Self-efficacy and confidence of medical students with prior scribing experience: A mixed methods study

Figures & data

Table 1. Summary of Respondent Demographics

CHARACTERISTIC	FREQUENCY	PERCENTAGE
GRADUATION YEAR
2020 (FOURTH-YEAR)	36	20.6
2021 (THIRD-YEAR)	36	20.6
2022 (SECOND-YEAR)	41	23.4
2023 (FIRST-YEAR)	62	35.4
SCRIBE EXPERIENCE
YES	58	33.14
NO	117	66.9
SETTING OF SCRIBE EXPERIENCE
EMERGENCY DEPARTMENT	26	44.8
PRIMARY CARE OFFICE	14	24.1
ORTHOPEDIC OFFICE	2	3.4
URGENT CARE	2	3.4
NEUROSURGERY OFFICE	1	1.7
ONCOLOGY	2	3.4
OPHTHALMOLOGY OFFICE	4	6.9
DERMATOLOGY	1	1.7
MOBILE OUTREACH CLINIC	1	1.7
UROLOGY	1	1.7
CARDIOTHORACIC SURGERY	1	1.7
SETTING OF SCRIBE EXPERIENCE
URBAN	18	31.0
OUTER URBAN	33	56.9
RURAL	7	12.1
ADMINISTRATIVE EXPERIENCE
CHIEF SCRIBE	16	27.6
QUALITY ASSURANCE SPECIALIST	4	6.9
NEW SCRIBE TRAINER	23	39.7
NUMBER OF YEARS SCRIBING
0–1 YEARS	29	50.0
1–2 YEARS	21	36.2
2–3 YEARS	6	10.3
MORE THAN 3 YEARS	2	3.4
NUMBER OF HOURS WORKED PER WEEK
LESS THAN 8	2	3.4
8–16 HOURS	8	13.8
16–32 HOURS	23	39.7
32–40 HOURS	17	13.8
MORE THAN 40 HOURS	8	13.8
MILITARY STATUS
PRIOR MILITARY SERVICE	5	2.9
CURRENT MILITARY SERVICE	5	2.9
NO PRIOR OR CURRENT MILITARY SERVICE	165	94.3

Table 2. Qualitative Analysis of Free Text Responses

THEME	NUMBER (PERCENTAGE)	EXAMPLE COMMENT
TERMINOLOGY	45 (75)	‘[S]cribing made me very comfortable with writing and understanding medical documentation […] very early on in medical school. I think it definitely gave me an advantage.’
MEDICAL DOCUMENTATION	45 (75)	‘Yes, it has helped me learn medical documentation and helped me feel more comfortable using EMRs’
PHYSICAL EXAM SKILLS	19 (31.7)	‘I heard about physical exam findings such as Murphy’s sign, Tinel’s sign, murmur grading, Cranial Nerve exams, and more.’
COMMUNICATION SKILLS	16 (26.7)	‘It exposed me to […] the different communications skills of a healthcare team.’
EXPOSURE TO MEDICINE IN GENERAL / UNDERSTANDING OF HOW MEDICINE WORKS	14 (23.3)	‘Scribing gave me a better sense of what happens to a patient as they move through the hospital system. Scribing allowed me to see the order or provider contacts the person might make (EMS, intake nurse, medic, nurse, PA/dr. etc.) and how long these processes take, which provider takes care of what responsibilities.’
ORAL PRESENTATION	14 (23.3)	‘Was much more proficient at oral presentation skills.’
PROCEDURAL SKILLS	8 (13.3)	‘Some procedural skills in M3 and M4 seemed to be easier to pick up since I had already been seen some multiple times.’
COMFORT WITH PATIENT INTERACTION	7 (11.6)	‘I feel less shy around patients.’ ‘It has […] helped mold my bed side manner and clinical approach to patients.’
BILLING PROCEDURES	5 (8.3)	‘I also saw ICD-10 codes and saw names for some of the diseases I would be encountering in patients.’
MEDICATION NAMES	2 (3.3)	‘I had some familiarity with commonly prescribed medications in Primary Care and their use (for example I could have told you that Lisinopril, Amlodipine, HCTZ were used for hypertension before stepping foot in a medical school).’
DEVELOPING A DIFFERENTIAL/ CLINICAL REASONING	2 (3.3)	‘The experience of seeing many sick patients helps develop a gut feeling for when you need to worry about a patient.’
CHANGED CAREER PLAN	1 (1.7)	‘It exposed me to medicine and opened the door to something I never imagined doing or what it was like.’

Figure 1. Mean clinical self-efficacy scores of scribes vs. non-scribes.

Figure 2. Scatterplot with regression lines between total hours worked with self-efficacy and confidence.

Table

#	QUESTION	RESPONSE OPTIONS
1	When will you be graduating medical school?	2020 2021 2022 2023
2	Did you have experience working as a medical scribe prior to entering medical school?	Yes No
3	Setting of prior scribe experience capacity:	Emergency Department Primary Care Office Other [Free text]
4	Administrative experience	Chief Scribe/ Manager Quality Assurance Specialist New Scribe Trainer Other [Free text]
5	Number of years spent working as a medical scribe	0–1 1–2 2–3 more than 3 years [Free text]
6	Approximate number of hours per week worked as a medical scribe	Less than 8 hours per week 8–16 hours per week 16–32 hours per week 32–40 hours per week more than 40 hours per week
7	Did scribing experience influence your clinical experience in medical school? Please add any comments to the text box. (Medical documentation? Terminology? Communication skills? Procedural skills? Physical exam skills? Oral presentation skills?	Free text
8	Describe the setting of your scribe experience	Urban Outer Urban Rural
9	Describe your military status	Prior military service current military member no prior or current military experience
10	Comments?	Free text

Table

#	QUESTION
1	Apply knowledge of normal function to each of the major organ systems?
2	Effectively manage the uncertainty associated with patient care, such as when the patient has multiple treatment options, each with its own risks and benefits?
3	Apply knowledge of epidemiology of common diseases, such as heart disease, to reduce disease incidence?
4	Use effective listening skills when interacting with a patient?
5	Demonstrate caring when counseling a patient?
6	Accurately gather essential information from a patient?
7	Perform a thorough physical exam?
8	Develop an appropriate differential diagnosis?
9	Generate a patient-specific treatment plan?
10	Use information technology to support patient-care decisions?
11	Work effectively with other healthcare professionals to provide high-quality patient care?
12	Improve clinical practice using a systematic approach?
13	Evaluate evidence from scientific studies relevant to your patients’ health problems?
14	Stay abreast of relevant scientific advances by reading peer-reviewed medical journals?
15	Demonstrate sensitivity to patients’ cultural differences?
16	Balance professional responsibilities with personal responsibilities?
17	Discuss methods of controlling healthcare costs?
18	Practice cost-effective healthcare delivery that does not compromise quality of care?
19	Deal with ethical dilemmas
20	See patients independently
21	Relate to a diverse patient population
22	Be a self-reflective practitioner
23	Explain medical information to patients
24	Contribute to patient care
25	Describe the natural history of illness over time