Program offers prescription for fruitful career

Scribes: An initiative gives future physicians hospital experience and lightens the paperwork load for doctors

April 21, 2002|By Nancy Knisley | Nancy Knisley,SPECIAL TO THE SUN

More time for patient care, less paperwork for doctors - and some real-world experience for pre-med students.

These are the goals of a joint program sponsored by the Greater Baltimore Medical Center and Towson University, in which students act as "scribes" for emergency room doctors, recording symptoms, medical histories, even doctors' orders.

"It helps patients get better attention, it gives doctors more time to do the job of being a physician and providing patient care, and the scribes are given a unique opportunity to witness medical care in direct fashion," said Dr. John M. Wogan, chairman of the Department of Emergency Medicine at the Towson hospital.

The program - formally known as the Physician's Record Assistant Program - is modeled after a similar initiative that Wogan saw during a visit in 1999 to the award-winning emergency department of Harris Methodist Hospital in Fort Worth, Texas.

Dr. Jeffrey P. Sternlicht, an emergency room physician and director of the GBMC program, said the amount of paperwork routinely done by ER doctors "makes it hard to keep up with documentation and focus on patient care, which comes first." A recent study commissioned by the American Hospital Association found that on average, emergency physicians spend one hour doing paperwork for every hour they spend providing patient care, he said.

Initiatives such as the "scribe" program are a way to shift some of that burden, while providing educational experience for students pursuing a medical career.

On a recent morning, student Nicole C. Klimt stood at a computer terminal in the corner of a small examining room, recording a patient's symptoms as the latter described them to Wogan.

Klimt, 26, a post-baccalaureate pre-med student and one of 14 Towson students in the scribe program, took notes as Wogan described his physical examination of the patient. Wogan was able to focus on the patient, rather than divide his attention between performing the exam and taking notes.

The GBMC program began in March last year, after physicians there gave the go-ahead and Sternlicht contacted several local colleges to learn whether they would be interested in participating. Towson University was the most receptive.

"We're very fortunate to have GBMC provide the opportunity for our students to learn and grow," said Frank R. Milio, director of pre-professional programs at Towson. "It's a mutually beneficial program."

For the scribe program, the university recommends students primarily from its undergraduate or post-baccalaureate pre-med programs.

Sternlicht looks for highly motivated, responsible students with good interpersonal skills who can juggle academics with the demands of the scribe program. Experience in data entry is required and, because some records at GBMC are handwritten, legible handwriting is important.

Scribes must commit to working part time for two years (10 eight-hour shifts per month) or full time for one year (40 hours per week).

Scribes staff the emergency room 24 hours a day, seven days a week. Each physician on duty is assigned a scribe during an eight-hour shift.

Although the students are not directly involved in patient care, they act as transcribers, said Sternlicht. They also help doctors keep track of tests ordered and procedures.

Scribes undergo four to six weeks of training, which includes memorizing medical terminology and learning what is and isn't important for inclusion in a patient's medical record.

And they do so for $7 to $9 per hour, without academic credit.

"It's not an easy job," Sternlicht said.

But scribe Robert Barnwell, 20, a pre-med major, has only positive comments about his experience.

Barnwell said he has always been interested in medicine and started working at GBMC as a clerk when he was 16. He jumped at the chance to become a scribe and is one of three who have been in the program since its inception.

"All the doctors are patient and love teaching us," he says. "Working as a scribe helps you retain information ... and prepare for med school."

The job has advantages over other kinds of volunteer or hospital work, said Jeff Weaver, 21, also a pre-med major: "You learn a thought process, how a doctor figures out what's wrong and how to treat it."

Other students are impressed by their exposure to hospital procedures.

"The actual patient contact, getting to see how a doctor figures out what's going on - you can't get that from a book," said biology major Katie Hayes, 21.

The program also wins high marks from the doctors.

"Working with scribes increases [doctors'] job satisfaction," said Sternlicht. "It makes it more fun to go into work, to teach and show others what you love. Having the students here has just made my job better."

And the patients, he said, "like the extra attention and feel they are helping teach the students. There are no negatives at all."

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