very end of the day. But I am also one to make them see patients instead of trying to make my life easier. Meaning, I would rather them get the experience and then stay late correcting, then not let them see more patients that I think they can handle just so I can leave at a normal hour. My job is to train them. I want to give them the most exposure while they have limited time with a trainer. They will have plenty of fuck-ups on their own, might as well give them a safe space to do it.
After seeing all of the day’s patients, I usually give them some time to edit/finish the notes from the day as I’m editing mine or working on other miscellaneous crap. Then we go over the notes!
Arrgh@!#@$^). I hate this part. It is always horrible.
Courtesy of giphy.com
You will be dissecting each section of the chart that they wrote and cross-checking it with your information to make sure it is correct. You will need to explain why something is wrong/incorrect and what they did well.
Tip: It’s going to be bad. But if you re-write every single sentence just because it is not the way you would do it isn’t going to boost their confidence/self-esteem and they won’t learn. It’s not going to be pretty, but if it is grammatically correct and all the information is there, don’t just re-write it because it’s how you would do it. Only re-organize if you can explain to them why moving this information will help their HPI flow better, or change it if the information is incorrect. You will be heavily editing, but I promise they will learn better if you aren’t constantly changing their work.
Tip: At the end of each shift, I go through a few points of what they need to improve on and what they did well that shift. The good & bad should be equal. Even though they will have so much to work on. That’s okay, just pick the super major things they need to start improving on. You can fine tune or get nit-picky towards the end of their training period. As they progress, there will be more good than bad (hopefully). If they don’t continue to improve over their training period with you, then scribing likely isn’t going to work out.
Phew! You made it through one day as a trainer scribe!
Remainder of the Training Period
Day 2: A similar flow, except I will cut down the amount of patients in between. I may make them start seeing every other patient until they start to get a little more than overwhelmed, then hang back to letting them see once every 2. They will need to start seeing a new patient note as well by day 2, and of course you will be taking notes the whole time if they go in. This is to help get them used to having to see every patient.
Day 3: Usually the same flow. Maybe I will have them see 2 in a row, then 1 or 2 off. Then 2 or 3 in a row, then 1 or 2 off. Keep pushing. Again, they need to start getting used to seeing patients back-to-back, but don’t push too much to where they are so overwhelmed they cannot complete any task. Tip: Even if your new scribble wants to see more in a row here, don’t let them. They need to learn to not just start to see more patients but also how to edit in a timely manner. They can’t be learning how to edit/fix their notes if they are in every room right now,
Day 4: We will have them see 3-5 in a row, then off 1 or 2. If they tell you they are royally struggling on a note, give them some extra time for them to fix it. After all, you are there as back up.
Day 5: Continue to push for them to see as many patients as they can in a row. They should overall be getting better at writing notes (less editing for you) and should be able to start fixing/editing/finishing their notes faster. This is something that they will also need to continually work on: increasing the patient load but speeding up their note-taking and editing abilities.
At this point, if it is family medicine/pediatrics/internal medicine, they should be getting much better as their training should be ending soon. In specialty, not so much.
Day 6: In the morning do what you’ve been doing. In the afternoon if they are progressing well, let them see an easy RV patient by themselves. You will likely know your provider well enough at this point to be able to tell if they would have voiced something a certain way or not.
Day 7: If they did well with seeing some on their own, you can allow them to see more RV’s by themselves and just enter in on NP’s. I would usually let them see a couple on their own and then just pop in randomly for RV’s, but always go with them on NP’s. If they didn’t start seeing patients on their own the last training shift, then we should at least test the waters with this shift. Again, pick easy RV’s for this. *If this is a family medicine/internal medicine/peds shift, they should be seeing all patients in the day and seeing most on their own.
Day 8+: They should be continuing to see more patients on their own (if not all of them) and starting to see more patients without you. You can slowly test the waters with them seeing NP’s (as these notes are typically harder) by themselves and progress from there. The biggest thing now is getting them to finish and edit their notes faster and without much fixing from you. You should be able to gauge how many more shifts your scribe may need at this point and what they majorly need to work on. The goal is to get them to be by themselves. They will screw up without you, but they will learn the most that way. Right now they know they have a security blanket –> You! Hopefully you can schedule a few more shifts, target what they need to work on, and if you see improvement it’s time to let your scribble graduate!
And yea, that’s about it. Like I said in a previous post, general medicine scribe training takes about 7-8 days, whereas specialty can be 10-13. My entire job with the last scribe company was to train, so I got a lot of experience doing this. But if you have been scribing for about 6 months and are looking forward to new experiences, giving training a go can be a really great learning and leadership experience for you!
As always, let me know what you liked or what you would like to see next in the comments below!
