Hafer Julia, Wu Xibin, Lin Steven
Stanford Family Medicine, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine.
Fam Med. 2018 Apr;50(4):283-286. doi: 10.22454/FamMed.2018.933777.
Medical scribes are an increasingly popular strategy for reducing clerical burden, but little is known about their effect on medical student education. We aimed to evaluate the impact of scribes on medical students' self-reported learning experience.
We conducted a mixed-methods pilot study. Participants were medical students (third and fourth years) on a family medicine clerkship who worked with an attending physician who practiced with a scribe. Students did not work directly with scribes. Scribes charted for attending physicians during encounters that did not involve a student. Outcomes were three 7-point Likert scale questions about teaching quality and an open-ended written reflection. Qualitative data was analyzed using a constant comparative method and grounded theory approach.
A total of 16 medical students returned at least one questionnaire, yielding 28 completed surveys. Students reported high satisfaction with their learning experience and time spent face-to-face with their attending, and found scribes nondisruptive to their learning. Major themes of the open-ended reflections included more time for teaching and feedback, physicians who were less stressed and more attentive, appreciation for a culture of teamwork, and scribes serving as an electronic health records (EHR) resource.
To our knowledge, this is the first study evaluating the effect of scribes on medical student education from the students' perspective. Our findings suggest that scribes may allow for greater teaching focus, contribute to a teamwork culture, and serve as an EHR resource. Scribes appear to benefit medical students' learning experience. Larger and more rigorous studies are needed.
医学抄写员作为减轻文书工作负担的一种策略越来越受欢迎，但对于他们对医学生教育的影响却知之甚少。我们旨在评估抄写员对医学生自我报告的学习体验的影响。
我们开展了一项混合方法的试点研究。参与者是参与家庭医学实习的三、四年级医学生，他们与配备抄写员的主治医生一起工作。学生并不直接与抄写员合作。抄写员在不涉及学生的诊疗过程中为主治医生记录病历。结果是关于教学质量的三个7分量表问题以及一份开放式书面反思。定性数据采用持续比较法和扎根理论方法进行分析。
共有16名医学生返回了至少一份问卷，共得到28份完整的调查问卷。学生对他们的学习体验以及与主治医生面对面交流的时间表示高度满意，并且发现抄写员对他们的学习没有干扰。开放式反思的主要主题包括有更多时间用于教学和反馈、压力较小且更专注的医生、对团队合作文化的赞赏以及抄写员作为电子健康记录（EHR）资源。
据我们所知，这是第一项从学生角度评估抄写员对医学生教育影响的研究。我们的研究结果表明，抄写员可能有助于更专注于教学、促进团队合作文化并充当电子健康记录资源。抄写员似乎有益于医学生的学习体验。需要进行更大规模、更严谨的研究。
