Why Premeds Should be Medical Scribes
According to The Princeton Review 1 gaining clinical experience is an essential prerequisite for crafting an outstanding medical school application – most medical schools today expect candidates to have worked for at least six months in a health-care setting. A 2020 survey of medical school faculty by US News 2 similarly revealed health-care experience to be a benchmark, with one senior admissions committee member terming the absence of clinical exposure a “deal-breaker”.
Research highlights the importance of scribing experience for premed students: A 2018 article published in the Journal of General Internal Medicine 3 showed that applicants who had worked as medical scribes were significantly more likely to be accepted into medical school compared to those who had not, with an Odds Ratio (OR) of 1.61. (OR values greater than 1 indicate that a given “exposure” is likely to have influenced an “outcome”; in this case, the exposure of medical scribing influenced the outcome of acceptance into medical school.)
A physician (MD) host of a popular YouTube channel 4 asserted that his lack of scribing experience proved to be a serious handicap during medical school, as it left him with a poor knowledge of medical jargon and hospital procedures. Conversely, a PhD thesis 5 published in 2017 reported that scribes-turned-medical students uniformly rated their scribing experience as extremely valuable, not only in preparing them for medical school, but in equipping them for careers in medicine.
Types of clinical experience in preparing for medical school
Of course, it is possible for a premed to gain clinical experience through different means. An important distinction made by committees evaluating medical school applicants’ clinical exposure is between Patient Care Experience (PCE) and Health Care Experience (HCE)6. As the terms indicate, PCE roles require direct involvement in caring for patients, including physical contact and responsibility for one or more aspects of patient care. On the other hand, HCE positions typically preclude any direct role in caring for patients.
Although PCE positions may seem preferable over HCE roles at first blush, a mix of both types of experience is more likely to be perceived as ideal by a medical school admissions committee. One reason for this is that PCE positions open to premed students often require limited medical knowhow and offer less scope for on-the-job learning. In contrast, HCE positions such as medical scribing provide much more varied and in-depth exposure to health-care.
Gaining clinical experience: options for a premed student
As outlined above, premed students can opt to gain clinical experience through a variety of health-care roles. Although the following list is not comprehensive, it lists some of the more popular options among premeds seeking clinical exposure:
Patient Care Experience (PCE)
Certified Nursing Assistant (CNA)7: Involved in bedside care of patients, including feeding, bathing, changing linens and assisting in patient mobility. Depending on state laws as well as employer policy, CNAs may also be involved in medical care activities such as measuring vitals and administering drugs under the supervision of qualified health-care professionals. CNAs often work in hospices, palliative care and end-of-life care facilities.
Patient Care Technician (PCT)8: Similarly to a CNA, a PCT also assists in patients’ bedside care. Certification is optional for this occupation (and requirements vary greatly across states and employers). Certified PCTs may qualify for greater involvement in direct medical care.
Medical Assistant (MA)9: Depending on the level and extent of training, an MA’s role may either be limited to front-desk and/or bedside assistance, or extend to more direct involvement in medical care, including administering injections and vaccines, drawing and preparing blood samples and even conducting minor lab procedures. MAs are typically certified, although program intensity and duration varies vastly, ranging from short, 6-week certification courses to two-year associate degree programs.
Patient transporter10: Specializes in aiding patient movement in health-care facilities, including helping patients move into and out of wheelchairs, lifting them into and out of hospital beds, and facilitating movement between wards or even between facilities, as necessary.
Patient safety observer/ sitter11: Generally employed in hospitals and nursing homes to monitor patient safety (for example, by ensuring that patients do not accidentally or intentionally pull out IV lines), as well to assist in basic activities such as feeding and walking.
Phlebotomist12: In charge of drawing and preparing blood samples, usually for testing and analysis. These professionals operate in clinical or hospital settings, although some phlebotomists work at blood donation sites.
