Lisa MBrown 1 Matthew J Benage 1 Andrew V Tran 1 Dane M Chapman MD PhD 2 1 2 nd year medical students at the University of MissouriColumbia School of Medicine Columbia Missouri ID: 396972
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Impact of Scribes Upon Emergency Physician Self Assessed Authenticity
Lisa M.Brown1Matthew J. Benage1Andrew V. Tran1Dane M. Chapman, MD, PhD2
1 2nd year medical students at the University of Missouri-Columbia School of Medicine, Columbia, Missouri2 Faculty Mentor, University of Missouri-Columbia School of Medicine, Columbia, MissouriSlide2
Background
Emergency physicians are among the most likely to experience symptoms of burnout: emotional exhaustion, increased cynicism, lack of empathy, self-doubt and lack of fulfillment represent feelings of not being authentic or true to self
Scribes are known to offset the administrative tasks of physiciansUnknown whether scribes would impact physician burnout and job satisfactionSlide3
Objective
To determine the impact of implementing a scribe program upon academic emergency department (ED) attending self-assessed authenticity and job satisfactionSlide4
Methods
A randomized control group design:ED Attendings with Scribes (N=8) randomly selected to work with experienced scribes (treatment group)ED Attendings without Scribes (N=12) had overlapping shifts (control group)
University Hospital EDSlide5
Methods
Treatment group (N=8):ED Attendings worked 3-5 shifts with experienced scribes over a 4 week study
period, Summer 2013Scribes had >1,000 hours prior experience with national scribe companiesScribes Duties:Completed the EMR for their assigned attending excluding physician order entry Followed up lab/radiology results, entered discharge instructions, obtained supplies, set up for procedures, etc. Slide6
Analysis
Authentic Physician Self Assessment (APSA) used to measure end-of-shift authenticity and job satisfaction of physicians with and without scribes: 17-item instrument, utilizes a 1 to 6
Likert scale Items from previously validated self assessment or independently derived a priori
Demonstrated high
internal consistency (
Chronbach
Alpha=0.911
)
Validated to assess
five behavior constructs thought to influence
physician authenticity and
job
satisfaction:
Clinical judgment (N=4 items)
Productivity (N
=3 items
)
Empathy toward patients (N=3 items)
Stress management (N=4 items)
Ability to share information (N=3
items)
SPSS
®
(20)
o
ne
-way
ANOVA
utilized to compare control and treatment groups Slide7
Results
APSA surveys (n=48) were collected from attendings with (n=24) and without (n=24) scribes Working with a scribe significantly improved ED physician APSA scores (F(1,46)= 6.463, p=0.014) 75.9 [73.6, 78.1] (scribe coverage)
68.3 [62.6, 74.0] (no scribe coverage) Unexpectedly, working with medical students also significantly improved ED physician APSA scores (F(1,30)= 5.07, p=0.033) 76.8 [73.4, 80.2] (medical student coverage) 69.1
[62.9, 75.3] (
no medical student coverage) Slide8
ResultsSlide9
Conclusions
ED Attendings working with experienced scribes had higher self-assessed feelings of authenticity and job satisfaction Implementation of scribe program may be an effective intervention to prevent and mitigate the risk of ED physician burnout