I guess things are different at other institutions. I just did an EM rotation and I had my own EHR username and password. I saw patients on my own, but the attendings and residents have to make corrections and cosign my notes and orders. My notes and orders were part of the patient's record.
Addendum:
I did a 2-wk IM outpatient as a MS3 where the attending would let me do clearance for surgery and would then see the patient for 2-3 minutes and cosign my notes... I guess the attendings at my institution let med students to do things.
As a note - until about 2 or 3 months ago, it was actually a CMS violation for medical student notes to be a part of a patients medical chart. There was an exception to this, but man it was a doozy.
Attendings could cosign your note, but at dramatically decreased reimbursement over writing their own note. Residents were never supposed to cosign (despite that being rampant in reality).
I wrote notes. I had attendings cosign them. I was so proud. Then a buddy of mine who later was employed as a hospitalist where i was a med student told me that medical records just removes all those notes from the record as leaving them in runs the risk of actively decreasing reimbursement for the chart. If there is no attending note (distinct from the cosigned note) theyll leave the cosinged note.
There is a fun issue of does it open medicallegal weaknesses to remove the astute observation of the medical student? But until recently, in reality those notes were never actually part of the record... so... the official stance is "what medical student note."
Now obvious places will differ. Where i was a resident the ED attendings didnt care about reimbursement so the students did have notes in the chart... until administration realized and disallowed students to write notes officially for the chart (stated reason: because we might forget their notes net the hospital less money and actually sign them or assume issues they coverrd dont need to be readdressed, forgetting most of them are expunged from the record). Not everyone is as brutal as the places i was a student and resident - but im sure many are as the administration response was pretty much the same everywhere i went - students can write notes but residents cant sign them and attendings sign them with knowledge that it becomes almlst impossible to bill for that note.
This is admittedly all different now as cms recently said medical students could be treated as medical scribes and write a note with regular reinbursment and no penalty if cosigned. But im goong to assume (maybe wrongly) you are referring to pre 2018 experiences.
Edit: idk how this applies to surgical fields as their money is in the surgery, not the pre op and follow up notes. This is primarily a big deal for IM, medicine consultants/specialists, and emergency medicine.
Most attendings make it extremely clear (even out loud) that med students have priority over PA/NP students for everything. Myself and other students have been expected to have the H&P done and have an accurate assessment or plan or risk being mocked. The midlevel students would be utterly clueless when it came to the A&P.