Health Care Experience (PCE)
Surgical/ OR technologist13: Responsible for assisting surgeons and relevant health-care personnel (e.g., anesthesiologist, OR nurse, etc.) in a surgery or operating room by providing sterile instruments and supplies, as needed.
Pharmacy technician/ assistant14: Assists the pharmacist in a hospital or other health-care facility dispensary in filling (making up) patient prescriptions, by retrieving drugs and other medical supplies. Duties may also involve assisting in billing and insurance paperwork.
Medical records clerk/ Health information clerk15: Aids in the management of patient records in a health-care facility, by ensuring that forms are accurately filled out and correctly filed, and facilitates the smooth transit of patient files between departments (/ labs) within a facility.
Medical receptionist16: Coordinates front desk duties in a health-care facility, including making and rescheduling patient appointments, as well as handling patient inquiries in person, telephonically and via email.
Child Life/ Patient care volunteer17: While Child Life volunteers are employed in pediatric wards, patient care volunteers may work in any department of a health-care facility, with the goal of improving patients’ hospitalization experience. Child Life volunteers engage children through storytelling, games and other activities like arts and crafts, while patient care volunteers typically engage adult patients by reading to or conversing with them, assisting them with hobbies such as painting or knitting, or activities like solving puzzles. These volunteers generally have no role in medical care.
Medical scribe: Documents practitioner-patient interactions in real time, creating a complete, comprehensive record of a consultation session, ensuring subsequent record verification by the practitioner, and coordinating across departments and facilities to ensure that online medical records (EHR/ EMR) are updated as necessary.
The profile of a medical scribe
Why is the role of a medical scribe best suited to preparing premed students for medical school?
There are several reasons. But before comparing scribing with other PCE and HCE roles, it is advisable to gain a better understanding of the duties and demands of the medical scribe profession.
A medical scribe, variously termed Clinical Scribe, Documentation Assistant, or simply Scribe, functions like a Personal Assistant (PA) to a physician or health-care practitioner (physician assistant, nurse practitioner, registered nurse or others). A scribe is responsible for documenting in detail the interaction between the practitioner and each patient, and subsequently updating the online medical record, termed Electronic Health Record (EHR) or Electronic Medical Record (EMR).
The information that a medical scribe tracks, processes and records is both highly technical and time-critical in nature. Scribing often occurs in a high-pressure environment such as an Emergency Room (ER) or a Trauma Care Center.
To cope with these demands, a scribe must have the following qualifications:
Have an excellent command of language skills, especially listening comprehension
Possess a very good vocabulary and advanced spelling skills, with the ability to spell new and complex medical terminology by approximation
Demonstrate an ability to type at speeds between 60 and 70 wpm18
Excel at organizing information through notes, charts and checklists
Be capable of focusing on a single stream of information in a complex, dynamic situation
Example Scenario19: In an ER, a medical scribe must generate an accurate record of the physician-patient interaction, despite being surrounded by high noise levels, emotional content (pain and distress) and potentially confusing data, as medical terms and patient information are being discussed by multiple health-care staff such as nurses, EMTs, and other health-care personnel.
Besides the above skills, successful medical scribes are also characterized by certain common traits. Unlike the verifiable skill-set listed above, these qualities go deeper, are harder to assess, and might not be easy to acquire through training or certification. A recent study20 found that dozens of practitioners as well as scribes unanimously identified crucial characteristics that make for an outstanding medical scribe, as outlined in the following section.
Five key characteristics of great medical scribes
Medical scribing advantages for premed students.
1. Not afraid to ask questions
Survey respondents ranked this as the #1 quality of a good medical scribe. In order to ensure the accuracy of information entered into a patient’s EHR / EMR, a scribe must unhesitatingly ask questions and clarify details with the practitioner.
2. Able to handle pressure and criticism
Since health-care is often delivered in crisis situations, a medical scribe must be able to adapt to rapidly changing, sometimes turbulent situations, and to withstand criticism, since health-care professionals are also functioning under pressure.
