need advice from ED scribes

[YoungProdigy]

hey,
I just finished up ~3rd training shift, and for this weekends back to back shifts I was being trained by a complete dingus, and so I'm not sure if I'm actually behind in my skill level or if he was just being an ass. I'm pretty slow at writing my HPI, and have a hard time deciphering whats pertinent and whats not, and how much information to write. I also need to work on turning it into a "story" with a nice flow.

I also miss out on a lot of information thats being said in the patient's room, either because im lagging behing the doctor and my trainer with the damn cart which causes me to miss out on the first 2-3 sentences the patient says, OR because I get too sucked into the conversation and forget to continue writing stuff down.

I want to say that most of these issues will be resolved with more practice, but IDK maybe I'm wrong? How can I improve?

I'm working on my medical terminology, and its a work in progress, but other than that I don't really konw how to improve when im not working.

Please help. I'm afraid my trainer is going to give me a couple of bad reviews, and I really need to improve before my next shift on saturday, which, thankfully, is with a different trainer.

also, can anyone pelase tell me what my skill level should be at this point in the game? I'm working with physassist (7 trainig shifts and then the 8th shift is a mock sol0).

I'm also having a hard time keeping track of all the menus and submenus of the mckesson program , but i do feel like im improving.

sorry this is extrmeley disjointed, but im really frustrated. i want to be one of the best scribes, but according to my trainer, I'm extremely bad. since i dont have anything to compare my skill level to, I'm sort of panicking.

thanks.

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[YoungProdigy]

Practice

how should i practice at home? access to the program would be amazing, but not possible. i def. need to improve on medical terms but i need help with hpi and knowing whats pertinent in the medical exam menu.

 

[getfat]

I also miss out on a lot of information thats being said in the patient's room, either because im lagging behing the doctor and my trainer with the damn cart which causes me to miss out on the first 2-3 sentences the patient says, OR because I get too sucked into the conversation and forget to continue writing stuff down.

Focus on what the doc is saying at this point i wouldn't be working as much about what the patient is saying you can't tell what is pertinent or not. Some of the better ones will emphasize what they want and repeat pt phrases. If you didn't get all of it simply say, "hey i think i missed a couple things on the exam can you tell me what you want".

If you are having trouble with the system, open up a word doc
HPI:
Exam:
Tx:
etc. etc. Fill out the word doc in the room and put into the system when you leave the room.

 

[getfat]

I've heard ScribeAmerica has a short, mediocre training program

Yeah it was pretty bad. When I trained (a while ago) it was 5 training sessions but they have like 3 info sessions at a local Panera bread.

 

[getfat]

sorry this is extrmeley disjointed, but im really frustrated. i want to be one of the best scribes, but according to my trainer, I'm extremely bad. since i dont have anything to compare my skill level to, I'm sort of panicking.

I wouldn't worry until you are at your later end of training. The learning curve is pretty big and when you are this early into scribing you get a lot better with each work day.

As long as you go in alert and ready each day you should improve enough for them to want to keep you.

 

[liquidsodium]

I train scribes in a different setting, though have done ED before.

I expect all new scribes to be pretty terrible. They typically have no prior training - just a bachelors in some science and an interest in medicine. Oftentimes, EPIC(/other EMR) is completely new, the language is new, the expectations are new, and the workflow of the ER is unfamiliar. It's extremely challenging, and you'll struggle a lot in the beginning. Don't let yourself be discouraged by this particular trainer -- stay motivated, and learn as much as you can when you can, from everyone that you can. The biggest factor that tells me if a scribe will ultimately "fail" is their level of motivation, NOT their initial skill level.

There is a decent ER scribe handbook on Amazon that you can read outside of work. Gives you a good idea of what to aim for, in addition to the quirks of your own ER/doc. I don't remember the title exactly, but it's one of the very few in existence and has a Vitruvian Man on the front cover.


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[CharlieBillings]

I was an ED scribe for over 1 year, and I remember doctors being surprised with how good my HPIs were. The secret? I was a clinic scribe before that!

~You need time to learn, and if you were at a large company like me then the answer is no. You won't get that time, and the doctors will have to suffer through a little bad scribing before you hit full stride.

I also miss out on a lot of information thats being said in the patient's room, either because im lagging behing the doctor and my trainer with the damn cart which causes me to miss out on the first 2-3 sentences the patient says, OR because I get too sucked into the conversation and forget to continue writing stuff down.

