Training Scribes

Follow these tips to get your exam room assistants up to speed quickly.

Dr. Bennett spends nearly as much time educating scribes on an ongoing basis as he does educating patients. “We try to make it fun,” says the Hawaii-based retina specialist. “Everything we do is learned by repetition, by interaction and discussion. My scribes have seen thousands of patients with me. They know why I'm choosing Y over Z. I think some of them are almost more intelligent than I was as a fellow.”

MEETING INITIAL CHALLENGES

Despite the prospects for long-term success, training a new employee to be a productive exam room assistant can be a challenge, especially if the person doesn't have a strong medical background or if you're introducing your first scribe to your practice.

“There's a definite learning curve,” says Dr. Harris. “We teach a scribe on paper first. It takes a while. We have dual scribes work with us, one using the EMR system and one using paper. The scribe who is training the new person compares the two entries and the trainee gets to see what she shouldn't have put in or what she hasn't put in that should be included.”

Most practices employ this “shadowing” technique, using experienced scribes to teach new ones. This approach spares the physician too many didactic teaching responsibilities while examining patients. New scribes can require 1 to 4 weeks to become comfortable in the exam room and up to 6 months to master their roles, depending on their skills and previous experience, according to the physicians and practice managers interviewed for these articles.

“You'll find that people who make good scribes will want to be on their own as soon as possible,” says Dr. Antoszyk.

“A new scribe needs a very patient doctor who is willing to take the time to explain things in the beginning,” says Sommer Dittman, Dr. Antoszyk's scribe. “Processes, procedures, terminology and names of diagnostic equipment may all be new to the scribe.”

Dr. Freund, a New York City-based retina specialist, agrees. “The more time you can invest into being sure scribes understand what you're doing and why you're doing it, the bigger the payoff in the end,” he notes. “We're paid many times over for the efficiency gains, the quality of our charts and the ability of these assistants to anticipate our needs.”

SPEAKING TO YOUR SCRIBE

“The most important thing is be explicit, consistent and regimented when you speak to your scribe,” says Dr. Brucker, Scheie Eye Institute, University of Pennsylvania School of Medicine. “I start with the slit lamp and go from front to back in an organized fashion. For the fundus, I examine the disc, macula, vessels and periphery, always in that order—even when I don't see anything in these areas. I never jump from the right eye to the left eye, and I'm always very comprehensive in my explanations.”

Vitreous Retina Macula Consultants of New York, where Dr. Freund is a partner, has a physician provide monthly lectures on disease and therapy to scribes. Scribes in the practice are also trained by a clinical educator and are encouraged to attend courses on coding and other issues at the yearly meeting of the American Academy of Ophthalmology.

Once a scribe is up and running, he or she can become the trainer—and not just for new scribes. “We give our best administrative techs to our new physicians,” says Dr. Brown, a partner in Retina Consultants of Houston. “The physician might not know how to go to a particular lab or how to schedule surgery in Texas. The tech can help get them started in the practice faster.” RP