3. Good at blending in and being unobtrusive
To put patients at ease, and to minimize distraction for both patients and practitioners, it is essential that a medical scribe should be able to function unobtrusively—in the survey, many people characterized a good scribe as, “the fly on the wall”.
4. Quick learner
Given the vast extent of medical terminology and technical jargon that a medical scribe needs to master on the job, it is not just desirable but imperative that a scribe should be able to quickly grasp concepts and terms, and to remember and use them appropriately.
5. Genuinely interested in medicine
A medical scribe can expect to excel at the job only by having a real, deep interest in medical practice, and particularly, in improving patient outcomes through health-care delivery.
Qualifying as a medical scribe
At present, medical scribing is an under-regulated sector, meaning that it is possible to be recruited as a scribe with little to no prior experience or certification. However, the highly demanding nature of scribing means that most recruiters expect new hires to successfully complete a training program lasting anywhere from two weeks to two months. An alternative option for aspiring scribes is to first complete an accredited, comprehensive certification program such as the ACMSO Medical Scribe Training21 or MST.
Generally, training programs for scribes include the following components:
Familiarization with medical terminology and health-care jargon
Orientation towards using medical record software
Basics of scribing, including recording CC (Chief Complaint), HPI (History of Present Illness), SOAP note (Subjective - Objective - Assessment - Plan approach adopted by physicians during patient consultations), Review of Systems (RoS) and PE (Physical Exam) results.
Shadowing a senior scribe during real practitioner-patient consultations
Supervised scribing, where a novice works as a medical scribe in the presence of a senior scribe
At the end of this training, a medical scribe is expected to be capable of taking on independent scribing duties.
The portfolio of a medical scribe
A medical scribe may be affiliated with any of the different types of health-care facilities22, including but not limited to:
primary care centers
urgent care services
specialist care clinics/ hospitals
emergency care centers
in-patient care clinics/ hospitals
The value of scribing
The accuracy of a patient’s medical record is critical for multiple reasons. While some are obvious, others have more indirect or long-term implications. Well-documented medical records lead to better health-care outcomes, by:
Improving patients’ ability to comply with recommendations regarding medication dosage, schedule, dietary and lifestyle adjustments24.
Allowing practitioners to track and monitor patients’ progress closely25.
Facilitating smooth health-care billing and insurance claims filing26.
Documenting health-care providers’ medico-legal compliance, particularly important when patients fail to comply with practitioner advice, for example, in cases of discharge Against Medical Advice (AMA)27.
Augmenting scientific knowledge of diseases, their prevention and cure28.
Evidently, medical scribes fulfill a critical need, helping providers deliver better quality patient care29. Not only that, the high-stakes nature of health-care means that there is very little margin for error in a medical scribe’s performance and output.
In any and all of the above settings, a medical scribe’s daily routine includes most or all of the following duties23:
Listening in during an ongoing practitioner-patient consulting session (either on-site or through a remote interface)
Compiling notes on the relevant case details
Completing the required checklists, charts and tables in the EHR
Ensuring that any medical jargon and abbreviations used during consultation are correctly spelled out and entered in long form
Tracking the entry of the patient’s physical exam, vital signs and medical test results (lab work, scans, etc.) into the patient’s EHR/ EMR
Obtaining information pertaining to other consultations recommended by the practitioner for the purpose of updating records (this may include requesting records from other facilities)
Entering billing-related coding into the EHR/ EMR under practitioner supervision
Following up with practitioners to ensure verification and approval of documentation
Retrieving a previously created EHR/ EMR for a patient’s follow-up visit
Creating a Discharge Summary (DS) which includes details of hospitalization, medications, complications and/or adverse reactions and patient’s condition at time of discharge
Difference between a medical scribe and a transcriptionist
The term ‘medical scribe’ is sometimes used incorrectly to describe a ‘medical transcriptionist’.