I handle this by taking a notepad/clipboard in with me with prewritten abbreviations and what not. On the left side going down it reads "F C N V D Blood - CP SOB - CO runny sore - etc" For fevers, chills, nausea, vomiting, diarrhea, blood in stool, chest pain, shortness of breath, cough, runny nose, sore throat. I also add abdominal pain, dysuria, last known menstrual cycle, and after that customize it per the doctor. Some like to ask about constipation, others like to ask about unilateral weakness, etc. This tends to cover everything ROS related, and then I can just focus on the story.

I think you'll become a better story writer as you learn more of what is actually going on medically. When I first started I was just spitting out present or absent symptoms, but later I was able to tell what needed to come first in the history and what was less important.

However I'm a bad guy, and I just write down everything that happens. If asked by the doctor to the patient: I put in the patient's primary care doctor, their medications, and anything else they might say that other scribes would leave out. I effectively write the ROS into the HPI, which is technically wrong. I never had complaints and some doctors even liked it, but I imagine if I was ever behind it would have been an issue.

 

[MareNostrummm]

However I'm a bad guy, and I just write down everything that happens. If asked by the doctor to the patient: I put in the patient's primary care doctor, their medications, and anything else they might say that other scribes would leave out. I effectively write the ROS into the HPI, which is technically wrong. I never had complaints and some doctors even liked it, but I imagine if I was ever behind it would have been an issue.

Writing down the medications is extremely difficult for a new scribe, because they have probably never heard of them before (other than OTC meds), don't know how to spell them, and do not know what they being used for, dosage, B.I.D, T.ID, etc.

(ex: various antipsychotics, antiepileptics, all the hypertension medications). Physicians also absolutely hate spelling out medications for you. So you're left recording a butchered name and trying to google it or hoping the triage nurse recorded it.

 

[CharlieBillings]

Writing down the medications is extremely difficult for a new scribe, because they have probably never heard of them before (other than OTC meds), don't know how to spell them, and do not know what they being used for, dosage, B.I.D, T.ID, etc.

(ex: various antipsychotics, antiepileptics, all the hypertension medications). Physicians also absolutely hate spelling out medications for you. So you're left recording a butchered name and trying to google it or hoping the triage nurse recorded it.

Ah. With the software I used the entire medication list was always digitized in case you ever needed to check it. Rarely were things different then what the patient said. Much easier for me that way than this person might have it.

 

[pnwhmt]

hey,
I just finished up ~3rd training shift, and for this weekends back to back shifts I was being trained by a complete dingus, and so I'm not sure if I'm actually behind in my skill level or if he was just being an ass. I'm pretty slow at writing my HPI, and have a hard time deciphering whats pertinent and whats not, and how much information to write. I also need to work on turning it into a "story" with a nice flow.

I also miss out on a lot of information thats being said in the patient's room, either because im lagging behing the doctor and my trainer with the damn cart which causes me to miss out on the first 2-3 sentences the patient says, OR because I get too sucked into the conversation and forget to continue writing stuff down.

I want to say that most of these issues will be resolved with more practice, but IDK maybe I'm wrong? How can I improve?

I'm working on my medical terminology, and its a work in progress, but other than that I don't really konw how to improve when im not working.

Please help. I'm afraid my trainer is going to give me a couple of bad reviews, and I really need to improve before my next shift on saturday, which, thankfully, is with a different trainer.

also, can anyone pelase tell me what my skill level should be at this point in the game? I'm working with physassist (7 trainig shifts and then the 8th shift is a mock sol0).

I'm also having a hard time keeping track of all the menus and submenus of the mckesson program , but i do feel like im improving.

sorry this is extrmeley disjointed, but im really frustrated. i want to be one of the best scribes, but according to my trainer, I'm extremely bad. since i dont have anything to compare my skill level to, I'm sort of panicking.

thanks.

How fast can you type? This is a really big part of it. When I started I couldn't tell what was pertinent so I would try and type out everything. Then after I would remove things that felt less important when I got an idea of the work up. If speed is an issue this is something you can definitely practice at home.

It can be hard, but try and always position yourself so you can see both the patient and the doc. It makes it easier to see the physical exam and catch the patient mouthing words if they speak more quietly. I also think it keeps you focused on their interaction more and less in your head.

You are on your third shift. Your only job at this point is to try and get as much information as possible down. Do not focus on telling a great story or putting it together in a way that flows yet. Especially while typing.

