Residencies with scribes

[EctopicFetus]

trying to do a little research. Anyone know which residency programs provide scribes for their em residents?

2 I know of are Penn state and university of Virginia.

Please let me know if the other ones.

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[NYEMMED]

trying to do a little research. Anyone know which residency programs provide scribes for their em residents?

2 I know of are Penn state and university of Virginia.

Please let me know if the other ones.

NY hospital Queens used to back when I was a resident, not sure if they still do

 

[deleted859535]

West Virginia is the only one I know of from when I interviewed years ago. Morgantown.

 

[bravotwozero]

Henry Ford Wyandotte Hospital. An osteopathic residency, though that’s not as relevant now


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[EctopicFetus]

Keep them coming for me.

 

[Angry Birds]

Every residency has scribes.

 

[BoardingDoc]

Every residency has scribes.

incorrect

 

[cyanide12345678]

Upstate NY program has scribes for residents after intern year.

 

[Mighty Mouse]

Henry Ford Detroit does -- for specific resident shifts, but not all resident shifts.

 

[Mad Jack]

Every residency has scribes.

Not even close. It's very state-by-state and metro-by-metro. I've worked in some big places without scribes and some small ones with over the years.

 

[EctopicFetus]

Every residency has scribes.

I think he means the residents are scribes for the attendings. Lol.

 

[Dr Mantis Toboggan]

Am I just an old fart knocker for thinking residents should be writing their own notes?

I think he means the residents are scribes for the attendings. Lol.

 

[bravotwozero]

Am I just an old fart knocker for thinking residents should be writing their own notes?

I did that when I was a resident. But we had paper charting with template sheets, which involved circling and took no time at all to complete. In that scenario, there's no need for scribes. Residents should have some experience with charting, so I don't think it's the worst idea in the world for them to chart, even in an EMR.

That said, if you're training at a high volume/acuity shop, which most residents are, the availability of scribes may help them focus more on clinical care rather than clerical duties, which is more important than learning how to click off boxes in an EMR, especially at the resident level.

 

[deleted547339]

I did that when I was a resident. But we had paper charting with template sheets, which involved circling and took no time at all to complete. In that scenario, there's no need for scribes. Residents should have some experience with charting, so I don't think it's the worst idea in the world for them to chart, even in an EMR.

That said, if you're training at a high volume/acuity shop, which most residents are, the availability of scribes may help them focus more on clinical care rather than clerical duties, which is more important than learning how to click off boxes in an EMR, especially at the resident level.

I dunno - I think knowing how to write a comprehensible, defensible note is a core competency of EM.....

I think Louisville gives their senior residents scribes IIRC.

 

[bravotwozero]

True, but even with scribes, you're still doing that. You still have to tell them what to document in the ED course, physical exam, HPI etc. The only difference is you're not the one having to physically type it all in.

 

[deleted547339]

True, but even with scribes, you're still doing that. You still have to tell them what to document in the ED course, physical exam, HPI etc. The only difference is you're not the one having to physically type it all in.

I’ve never read an MDM by a scribe that has any substance.

 

[deuist]

Am I just an old fart knocker for thinking residents should be writing their own notes?

You are definitely not alone on that sentiment. I think writing several thousand charts as a resident by hand gets us used to the idea of what a chart should look like and how to properly document medical decision-making. Allowing someone else to click boxes for you really misses out on that arduous learning experience.

 

[OneJob]

Denver Health does.

 

[deleted859535]

I’ve never read an MDM by a scribe that has any substance.

I don't like using scribes mostly because of this. The time saved in HPI and exam isn't worth the money for me as an attending. But I digress.

 

[Angry Birds]

I think he means the residents are scribes for the attendings. Lol.

 

[Hercules]

I don't like using scribes mostly because of this. The time saved in HPI and exam isn't worth the money for me as an attending. But I digress.

