Tag: Medical Scribe Systems

Scribing: What to expect your first week of training

Okay. I can do this. I finally got the email telling me that they are interested and I’ve passed all their benchmarks. They know I don’t have any experience, they said they would teach me everything! So why am I so nervous?

My ticket is paid for. They will pick me up from the airport and take me to the hotel where we will all be staying. They will be shuttling us everywhere and we are going to be in classroom training for a week. But why, oh why, am I still so nervous even though they’ve given me all this information?

The unknown. The unexpected.

How hard is this going to be? I’m a perfectionist you know. Am I even going to be good at this or am I finally going to meet a hurtle I can’t jump? Is this my demise where I find out I don’t have what it takes to become a scribe and my dreams of getting experience and going to medical school have just flown out the window?

Going into classroom training my first time as a new scribe was nerve-racking to say the least. I had no idea what I was doing, and not to mention my underlying anxiety that was severely mismanaged (well actually not managed at all at this point) was getting the best of me.

Sound familiar new scribes?

You aren’t the only ones that have freaked out about a new experience. Hell, show me someone going into training or a job interview for the first time who hasn’t been nervous. Either they are lying or are a cocky bit of bull-shit who will likely think they are too good for this and actually suck hardcore (those are by far my favorite type of people to watch fall flat on their face. No judgement…I’m not judging, you’re judging!)

It’s been quite a bit since I was the new trainee (2011 to be exact), but I remember vividly how I felt. And it was hell on my anxiety for the entire week I was in classroom training. Mix having to learn lots of new content, being tested along the way and having to pass, learning to all of a sudden rely on my typing skills instead of my handwriting (what? who does that?), and lots of sleep deprivation because I was scared of not passing; just a bad combination. Actually to be honest that week was hell.

But I passed, and so can you. 

Photo Credit:
https://weheartit.com/entry/216353594

Just stop and take a deep breath.

I won’t bore you with the details of my intense anxiety and sleep deprivation because honestly it was a massive blur once I started. There were a lot of people I started with and some most definitely failed out before we were done with classroom training. Others failed during floor training or decided this wasn’t for them. But let’s start with some common questions that you may have.

Potential First Day Questions:

What should I bring?

You will need your scribe manual, a pen/pencil, and your login information. If you weren’t given a scribe manual before, you should get it on your first day or a version of one. For your login information, if you are signing in/out online, bring this username and password (so you can get paid!) and if you happen to have your login information from the EMR training course you were likely required to take, bring that as well. If you really want to you can bring a notebook.

What should I wear?

Professional dress. No need for suits, but please do not show up in jeans and flip flops. If you were given information on scrubs/color/brand beforehand you may show up in your scrubs and close-toed shoes. But usually by the first day you haven’t sorted this out yet. And be comfortable! You will be there for a bit, so make sure you are comfortable so you can optimally learn.

How long will I be there?

Each classroom training day is a bit different. When I went for my initial classroom training I was there all.freaking.day. It sucked. But for the second company I worked for and for the homegrown program I worked for, usually 2-4 hours each classroom training shift.

Should I have taken a medical terminology course?

Honestly, I don’t think it’s that helpful. One, you waste tuition money by taking it if it is offered at your university and they are usually a joke of a class. Two, you probably forgot everything from that class anyways. Three, you are going to learn it all again, so really I don’t find it useful.

Am I meeting professionals here? Am I meeting my physician(s) I will work with here?

The only professional(s) you will meet are your trainers likely. Maybe their boss if he/she decides to make an appearance – which is highly unlikely by the way. Usually they will just phone in and give you some blah blah about how they are always there if you need it and they are so happy you are joining the team and just barf stuff. Really, I rolled my eyes every time I had to call my manager for that, but its necessary, I get it. Makes you feel welcome or something like that.

And good joke about meeting your physicians you will work with! They don’t want to see you until you have an inkling on how to be a scribe because they don’t have time to waste dealing with someone who doesn’t know what they are doing. So it’s just going to be you and your trainer and your other classmates.

Oh god am I meeting patients on my first day?!?

Nope. Face it you are going to suck and have no idea what you are doing that first week. We aren’t bringing in patients yet!

