What I Learned From Being an ED Scribe

Like many pre-health students, I worked as a Medical Scribe in the ED at a relatively small hospital for about 2.5 years. When I started, I was about 19 years old and my only intention with this job was to get some exposure to the hospital setting, learn and earn enough money to pay for gas. However, I came to absolutely love this job. I learned a wealth of information, made truly meaningful connections with my coworkers and obtained so many opportunities.

Our ED was small - 16-beds with very limited services. We didn't have dialysis for the longest time. To this day, they still use tele-neurology as consults for any stroke patients or patients with neurological diagnoses. Patients who needed immediate cardiology services (like STEMI/heart attack patients who needed the cath. lab) or the trauma cases would be diverted to the Level 1 Trauma Center that was about 30 minutes away. Regardless of all that, we still saw everything... from gunshot wounds to stab wounds to 2-week old babies in respiratory distress to someone who came in by ambulance for a cough they'd had for about 6 months. We had 1 doctor for the entire ED, their scribe, 2-3 NP/PAs and an amazing ED team to get us through the shifts. Truly, they were all superheroes with their cape hidden under the scrubs.

And, this is why I would highly recommend medical scribing for any pre-health student!

Here's some helpful information on Scribing! :)

What's a Scribe?
As a scribe, you're basically like a personal assistant to the care provider. So, whenever the provider goes in to see a patient, you go with them to collect the appropriate information (i.e. the reason for the patient's visit) and document it in the medical record (EMR). You continue to update the EMR with any ordered diagnostics (CT, MRI, X-ray), changes in patient condition, medications ordered, etc. until there's a disposition. So, basically, until the patient is either discharged, transferred or admitted. The doctors then review everything you've written, make any changes before finally signing it.

The Benefits of Becoming a Scribe
The most important benefit is how you get a one-on-one chance to communicate with the doctor on a consistent basis. This is a great chance to build solid relationships with them. So, when there's some downtime, you can ask them about their work-life balance, learn medicine from them, and seek advice. I've had doctors draw out the entire jaw anatomy to explain the reduction of a dislocated jaw or draw out the chemistry of acid-base balances for a patient in Respiratory Acidosis. Take advantage of this opportunity! Plus, when you need those letters of recommendation, the doctors you work with and build relationships with will be the first person to write them for you!

You also get to build a great rapport with the entire staff. Usually, RNs or RTs will come to you prior to approaching the doctors since you know their whereabouts or what's going on with the patient(s). Not only does this allow you to pick their minds if you're interested in their profession but it also pushes you to work as a team member. Plus, if you get along with the people you're working with, it makes the long hours somewhat bearable. You can truly build long-lasting relationships with them as they become a part of your support system!

Also, for so many people, this position is their gateway to so many more opportunities. Because I was a scribe in this ED, I got the opportunity to help one of the medical directors start a scribe program at an even smaller, rural ED. I got to collaborate with the ED director to hire and train new scribes who later became the lead scribes and took on my role. Because I was a scribe in the ED, I got accepted for an externship position in that same department. In the previous years, there had only been 1 other ED Extern so this was definitely a huge opportunity that had come my way because of my prior experience. And finally, because I worked as a scribe, I felt more prepared to become a nurse and a doctor. I felt more comfortable using medical jargon and I didn't feel as hesitant to approach the doctors. Because I had developed a good relationship with my coworkers, I received one of the best and most experienced preceptors during my externship. Both he and the rest of the ED staff were so invested in my externship experience that they would go out of their way to ensure that I got exposure to a vast amount of clinical skills. In the end, when I applied to new grad programs and post-baccalaureate programs, I was able to get letters of recommendation from both my preceptor and the doctors I had worked with.

So yeah, these are just a few of the benefits!

Who do you work with as a scribe?
At some hospitals, Scribes only work with doctors. However, at most hospitals, you're working with doctors, NPs and PAs.

Do Scribes only work in the ED?
Nope! Medical Scribes work everywhere - from private offices to big trauma centers.

Do they accommodate student schedules?
It really depends. This is a formal job with a paycheck so it should be treated like one. However, some companies do offer Per-Diem positions and self-scheduling which offers more accommodation.

How do you become a Scribe?
Do a Google search for scribing positions near you. There are so many companies who are hiring scribes - the 2 I've worked with are CEP America (which is now Vituity) and ScribeAmerica. My experience with CEP was ten times better than ScribeAmerica but they're both great companies. There are also office scribe opportunities so I would also look into that.

I got hired. What should I expect now?
Get ready for training!

At both companies, the hiring process for new scribes was pretty much the same. They all received about a week's worth of orientation where they were given a packet of common medical terms they needed to know as well as education on the computer system that they will be using for documentation.

The second part of the training took place on the floor where new hires were paired with experienced scribes to teach them the "ins & outs" of scribing as well as providing immediate feedback on their work. During the training, new hires were taught how to communicate with doctors/staff (which doctor was not so friendly vs. this guy loves to teach), how to navigate EMR, how to write proper HPIs. For both companies, the training ended with an exam on the medical terminology.

And then, you're ready to go!

How much do they get paid?
The pay really varies. Some companies are more generous than others but typical pay is $10-15/hr. If you're working for a private office, you may get paid more.

Do Scribes get direct patient care?

Nope. As a scribe, you cannot touch patients, explain any tests/results, provide any medical advice/recommendations on behalf of the doctor or handle any kind of bodily fluids. 

What are the pre-requisites?
For most companies, there are no mandatory pre-requisites, except maybe a HS diploma. Most companies do prefer that you have some form of medical terminology course with a good typing speed.