Then you’re doing it wrong. I don’t mean to sound harsh, but in all honesty a lot of what we do is cookbook and scribes were invented for cookbook. Are each of your ankle sprains, gastroenteritis, head injuries, chest pains really that unique? Mine aren’t. I write almost the same MDM on many of my patients with common complaints. I have a macro and I tell my scribe to type that macro just like I would if I’m doing the hart myself. This saves time. On complex patients I do the MDM myself. The net gain is still huge. It makes me more efficient and makes me like my job more. We also give scribes a lot of feedback when they start out and some of them wind up quitting.

Having said all that I think having scribes from day 1 in residency would handicap your development. If you haven’t learned how to put together a coherent and defensible chart on your own than how would you know how to teach/correct your scribes and the charts they produce? I trained dictating my charts in residency and think this was an important experience. I realize I am old though because I also think it’s important to know how to put in a central line without ultrasound and intubate without fiber optics when the situation arises (and it does).


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[GonnaBeADoc2222]

Am I just an old fart knocker for thinking residents should be writing their own notes?

IMO, most residents should be writing their own notes. If you are unfortunate to be in a 4 year program, use of scribes may be useful during PGY4 year, as learning to work with a scribe is a skill in its own right I think.

I’ve never read an MDM by a scribe that has any substance.

I am lucky to work with excellent scribes who save me a lot of time. I specifically tell them to leave the MDM to me. I don't expect a college student to know how to write an MDM, that's why we went to medical school and residency,

 

[Mad Jack]

The scribe notes I have to read over the years are generally terrible, I truly can't believe people trust their licenses to that standard of documentation. Like, you're literally putting all of your hard work and your financial security in the hands of what is usually a premed

 

[GonnaBeADoc2222]

The scribe notes I have to read over the years are generally terrible, I truly can't believe people trust their licenses to that standard of documentation. Like, you're literally putting all of your hard work and your financial security in the hands of what is usually a premed

Your mileage may vary, but my scribes are great. Like I said above, they are a college student, you are a physician. I routinely review and edit their notes, but even a basic HPI and doing all the clicks saves me a ton of time and stress. Some of my colleagues sign off on their notes without even reading them - that is not good practice.

 

[noke]

Virginia-Tech Carilion has scribes for PGY 2's and 3's

 

[BoardingDoc]

Your mileage may vary, but my scribes are great. Like I said above, they are a college student, you are a physician. I routinely review and edit their notes, but even a basic HPI and doing all the clicks saves me a ton of time and stress. Some of my colleagues sign off on their notes without even reading them - that is not good practice.

Macros >>>>>> scribes. I just don't see the point of a scribe if I'm going to have to review all of their charts later anyway. That just takes work I could be doing now and makes it a problem for future me. I'd rather keep adding to my lengthy list of macros for MDMs/discharges/etc and edit as necessary.

 

[Rekt]

As a prior scribe there's huge variability between scribes and on my aways the weakest scribes have been from the national companies. But overall, I strongly disagree. Most of the residents notes I've seen are downright absymal in comparison and how they aren't constantly sued is beyond me. I'm pretty sure most somewhat fresh scribes could write better notes than certainly any intern and PGY2. The exception obviously is MDM because they don't have any medical training. Just dictate the MDM to them and have them put everything else in.

 

[EctopicFetus]

As a prior scribe there's huge variability between scribes and on my aways the weakest scribes have been from the national companies. But overall, I strongly disagree. Most of the residents notes I've seen are downright absymal in comparison and how they aren't constantly sued is beyond me. I'm pretty sure most somewhat fresh scribes could write better notes than certainly any intern and PGY2. The exception obviously is MDM because they don't have any medical training. Just dictate the MDM to them and have them put everything else in.

This is exactly what I do. If you think there is some magic about your hip you are insane. Having a well trained scribe let’s you do the whole chart short of the mdm without need to do stupid stuff is worthwhile.

I tell them what to change. Using macros for hpis and exams puts you at risk. Don’t believe me? Go to the acep reimbursement conference. The proof is in the pudding. The feds are watching.

 

[deleted547339]

This is exactly what I do. If you think there is some magic about your hip you are insane. Having a well trained scribe let’s you do the whole chart short of the mdm without need to do stupid stuff is worthwhile.