Where am I meeting? What about parking? 

For one company I was taken to and from my hotel to the place where they were holding classroom training. For the other company and the homegrown program I always sent out a detailed email about where parking was, if you had to pay for parking, what the building address was, and where within the building to meet and I always gave my cell phone in case you newbies got lost. Because half of the class always got lost…

Your trainer or scribe company should be doing the same thing.

On-boarding:

This is the thing that should be started from day one of you signing your tax documents and hiring documents. These are the things required by both your scribe company and the hospital you will be working for that will say you are medically clear and can obtain your badge. No badge = no working in the hospital or clinic.

I repeat, no badge = no working in hospital or clinic!

Common things you will need to complete and turn in during the on-boarding process:

  • Vaccinations. Each site is different but usually requires MMR, varicella, tDAP, and some places also require hepatitis B series. You will likely need to get titers as well to show you are immune, but this varies based on clinic site and company you work for.
  • TB test. Yup, need to know if you have been exposed or not. If you have, you need to have been treated and this needs to be thoroughly documented. You are about to work with patients, usually whom are sick. The hospital doesn’t want to be liable for you possibly spreading TB if you have it. But honestly, most of you will have a negative test. Some of you will just have to get a chest x-ray instead to show you are all good!
  • All tax documents filled out and returned. All direct deposit paperwork filled out. If you want to get paid I suggest you do a direct deposit. Most companies now will send you a card with your wages on it if you don’t set up direct deposit. IDK about you, but I don’t want that. I want my money and I want it now!
  • Badge clearance. These instructions will be given to you once you have usually turned in all of your vaccinations and TB testing requirements and so forth. Again, you need this to enter and work in the clinics!
  • Completing all hospital required courses/mandatory training. Most of this is just saying you attended the EMR course and can functionally use it. But when I held classroom training I made sure my scribes knew how to navigate the chart during our training sessions which made their mandatory training easy. But they still had to go just to click the checkbox off.
  • Scrubs! This one isn’t mandatory but you will need these before starting your shift. Unless your company makes you wear a different uniform, you will likely be in scrubs.

Breakdown of Content for Each Day:

Day 1: General overview.

  • General housekeeping items like how to clock in, what to wear/importance of dress, proper behavior in a clinic, etc.
  • Usually a very general powerpoint presentation on the overview of the chart and charting areas itself.
  • Learning objective vs subjective is big on this day.
  • First look/walk through of the EMR in a controlled practice environment and allowing you to play around with it.
  • Discussion of quizzes. Usually you have a quiz at the start of the next section going over what you learned in the powerpoint for this current session. Usually you have to pass with an 80% or better. If you are unable to pass a quiz, most places will let you fail one quiz and retake it the next day on top of the additional quiz that was already scheduled. However, most places will not allow you to fail more than one quiz.

Day 2: Chronic illnesses (or some variation on chronic disease)

  • Quiz Time!
  • Presentation on chronic illnesses that are usually present in all types of clinics/medicine. Such as diabetes, heart disease, kidney failure, etc.
  • If time more playing around with the EMR.

Day 3: Subjective Day!

  • Quiz Time!
  • HPI  & ROS presentation. This talks about everything regarding History of Present Illness or HPI and the Review of Systems or ROS. All of the elements, what types of HPI’s and ROS’s there are, etc.
  • HPI practice first. 
  • Then usually HPI + ROS practice. These should be done in the EMR if able to do so, so you learn how to navigate your charting system.

Day 4: Physical Exam Day!

  • Quiz Time!  
  • Then the powerpoint which will make your head spin. PE or physical exam has the most content to learn. This is the hardest powerpoint to digest and learn and most people fail the quiz on this.
  • HPI, ROS, PE practice in the EMR.

Day 5: Results

  • Quiz time! 
  • Powerpoint usually on being able to capture results and where they go and different types of labs /imaging that can be obtained.
  • If you are allowed to, you will learn how to enter orders so your physician can sign them.
  • So much more practice here.

Day 6: Plan/MDM

  • Quiz time again!
  • Powerpoint usually explaining this section of the chart and different types of plans that you may see. This varies widely between specialties, offices, and provider preferences by the way.
  • So many more practice scenarios. By now you will be practicing doing the whole entire chart.

