Given that scribes earn minimum wage to $12/hour, working as a scribe for any significant amount of time would further complicate debt load as well. If most applicants had to do the training described above and work full-time for 6–12 months, the total time investment to become a doctor would increase by at least a year. Even an informal expectation that applicants have scribing experience, specifically, may lead to further admissions barriers for applicants. It is common knowledge that most medical schools prefer that applicants have exposure to the practice of medicine in some form prior to applying. 6 Given the cost and training time, borne by health systems and providers, most practices want scribes for at least 6–12 months full-time. 5 Scribe America provides a minimum of 120 h of training, including online, classroom, and clinical training while another commercial competitor describes training as including 40 h of coursework, EMR and facility courses, and a minimum of eight shifts at the facility with a trainer. Scribe America, the largest scribe training company in the US states, “A background in Medical Scribing is quickly becoming the standard for pre-medical experience, and is suggested by medical school acceptance committees across the country.” 4 Scribe training varies but employers generally pay for scribes to complete training. The increasing prevalence of scribes, and the opportunity for pre-medical students to work as scribes, may significantly impact medical students and admissions processes. Potential Implications for Medical School Applicants and Admissions Committees Importantly, the Centers for Medicare & Medicaid Services (CMS) recently announced that students will again be allowed to contribute meaningfully to patient documentation as of March 5th, 2018, by “ the teaching physician to verify in the medical record any student documentation of components of E/M services, rather than redocumenting the work.” 3 This recent ruling provides an opportunity for educators to re-examine how medical students could participate in and learn from documentation responsibilities, i.e., how we design experiences that would enhance medical student knowledge and clinical reasoning skills without using students as scribes per se. However, the presence of scribes may reduce access to clinical experiences for medical students since scribes inadvertently compete for space in examination rooms and physicians’ time as required to interact with and train scribes. The main purpose of scribes is to reduce physician documentation time. The aim of this paper is to discuss how widespread adoption of scribes might impact admissions processes and clinical learning opportunities for medical students. Additionally, no studies address the potential impact of scribing as a growing pre-medical clinical experience option. 2 However, there has been no published discussion on the impact of scribes on medical student education. Given the epidemic of burnout, partially attributable to the documentation burden in the USA, having a scribe could be career-saving for many physicians. Despite growing calls to reduce wasteful documentation in the USA, 1 real change seems elusive and scribes are providing some relief. Scribes are increasingly common in many specialties. Educators should consider when and how students can maximize the educational benefits of participating in patient documentation despite the templated methods commonly used in electronic health record (EHR) systems. The recent ruling allowing medical students to contribute directly to clinical documentation without requiring redocumentation by supervisors gives medical schools and clinician-educators an opportunity to consider the unintended consequences of the scribe movement for medical education. Medical documentation duties could provide valuable learning experiences for medical students. While trained scribes are highly valued by providers struggling to deal with increasing documentation burdens, supervising or training scribes also requires time that cannot be devoted to teaching. Scribes may also inadvertently make it harder for medical schools to secure clinical placements for medical students. One season of our admissions data showed that scribes were more likely to be admitted (OR = 1.61). Scribing is already perceived by some as a new key to successfully gaining entrance to medical school. Many medical school applicants become scribes to understand life as a doctor and gain clinical experience. The presence of scribes in various specialties, including internal medicine, is being heralded as a way to decrease clinician documentation time and burnout.
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