You will get better with time. Don't stress. Some trainers are better than others.

 

[precisiongraphic]

Saw this post as a "similar thread" below. Looks helpful. https://forums.studentdoctor.net/threads/ed-note-writing-and-general-scribe-advice.1220631/

 

[sfkniner81]

Currently a scribe in a clinic... you will get better with experience. I had trouble as well but you just get through the growing pains. It was nice that the physician I worked for was understanding and realized this was all new to me (especially spelling all the medication names)! A lot of times now I get really surprised at just how much I've learned - you'll be the same way .. it took me a few months (started out doing part time at first). Just stick with it! I think what helped most was just reading other physician notes and trying to model my note similarly - you get a good sense of what matters and what doesn't from that.

 

[hopefuldoctor93]

You will get better as time goes on, but just know that over your training shifts you will be responsible for filling out even more of the chart. I know for my first couple of shifts it was only the HPI, ROS, and PMH. My best advice is to have your chart taking up most of the screen and a notepad window open where you can type out the HPI. I fill out the sections that are clicked out while the pt is saying non pertinent stuff and then tab over to my notepad when I hear something that matters. It will take a little while to get used to, but if you are just sitting there in the room listening your chart will be incomplete when you walk out. IDK how other programs are, but with Meditech it is a pain in the ass to fill out a chart. So many boxes that need to be checked, but after a while you get in a rhythm where it is muscle memory for a normal exam/chart.

 

[YoungProdigy]

A big thank you to everyone who took time out to help me out. It really helped me to get back to a positive mindset. Unfortunately though, I had another shift this past weekend, and that trainer also gave me a pretty bad overall score. I e-mailed the chief scribe on details/feedback on what exactly I was doing wrong., and some of what he said has really rubbed me the wrong way. For example:

"A concerning trend throughout your evals is that you are unable to grasp or understand why we do certain things in the ED, and I know this information has been discussed with you. For example, X mentioned you were confused about why we contact primary care physicians for admission. This is all information which I know has been covered in past training shifts, and the information is also available in the information I emailed you."

I'll understand if you all criticize me and call me ignorant and stupid for not knowing exactly why we contact PCP's, but in my defense, I had thought it was only for information on the patients' medical records. I hadn't really thought about about the second reason, which is that the patients are only in the ER for a short time, and the PCP's are contacted once they're moved out of the ER (I know this is basic logic, but it just never occurred to me). Anyways, this "example" he's giving me took place only because I wanted to reaffirm my reasoning from the trainer for why we need to know the PCP's for the patient. And it seems to have backfired on me. It seems like the more questions I ask the trainers, the worse my scores get.

I also get terrible scores on placing my attestations and pulse ox in the EMR, despite my diligent effort in placing those pieces of information in every damn chart I did. SO, I really don't get it.

--------------------------------
BTW, I don't know where he's getting the idea about that particular information already being explained to me when he's never personally trained me. That really pisses me off, because he's basically saying that my memory is **** and that I can't remember crap and im stupid, when the fact of the matter is that it never was explained to me

Anyways, what do you all think? Am I the one in the wrong here, and just so inept and stupid that I'm not a good fit to be a scribe? I now dread going to work, only because I know I'm going to be ripped apart by the trainers. But I really do'nt know how to fix it. When I ask the trainers directly, they say something along the lines of "it's all about experience. I was diong the same stupid **** you were. I was writing everything long handed too, etc...".


wtf am i supposed to do? I already have enough stress/problems on my shoulders, and now this crap? ughhh...Just for the record: I'm willing to do anything to get better. I just don't know HOW to. Everytime I leave a training shift, I feel pretty good because I KNOW I learned a lot, but then when I get my trainer evals, they're complete ****, even though when I'm there in person, they do'nt say anything negative to my face.

Again, thank you to anyone who takes the time out of their day to help me.

 

[FeinMS]

A big thank you to everyone who took time out to help me out. It really helped me to get back to a positive mindset. Unfortunately though, I had another shift this past weekend, and that trainer also gave me a pretty bad overall score. I e-mailed the chief scribe on details/feedback on what exactly I was doing wrong., and some of what he said has really rubbed me the wrong way. For example:

"A concerning trend throughout your evals is that you are unable to grasp or understand why we do certain things in the ED, and I know this information has been discussed with you. For example, X mentioned you were confused about why we contact primary care physicians for admission. This is all information which I know has been covered in past training shifts, and the information is also available in the information I emailed you."