I tell them what to change. Using macros for hpis and exams puts you at risk. Don’t believe me? Go to the acep reimbursement conference. The proof is in the pudding. The feds are watching.

I think it depends on what your macros are. If you have a basic physical exam that you can do from the door, then add in a focused exam of (insert why they are here) I think that’s fine. If you have a macro for potential early apply return precautions or seizure precautions - I think those are fine. You do them the same every time and need to document them. The problem is when you use the macro for something you didn’t do.

 

[Hercules]

Macros >>>>>> scribes. I just don't see the point of a scribe if I'm going to have to review all of their charts later anyway. That just takes work I could be doing now and makes it a problem for future me. I'd rather keep adding to my lengthy list of macros for MDMs/discharges/etc and edit as necessary.

Macros + scribes >>>>>>>>>> macros - scribes. Why separate the two? My scribes can use all my macros and I frequently call them out to the scribe while walking between rooms. Why not take advantage of multiple efficiencies instead of picking just one?


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[enalli]

Most of the residents notes I've seen are downright absymal in comparison and how they aren't constantly sued is beyond me.

If you think resident notes suck, wait until you see their supervising attendings' solo notes (especially the ones who trained in the pre-EMR days).

 

[RustedFox]

I think it depends on what your macros are. If you have a basic physical exam that you can do from the door, then add in a focused exam of (insert why they are here) I think that’s fine. If you have a macro for potential early apply return precautions or seizure precautions - I think those are fine. You do them the same every time and need to document them. The problem is when you use the macro for something you didn’t do.

This is precisely my approach. I have a Macro for "normal exam", and then I can click or dictate to my heart's content.

My entire MDM for common cases is all Autotexts. Nonspecific belly pain, going home ?

"SAFE 1" (Patient has remained safe, stable, and in good clinical condition throughout.... etc)
"RESPOND" (Patient reports excellent response of their symptoms to care provided here.... )
"DISCUSSED" (Discussion held/all results reviewed with patient.)
"NDD" (No definitive diagnosis is able to be established at this point in time, and this was discussed with the patient. No admittable condition has been identified as of now.)
"MDM-ABD.PAIN" (details all the things that it's NOT, and why - along with a non-surgical repeat belly exam)
"DECISION:AGREE" ("Decision made and agreement reached between patient and physician to... )
"GDSCH" ("Proceed with supportive care measures, discharge home, and follow-up with return if necessary.")
"EDU" ("Care taken to educate patient about the warning signs/symptoms for XXX/YYY and ZZZ if XXX/YYY.)

I can "mad lib" this together quicker than it takes the scribe to locate the latest social media post, let alone think about what I want them to do.

 

[gamerEMdoc]

Not all resident and attendings notes stink. Some of us still teach the business of medicine. My residents are taught from orientation on the different levels of charting for coding, etc. Our residents graduate and all chart extremely well from a coding standpoint.

 

[deleted547339]

Not all resident and attendings notes stink. Some of us still teach the business of medicine. My residents are taught from orientation on the different levels of charting for coding, etc. Our residents graduate and all chart extremely well from a coding standpoint.

Same

 

[EctopicFetus]

Not all resident and attendings notes stink. Some of us still teach the business of medicine. My residents are taught from orientation on the different levels of charting for coding, etc. Our residents graduate and all chart extremely well from a coding standpoint.

Same. Its uncommon though.

 

[Hercules]

This is precisely my approach. I have a Macro for "normal exam", and then I can click or dictate to my heart's content.

My entire MDM for common cases is all Autotexts. Nonspecific belly pain, going home ?

So tell me again why you can't tell the scribe those macros? I'm not trying to be difficult-- I just keep hearing everyone say they're macros are great as an argument against scribes. With my scribes and my EMR, that is an argument FOR scribes. By the time you walk out of the room they should have your HPI, PE, DDx. Bark out a couple macros and they can input those for you as well. Do you guys all work with EMRs that won't let the scribes access your macros?