Need Clinical Experience? Consider a Medical Scribe Position.

If you’re a pre-med on the hunt for some high-quality clinical experiences, medical scribing could be an excellent fit. This paid position can help you to develop a strong network of provider relationships, gain an excellent foundation in medical terminology, observe clinical decision-making first-hand, and learn about the daily work and challenges of life as a physician. 

The work. Medical scribes serve as assistants to a physician (or multiple physicians) taking notes and charting patient encounters, inputting documentation into the Electronic Health Record (EHR), responding to patient questions and messages as directed by the physician, locating health records, and even researching information as requested by the physician. Scribes play a key role on a medical team as they free up the physician to focus on patient interactions while the scribe takes responsibility for administrative tasks. Scribes work closely under the supervision of a physician and do not have independent decision-making responsibilities. They work across a variety of specialties, including but not limited to: Emergency Medicine, Oncology, Dermatology, Gastroenterology, Family Practice, Pediatrics, Internal Medicine, and Pain Management.

The training. After obtaining the position, medical scribes receive between a few weeks to a month of training in preparation for the position. This training is typically paired with a period of shadowing a fellow medical scribe. Even with this onboarding, most scribes feel overwhelmed early on in the role due to the steep learning curve. Scribes need to learn the styles and preferences of the physicians that they work alongside, including their preferred charting methods, as well as the EHR system and the new terminology. 

The benefits. 

• Medical school admissions committees view scribing favorably. A scribe’s work demonstrates their commitment to a career in medicine by showing that they have an intimate understanding of the work of a medical provider. They will gain foundational medical knowledge and experience that will be useful throughout medical school and may ease the transition between their undergraduate and medical studies, and inform their future career path.

• Scribes can gain experience within a specialty, including a more thorough understanding of the challenges that physicians in those roles face. 

• Scribes will have the opportunity to develop a wide network of provider relationships, some of whom may be willing, and able to write detailed recommendations based on their work alongside of them.  

• Scribes will demonstrate their ability to thrive on a team. Scribes must learn to work well with a variety of physicians who will each have a different style. They will also learn to deal with stress and be proactive in asking questions and picking up information quickly, which will benefit them as a medical student, resident, fellow, and attending physician.

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Trends in Medicine: Shortening the Preclinical Timeline

American medical schools have traditionally followed a similar structure: two years of preclinical work followed by two years of clinical rotations. But there is an emerging trend within medical education, which accelerates preclinical studies in order to allow students more time to gain clinical experiences. According to the Liaison Committee on Medical Education, during the 2019-2020 academic year, six percent of medical schools ended pre-clinicals after one year, 29 percent ended them after 1.5 years, and 56 percent retained the traditional two year structure. 

Kim Lomis, MD, and Vice President for Undergraduate Medical Education Innovations at the American Medical Association, explains that the reasoning for the curriculum update is so that students are better able to contextualize learning within patient care. “Proponents argue that learners are able to better anchor their learning of foundational sciences in a meaningful context, fostering professional identity formation as well as knowledge base,” she said. Early adopters include the elite medical schools at Harvard, Duke, Vanderbilt, and NYU Grossman. Each of these schools now condense preclinical learning into the first year, with students beginning clinical clerkships at the start of their second year. 

Rutgers Robert Wood Johnson Medical School recently launched its updated curriculum, which starts the clerkship after 18 months. Carol A. Terregino, MD, and Senior Associate Dean for Education and Academic Affairs at Rutgers, notes that the curriculum change is beneficial because it puts an emphasis on “knowledge for practice.” 

“Anything that is going to increase students’ clinical knowledge and ability to apply that knowledge to clinical practice is going to make students stronger as future physicians,” she said. She also noted the presence of unknowns related to the recent pass-fail update of the USMLE Step One exam, which could potentially increase the importance of the Step Two exam. “To make sure my students are able to do well and prepare for the licensing exam, I want a longer launching pad to get them there,” she said.

Others say that looking just at “preclinical” and “clinical” years oversimplifies medical education. Students at Ohio University Heritage College of Osteopathic Medicine, for example, follow the traditional two and two calendar, but are exposed to clinical experiences through observations and interactions during the first two preclinical years. “Distilling a college’s program to the length of time in preclinical or clinical curriculum misses all the nuances of what each college does to prepare its students. We emphasize patient-centered care from the first day of medical school, making our students well-rounded when they engage in their clinical rotations,” said Jody M. Gerome, DO, and Heritage College’s Senior Associate Dean for Medical Education.

Related Blog: U.S. Medical Licensing Examination’s (USMLE) Step One Moves to Pass-Fail Scoring

Medical School Enrollment Growth Limited by Space Constraints in Clinical Training and Residency Programs

Last month, MedPage Today reported that applications to medical school have risen significantly compared to the same period last year, according to both the American Association of Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM). AAMC reported a year-over-year increase of 14 percent in early August, and AACOM reported an uptick of 17.7 percent as of mid-August.

Sources speaking to MedPage Today pointed to the pandemic as a reason for the spike, suggesting that the current high-profile nature of medical personnel may be inspiring applications to medical school. Other applicants may be taking advantage of idle time to submit their applications early, while some may be seeking alternative paths to mitigate economic uncertainty. Geoffrey Young, AAMC’s Senior Director of Student Affairs and Programs, told MedPage that the early indicators may not necessarily indicate a more competitive year, noting that the pandemic has created “an unconventional time.”

While both AAMC and AACOM schools are expanding their capacity where possible, both note that their growth is limited due to a lack of corresponding residency spots. The AAMC has launched a few new schools, which has increased overall enrollment, and remains optimistic that many schools will be able to make incremental increases in class size. Larger updates to class sizes, however, would have to be approved by the accrediting agency. Osteopathic school enrollments are growing faster, with a 6.6 percent increase approved for the upcoming year by the accrediting agency, up from a 5.6 percent increase the year before.

This capacity constraint suggests that many qualified candidates may not find a place in medical school, despite a national need to grow the physician workforce. Results released last week from the AAMC Annual Survey also focus on the significance of the clinical experience constraint. In the survey, which was administered in November 2019 to 154 medical schools, school leaders voiced apprehension about the number of residency positions and clinical training sites available to students.

Just under half of the schools reported “major or moderate” concern about their students finding post-graduate residency positions of their choice. While medical school enrollment has seen significant growth over the last two decades, an increase of 33 percent since 2002, residency availability has grown much more slowly. Federal support for Graduate Medical Education (GME) provided through Medicaid, has been capped for the last two decades, effectively leaving funding for GME at teaching hospitals at 1996 levels. The National Resident Matching Program reports that this year 40,084 MD and DO graduates applied for only 37,256 residency positions though the Main Residency Match.

In addition to concerns about residency, a large majority of medical school leaders reported concern over the availability of clinical training sites for students. As demand increases for clinical experiences from other medical trainees, including nurse practitioners, physician assistants, and DO programs, AAMC medical schools are feeling more stretched to meet their students’ needs. Most of the survey respondents reported concern about clinical training sites and qualified primary care preceptors, 84 and 86 percent respectively, and just under three-fourths, 71 percent, mentioned concern about students having access to qualified specialty preceptors.