If the programs are not partnered with third-party like CEP America or ScribeAmerica, they may have their own requirements. For example, one of the local hospitals, hire their own scribes so their requirements include:

• being a pre-medical student for 2 years
• having an open availability unless you have classes during those days/time (so provide school schedule)
• 2-year commitment.

Advice for New Scribes

• Everyone struggles. Ask for help. Communicate with your team.
• Don't be scared of the doctor. Clarify if you have to. Ask again if you have to. Just pick the right moments. 
• It's okay if you feel overwhelmed at times. It's normal and part of the process. Take those deep breaths and start typing!
• Take care of yourself on shifts - remember to take your lunch and drink plenty of water.
• Wear comfortable shoes.
• Take those moments during downtime to ask about that really weird case you saw or any questions you have. This is the time to pick their brains.
• Build connections.
• Don't do any medical procedures. As tempting as it may sound, just don't do it. Remember, the doctor or nurse that you're working with has liability insurance. You don't. So even if it's a simple stapling of a laceration, just don't do it. 
• Don't take part in the department gossip. 
• Keep a running journal/notebook on whatever you learn.
• Always have a piece of paper and a pen with you. 

Let me know what you think! If you have more questions that I didn't mention here, feel free to drop a comment or shoot me a message! 

Post-Bacc Application Advice

From my Interview Trail (New York)

I'll be starting my Post-Bacc program in August 2020. I'm so grateful and excited to finally start on this path! In the meantime, I wanted to share my application experience so you sort of know what to expect if you're thinking of applying for the upcoming cycle. As for my background, I applied to about 7 post-bacc programs including Johns Hopkins, Goucher, Bryn Mawr, George Washington, Columbia, UPenn, and UCSD. I was accepted to 5 out of the 7 programs! Here are my two cents on the application process.

1. Apply Early
One of the best pieces of advice that I can give anyone is to apply early. Most programs admit on a rolling basis, which means that admissions committees don't necessarily wait until the deadline for interviews/acceptances. They admit on a continuing basis. Even though they might have a deadline of March, please don't wait to apply until March. By that time, they will have most of their spots already filled with students and it will become extremely competitive for someone to get that last spot.

2. Call Each Program
You don't have to call. You can email/message them but find a way to reach out to the programs you're interested in. Discuss your career path and what you're trying to seek out of that program. They will give you the information you need to decide if it's the right program for you. I remember calling different programs to ask if they had any RNs in their program or if they were okay with accepting students who had taken some of the pre-med pre-requisites. Some programs were very open to that idea and others were very blunt to state that they purely wanted true career changers with no previous classes. And that's totally okay! It's better to know this information up front rather than finding out after spending that money on applications and your sanity while waiting.

3. Prepare Yourself Financially 
Applying to these programs is VERY expensive. It almost gives you a taste of what it'll be like to apply to medical school(s). Here are all the things you can expect to spend your money on: sending transcripts from every high school and college to each program, your SAT/ACT/MCAT/GRE scores (if applicable), PostBacCAS (if applying through this service), each program's own sub-application cost, traveling for interviews, etc. I spent about $800 on the applications/transcripts and then dropped $1,000+ on traveling. I will admit that the traveling part could have cost less but I chose this time to travel for leisure as well as interviews so that's why the price is a bit higher. But, you get my point. It's expensive so prepare yourself for it!

Taken from the window of the waiting room - just a few minutes before my interview (Maryland)

4. Prepare for Interviews
Start preparing for interviews even before you hit that submit button and wait in agony to hear something back. It's better to be prepared and have the opportunity than to have that opportunity without being prepared. I remember being on StudentDoctorNetwork (I know...) and just looking through pages of information on each program and the type of questions they asked during interviews. I read Dr. Gray's Premed Playbook on Medical School Interviews like my life depended on it. I made a list of all the questions I expected them to ask and wrote bullet points of everything I wanted to discuss. Then, I just practiced my answers over and over again. I had my application memorized as well as my why because every single program started with the why. You're a nurse. You have a great career and make good money. Why are you now making that change to becoming a physician? Boom. That's your cue to answer them. Sure, they'll throw curveball questions at you like, "If you could be any shape, what would it be?" but just take a deep breath, think about it and answer. Pause and think always before rumbling on for a few minutes before finally admitting that you've lost your train of thought. Trust me, I learned this the hard way. More than anything, be yourself and remember that the interviewers are human too. Laugh, be honest and share your passion with them!

5. Keep Yourself Busy 
It's so easy to get hung up on the wait after you submit your applications. I remember sitting in silence and staring at my screen after I had hit submit and spent a portion of my savings. I constantly thought about getting rejected from every single program I had applied to. But even then, I'd tell myself that I'll just improve my application, gain more experience and apply again. The thoughts would still creep up but I moved on with my life. I didn't hear anything back for 2-3 weeks. Until then, I continued going to work, traveling, spending time with family and volunteering. I remember being asked about what I had been doing since I applied during my interviews and this way I had something to share besides "Oh, impatiently waiting for your response while binge-watching Friends for the 6th time and eating junk food." No matter what happens, remember you're a bad-ass and you got this!

Top 5 Resources for Nursing Students

When I started nursing school, we received this 3-day orientation in which we HAD to buy about $3,000 worth of textbooks and materials. I say "had to" because we had to show the receipts as proof of purchase. These books then made their home in my garage where they just collected dust for the next 3 years. Instead of using these books, I found other resources that were cheaper and way more useful. So here are the top 5 resources that will save you some money and help you pass those exams! 

1. Quizlet. Quizlet. Quizlet. 

This is such a great and free resource for both pre-nursing and nursing students. You can either take your own notes and convert them into flashcards if that's your study method. Or... you can do what most of my classmates and I did. You know those NCLEX style questions that come with each book but are only available for teachers? Well, