Impact of Scribes Upon Emergency Physician Self Assessed Authenticity

Lisa M.Brown1

Matthew J. Benage1

Andrew V. Tran1

Dane 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, Missouri

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 physicians

• Unknown whether scribes would impact physician burnout and job satisfaction

Objective• To determine the impact of implementing a

scribe program upon academic emergency department (ED) attending self-assessed authenticity and job satisfaction

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 ED

Methods• Treatment group (N=8):– ED Attendings worked 3-5 shifts with experienced

scribes over a 4 week study period, Summer 2013– Scribes had >1,000 hours prior experience with

national scribe companies– Scribes 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.

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:1. Clinical judgment (N=4 items)2. Productivity (N=3 items)3. Empathy toward patients (N=3 items)4. Stress management (N=4 items) 5. Ability to share information (N=3 items)

• SPSS® (20) one-way ANOVA utilized to compare control and treatment groups

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)

Results

Scribe

No scribe

17 27 37 47 57 67 77 87

Figure 1: Mean APSA scores with and without scribe coverage in the ED, (F(1,46)= 6.463, p=0.014)

Mean APSA score

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