I'll understand if you all criticize me and call me ignorant and stupid for not knowing exactly why we contact PCP's, but in my defense, I had thought it was only for information on the patients' medical records. I hadn't really thought about about the second reason, which is that the patients are only in the ER for a short time, and the PCP's are contacted once they're moved out of the ER (I know this is basic logic, but it just never occurred to me). Anyways, this "example" he's giving me took place only because I wanted to reaffirm my reasoning from the trainer for why we need to know the PCP's for the patient. And it seems to have backfired on me. It seems like the more questions I ask the trainers, the worse my scores get.

I also get terrible scores on placing my attestations and pulse ox in the EMR, despite my diligent effort in placing those pieces of information in every damn chart I did. SO, I really don't get it.

--------------------------------
BTW, I don't know where he's getting the idea about that particular information already being explained to me when he's never personally trained me. That really pisses me off, because he's basically saying that my memory is **** and that I can't remember crap and im stupid, when the fact of the matter is that it never was explained to me

Anyways, what do you all think? Am I the one in the wrong here, and just so inept and stupid that I'm not a good fit to be a scribe? I now dread going to work, only because I know I'm going to be ripped apart by the trainers. But I really do'nt know how to fix it. When I ask the trainers directly, they say something along the lines of "it's all about experience. I was diong the same stupid **** you were. I was writing everything long handed too, etc...".


wtf am i supposed to do? I already have enough stress/problems on my shoulders, and now this crap? ughhh...Just for the record: I'm willing to do anything to get better. I just don't know HOW to. Everytime I leave a training shift, I feel pretty good because I KNOW I learned a lot, but then when I get my trainer evals, they're complete ****, even though when I'm there in person, they do'nt say anything negative to my face.

Again, thank you to anyone who takes the time out of their day to help me.

I'm not here to say whether you're wrong or right without listening to both sides. But if you're unsatisfied with the management, you can elect to resign from the position. Keep in mind that it's not just them choosing you, but also you have to see whether you can put up with them during your employment.

Ask the trainer if you're improving and meeting benchmarks for the training. Ask them what areas need to be improved. Ask for specific example (print out charts that's missing pulse ox or attestation) or even better is ask the trainer to point out error in charts while you're working, so you can fix them right away.

 

[precisiongraphic]

I'm only familiar with another major scribe's training but this program seems a bit light on training or too fast paced. To be competent in 7-8 shifts seems rather fast. But like most scribe companies you're being trained by other scribes who are (1) not professional trainers (2) probably young and/or inexperienced (3) not too invested in training new employees and (4) time pressured. I've done training professionally and it's not as simple as some scribe companies make it out to be.

My suggestion is to go back to the beginning and outline everything you've learned to date. Then write down all the criticisms one by one in bullet points. And a third list of all your questions or things that you need help/answers on.

You might want to keep note cards with list of everything you need to know before you leave a room. You'll also need to focus and not listen but keep up with the doctor's questions.

Finally, you'll need to meet in person with your chief scribe and ask for more training or more shifts and advice on how to get faster while learning. I think most scribes aren't ready to be on their own for 2-3 weeks so I think 7-8 shifts is crazy. Good luck.

 

[MareNostrummm]

I'm only familiar with another major scribe's training but this program seems a bit light on training or too fast paced. To be competent in 7-8 shifts seems rather fast. But like most scribe companies you're being trained by other scribes who are (1) not professional trainers (2) probably young and/or inexperienced (3) not too invested in training new employees and (4) time pressured. I've done training professionally and it's not as simple as some scribe companies make it out to be.

My suggestion is to go back to the beginning and outline everything you've learned to date. Then write down all the criticisms one by one in bullet points. And a third list of all your questions or things that you need help/answers on.

You might want to keep note cards with list of everything you need to know before you leave a room. You'll also need to focus and not listen but keep up with the doctor's questions.

Finally, you'll need to meet in person with your chief scribe and ask for more training or more shifts and advice on how to get faster while learning. I think most scribes aren't ready to be on their own for 2-3 weeks so I think 7-8 shifts is crazy. Good luck.

I was thrown into the wild after ~3 shifts and it was pretty rough (some physicians did NOT have the patience to deal with someone who does not even know how to log into the system (first time at a new hospital that I did not train at lol..) Interestingly the physicians still prefer a terrible scribe to no scribe at all so they just ended up dealing with it.

 

[wb100]

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