Can scribes boost FPs' efficiency and job satisfaction?

PURPOSE: Research in other medical specialties has shown that the addition of medical scribes to the clinical team enhances physicians' practice experience and increases productivity. To date, literature on the implementation of scribes in primary care is limited. To determine the feasibility and benefits of implementing scribes in family medicine, we undertook a pilot mixed- method quality improvement (QI) study. METHODS: In 2014, we incorporated 4 parttime scribes into an academic family medicine practice consisting of 7 physicians. We then measured, via survey and time-tracking data, the impact the scribes had on physician office hours and productivity, time spent on documentation, perceptions of work-life balance, and physician and patient satisfaction. RESULTS: Six of the 7 faculty physicians participated. This study demonstrated that the use of scribes in a busy academic primary care practice substantially reduced the amount of time that family physicians spent on charting, improved work-life balance, and had good patient acceptance. Specifically, the physicians spent an average of 5.1 fewer hours/week (hrs/wk) on documentation, while various measures of productivity revealed increases ranging from 9.2% to 28.8%. Perhaps most important of all, when the results of the pilot study were annualized, they were projected to generate $168,600 per year--more than twice the $79,500 annual cost of 2 full-time equivalent scribes. Surveys assessing work-life balance demonstrated improvement in the physicians' perception of the administrative burden/paperwork related to practice and a decrease in their perception of the extent to which work encroached on their personal lives. In addition, survey data from 313 patients at the time of their ambulatory visit with a scribe present revealed a high level of comfort. Likewise, surveys completed by physicians after 55 clinical sessions (ie, blocks of consecutive, uninterrupted patient appointments; there are usually 2 sessions per day) revealed good to excellent ratings more than 90% of the time. CONCLUSION: In an outpatient family medicine clinic, the use of scribes substantially improved physicians' efficiency, job satisfaction, and productivity without negatively impacting the patient experience.

Family medicine educators' perceptions of the future of faculty development.

BACKGROUND AND OBJECTIVES: Faculty development has been an important part of academic family medicine for 3 decades. However, few studies examine the effectiveness of various faculty development delivery methods. With little quantitative data from the literature with which to recommend future directions, this study examined key stakeholders'perceptions. METHODS: A total of 127 family medicine faculty participated in 14 different focus groups. Department chairs, full-time and part-time faculty, and volunteer preceptors responded to seven questions about delivery methods. RESULTS: Discussants emphasized that future faculty development methods must be proven effective, woven into the fabric of clinical practice, and deal with increasing time and financial pressures. Much discussion was related to the need for national and regional strategies allowing for emphasis on outcome evaluation, flexibility, and access. Web-based delivery methods and preceptor needs were emphasized. CONCLUSIONS: Study participants called for a more rigorous evidence-based approach to faculty development. A more systematic and stable approach could include the establishment of new federal criteria for funding projects that address different levels of development and implementation. For example, one set of review criteria would be applicable to systematic case-control studies of new interventions while another set would relate to dissemination studies of proven methodologies.

Using differences between perceptions of importance and competence to identify teaching needs of primary care preceptors.

BACKGROUND: An important goal of a comprehensive faculty development plan is to improve teaching. This is especially important for clinical preceptors. PURPOSE: This study used a novel approach to assessing the teaching needs of preceptors, an essential and often neglected first step in faculty development. Measurement focused on discrepancies between importance and current performance related to a rich variety of teaching behaviors. This study also considered differences in perceived teaching needs among primary care specialties. METHOD: Twenty-six clerkship directors from 13 participating medical schools in the Northeast United States invited randomly selected family medicine, internal medicine, and pediatric preceptors to complete a teaching needs survey. One hundred five preceptors responded. RESULT: Findings revealed that preceptors most need to develop general teaching skills that will help them save time such as selecting appropriate teaching behaviors, assessing learners' needs and providing appropriate feedback, and helping learners learn independently. On the other hand, preceptors expressed less need to improve teaching related to cost containment, disease prevention, clinical decision making, office management, and using computers to aid teaching. Family practice preceptors rated their current teaching performance significantly higher than pediatric preceptors despite no differences in previous faculty development experience. CONCLUSION: Faculty development for preceptors should focus on general teaching skills relative to teaching skills tied to specific medical areas. Novel approaches to teaching while practicing medicine that increase efficiency should be explored. Faculty developers should consider differences in confidence among preceptors from different specialties.