A medical transcriptionist, similarly to a scribe, is responsible for creating a complete record of practitioner-patient consultations and follow-ups30. However, unlike a medical scribe, a transcriptionist does not track consultations in real time, but uses dictated notes (usually an audio recording) to compile the medical record.
Although both occupations involve documenting health-care delivery, there are critical differences between them. See the table here for a summary:
Advantages of medical scribing vs. other PCE, HCE roles
Experience as a medical scribe evidently strengthens a medical school application. The earlier sections outline some of the obvious advantages of working as a scribe, compared to working in other PCE or HCE roles. These include:
Shorter training/ certification period: Medical scribes can begin working with just a few weeks of training, compared to the months (or even years) of training required for profiles like CNA, MA, and in some cases, PCT.
Wide spectrum of health-care specialties: Scribes are employed across nearly all departments and specialties in health-care facilities. This means that as a medical scribe, a premed can potentially gain knowledge and experience of different branches of medicine, from ER to cardiology to dermatology to neurology. In contrast, roles such as surgical tech, phlebotomist or pharmacy technician offer only limited exposure within the medical field.
Greater opportunity for learning: Because medical scribes are required to document practitioner-patient consultation, they naturally gain more in-depth exposure to medical practice, including disease processes, presentation and symptoms, tests and analyses, and treatment methods. Even though medical transcriptionists may perform similar documentation to scribes, the former have no exposure to the process of assessment, diagnosis and monitoring of patients, whereas scribes obtain first-hand experience of the entire health-care delivery process.
Aside from improving the likelihood of gaining medical school acceptance, working as a medical scribe can help a student to prepare for a long-term career in medicine. Some of the less evident advantages of scribing over other PCE and HCE positions are summarized below.
The close interactions of medical scribes with various health-care experts, from physicians to nurses to EMTs to laboratory personnel can all combine to help premeds build powerful assets for a successful career in health-care.
Secondary advantages of working as a medical scribe
Although not high-paying, the average hourly rate of roughly $14 for a medical scribe far exceeds the minimum federal hourly wage of $7.2536 paid by most service industry positions open to students. Estimates of the average pay for a medical scribe vary, ranging from $30,225 (talent.com) through $32,506 (glassdoor.com) to $32,616 (indeed.com) and the highest at $35,922 (salary.com).
However, a collateral benefit of gaining experience as a medical scribe is that it opens up alternative career opportunities for individuals who may decide that a career as a physician is not for them. The fact that most of these job profiles still allow individuals to contribute positively to people’s health-care outcomes is a distinct incentive:
Medical records and health information specialist: Generally found in the records departments of large health-care facilities. Although some organizations require specialist certification, many consider candidates experienced in medical record-keeping, particularly experience in EHR. The median salary for this occupation is estimated at $51,84037.
Insurance verification specialist: Required to be proficient in medical and drug terminology, EHR coding, data entry and management, as well as verbal and written communication. The median salary for this occupation is estimated at $60,93638.
Of course, a significant percentage of medical scribes go on to earn degrees in one or more health-care specializations, which enables them to pursue careers such as:
Registered Nurse (RN): median salary estimated at $75,33039.
Nurse Practitioner (NP): requires an advanced degree in nursing, median salary estimated at $111,68040.
Physician Assistant: median salary estimated at $115,39041.
Physician: median salary estimated at $208,00042.
In sum, gaining experience as a medical scribe is arguably the best strategy for a premed student wishing to gain clinical experience preparatory to entering medical school. Not only does scribing confer a distinct advantage in applying for and facing medical school interviews, it provides a premed student with singular opportunities for gaining the kinds of knowledge and skills that can help build a strong profile and a successful career as a health-care practitioner.