Day 7: HIPAA & all practice

  • Quiz!
  • You go over HIPAA rules (this is the one where I got to scare all of you so you wouldn’t do anything shady). This is usually a pretty short powerpoint.
  • The rest of this is all practice.

Final Exam

Yes, you have to take a final exam. This is usually a combination of your pre-classroom training test and what you learned in classroom training. There are a lot of questions, but the also means you can get a fair amount wrong and still pass!

HOLY CRAP that was long. But you got though this post just like you will get through classroom training. Just remember, you aren’t the only one who is nervous about this and freaked out by this process. Your trainer was in the same place you are now when they were newbies too. Put in the work and you will do fine.

 

What is a medical scribe?

You are probably thinking, Joyce, how on earth do you know what this is. Have you done it? Do you know people who have worked as scribes? Show me all of your credentials!

I can assure you, I have a handle on what a scribe is and all things about scribing. At least I hope I do, I did spend 6 years doing it!

So what is a medical scribe? 

A medical scribe is someone (usually pre-med, pre-PA, or pre-nursing) that follows a physician around and types up their notes for them. Your whole job is to type down what is dictated to you and what you hear/infer between the patient and the provider: in person, in real-time. This is different from a transcriptionist. As a scribe, it is your job to completely capture the HPI or patient’s story on your own, and be able to write it down in a medical legal document that is grammatically correct and flows well. This is seriously the hardest thing to learn. It took me a while to really get the hang of it, and every scribe I trained had a hard time with it too.

Why? Well its difficult because you have to follow the conversation between the physician and patient, the patient will not go in order of how you are taught, may have 10 complaints, and you also have to switch the conversation from layman’s terms to medical terminology. All of that is a lot, and having to type it in real-time because the conversation DOES. NOT. STOP. is also difficult. I know it sounds scary, but after doing it several times with a trainer by your side it gets easier. You are going to want to be good at multi-tasking for this job.

There are sections of the chart that are directly dictated to you, such as the physical exam findings and the medical decision-making (if you are in a specialty that does this). Otherwise, the remainder of the chart is inferred between provider-provider conversations, interpreting lab results, and more provider-patient interactions.

Even though there is a steep learning curve with being a scribe, once you get the hang of it, you can do it in your sleep. Or at least I felt I could!

What skills do I need?

First off, because there is a very steep learning curve and you basically get paid in medical knowledge, I only suggest you go after this job if you are thinking about going into medicine or some sort of medical career. If you are not, then don’t bother because it will be a lot of work for you to learn and you won’t benefit from using the knowledge later.

Here is a list of skills that as a former trainer will help you the most:

  • semi-fast typing ability.
  • multi-tasking
  • ability to learn a vast amount of material in a short amount of time
  • good listening skills
  • ability to take criticism and grow
  • resourcefulness

That’s it. You learn everything else on the job. You need no previous knowledge on anything other than you want to put in the work and hope you like what you see so you can continue on in the medical field. But why this list?

Although you do not need to be able to type fast, it will greatly help you. The faster you are able to type what you hear, the less you will miss and the easier it will be for you to go back and form your jumbled notes into coherent, medical sounding sentences.

For resourcefulness, make Google and spell check your BFF. Learning how to navigate your charting system to help you find old notes for what you’ll need will also greatly help. You’ll thank me later.

Now I’m interested! How to I find a job?

There are some major scribe companies that have been churning out scribes for years. They have a system down pat and this is where most scribes start:

  • PhysAssist
  • ScribeAmerica
  • Elite Medical Scribes
  • ProScribe
  • Iscribes
  • Medical Scribe Systems

Are just to name a few. I worked for the two biggest companies: PhysAssist and ScribeAmerica. You can usually go on their website and see if there are any sites near you that you can work at and if they are hiring. As scribing is a high turn over job, even if they aren’t hiring right that second, you can put in your application and they will usually always be going through their applicants to prime them for the next position that is open.

You can also find jobs directly through the hospital system itself. I at one point ended up working at a “homegrown” program (which just means the hospital itself is running the program). You can check your local hospitals or hospital systems to see if scribing jobs are available there. For some of these positions, you may have to know someone who is already a scribe there and they can get you in. If they are large enough though, they will be able to have a more direct link online for you to apply.