How experience as a medical scribe is an asset for careers in healthcare
1. Insight into Medical Decision Making (MDM) 31
A scribe has an unparalleled opportunity to learn the process used by health-care practitioners to arrive at diagnoses. They are exposed to how practitioners use information about physical (and/or behavioral) signs and symptoms, possible antecedent events, medical history and test results to put together a clinical gestalt32 of the patient.
2. Introduction to Differential Diagnosis (DDx) 33
One of the major challenges, especially for medical students and novice practitioners, is the confusing similarity among symptoms of various diseases, which makes it difficult to arrive at an accurate diagnosis. (Consider that chest pain may be a sign of a myocardial infarction aka heart attack, pericarditis or Gastroesophageal Reflux Disease (GERD), among other possibilities.) A medical scribe is enabled to witness practitioners using clinical reasoning 34, including their own assessment as well as data obtained through lab tests and scans, as they rule out other possibilities to arrive at a Differential Diagnosis.
3. Interpretation of test and scan reports
As a medical scribe works to input patient data from tests, scans and lab reports, s/he begins to gain a better understanding of how to read and interpret a host of clinical tests, scans and laboratory reports, such as data from electrocardiogram (EKG). CT scans, blood assays and myriad other tests.
4. Insurance claims, medical billing and reimbursement 26
Part of a scribe’s duties may involve compiling information related to health insurance coding of medical tests, treatments and medications, under the supervision of a health-care practitioner. Through this process, medical scribes gain valuable knowledge about the intricacies of health insurance billing codes, as well as practical knowhow on the probability of reimbursement for different types of medical claims.
5. Health-care facility work-flow management
Learning to cope with and efficiently manage the variable work-flow within a health-care facility is often challenging for health-care providers. Medical scribes have the opportunity to learn from expert practitioners how to deal with the peaks and ebbs of work-flow in clinical and hospital settings.
6. Bedside manner and patient responsiveness 35
Learning to negotiate patient emotionality represents a significant challenge for novice health-care practitioners, since patient temperament and mental condition varies widely across individuals. Medical scribes can gain a real edge in this domain, as they are exposed to expert practitioners dealing with a spectrum of cooperative, communicative, anxious, fearful, aggressive and even hostile patients.
7. Practitioner coping strategies 35
Lastly, but perhaps most importantly, a medical scribe has a really unique opportunity to learn through observation how health-care practitioners adapt and cope with the high demands and stress levels of their jobs. The insights gained while scribing can go a long way in helping future medical professionals to develop effective strategies of their own for coping with such demanding careers.
The best premed option for gaining clinical experience
Today, gaining clinical experience is an essential prerequisite for crafting an outstanding medical school application. A 2020 US News1 survey of medical school faculty highlighted the crucial role of health-care experience on medical school admissions – One senior admissions committee member termed the absence of clinical exposure a “deal-breaker”.
This viewpoint is supported by research: A 2018 article published in the Journal of General Internal Medicine showed that applicants who had worked as medical scribes were significantly more likely to be accepted into medical school compared to those who had not. More recently, a study published in 20213 that surveyed hundreds of medical students revealed that those with previous scribing experience – less than a third of the students surveyed – were more confident in collecting patient history as well as compiling medical notes.
Of course, it is possible for a premed student to gain clinical experience through different means. An important distinction made by committees evaluating medical school applicants’ clinical exposure is between Patient Care Experience (PCE) and Health Care Experience (HCE)4. As the terms indicate, PCE roles require direct involvement in caring for patients, including physical contact and responsibility for one or more aspects of patient care. On the other hand, HCE positions typically preclude any direct role in caring for patients.
Although at first blush, PCE positions may seem preferable over HCE roles, medical school admissions committees generally consider a mix of both types to be ideal. The reason for this is that PCE positions open to premeds often require limited medical knowhow and offer less scope for on-the-job learning. In contrast, HCE positions such as medical scribing provide much more varied and in-depth exposure to health-care. The section below outlines some of the most popular health-care positions opted for by premeds trying to gain clinical exposure:
References:
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