Lastly, if you know a physician who wants a scribe to hire privately and they are willing to teach you how they want you to scribe for them, you can do that as well! I at one point was also scribing privately for a provider in this fashion, however this one is much harder to ascertain especially if you don’t have any contacts with physicians.

What’s the selection process like?

Just like with most jobs now, there is an online application. Most places know you are a college student, but beware that if you put you are only available on Saturdays from 9am-12pm you won’t get selected. You need at least 2-4 days availability. This doesn’t mean that you will work that much, but you do need to have time to show up for work. Some places, like in ER’s or hospitals, there are shifts for 24 hours. So in those cases, are you willing to work nights? If not, make sure you are available for a decent amount of afternoons or mornings.

You may also be asked to move your class schedule. What this means is come next semester, are you willing to take your classes all on Tues/Thurs? Or Mon/Wed/Fri? If this is a feasible option for you, then this not only allows scribe employers to see you are flexible, but that you are truly interested in this job.

You may be asked to take a typing test as well so they can see what your wpm (or words per minute) is. The faster you type, the better you’ll be selected. Most places will take a 50 or 60 wpm or above, but personally unless you can type 80 wpm and above, you will struggle a lot.

Should they like you, then yay! Your next step is usually a virtual interview. Likely through Skype or FaceTime. You will need to dress professional for this, it is an interview.  Brush up on the company’s website, their motto, what they stand for, etc. Mostly, they know you likely have never worked a day in your life and are just looking to see if you can give professional and competent answers.

Once all of that is said and done you are hired! There is a conditional with this hire though. You must pass training in order to be completely hired. You will get paid during training, but just know that if you cannot keep up or progress along well in training, they will never let you be on your own.

What is taught to me?

Most scribe companies (at least PhysAssist and ScribeAmerica) put you through about a 2-2.5 week crash course in all things medical scribing in something called “classroom training”. For PhysAssist, (remember this was 6 years ago for me so it may have changed) I was flown down to Texas for a crash course at their headquarters. This meant that they put me up in a hotel and we went to class all day to learn about being a scribe. For ScribeAmerica, they did training at the individual site you were going to be working at, so this could have meant training during the day or night, depending on when the trainer was available.

For this part of training, you need to breathe, sleep, eat all things medical scribe training related. You will be tested at every step of the way to make sure you can pass. Why? They need to know you can think fast on your feet, learn quickly, and synthesize a large amount of information. Because once you are out on that floor, it’s just you. 

Helpful tip: As a trainer I knew most of what I was teaching to my scribes during this classroom training would not be retained, and that anything they needed for their specific speciality would be re-learned on the floor. Most of these trainers and companies know this, but they still want to know you can do well when they make you jump through hoops. In your future in medicine, nothing will be handed to you either, so you might as well get used to it!

You will learn:

  • medical terminology
  • what is a chart and the breakdown of a chart/what goes in each section
  • how to start listening and typing what you hear (this will be what is dictated to you)
  • how to start navigating a chart electronically
  • lots and lots of practice scenarios!

After you pass classroom training, you get to see real patients with a trainer in something called “floor training”. Here you will put to use the listening/typing skills you started to learn, will have to start putting in information in the correct part of the chart, you’ll have to get your provider dictations correct and the patient’s story correct, and basically you’ll be doing the whole chart! This chart will be kept electronically as part of the patient’s health record and can be shared with other hospitals if needed to ensure the patient’s care is seamless.

As time goes on, your trainer will help you less and less as you gain more confidence and skills to do all of this on your own. Once a trainer gives you the green light, you are officially a scribe!

Phew! Thanks for coming along on that ride with me, hopefully this helps clear up some questions you may have about scribing.

 

Disclaimer: I understand that the above post makes it sound like scribing is very difficult. Well, it is, but it’s not a mountain that you cannot climb. I prefer to give a realistic view on things because that is what I would want to know. If you are truly interested in becoming a scribe, you should know the amount of work you will need to put in to pass all the required steps. Once you get the hang of scribing (which can be a couple of months), it really is straightforward.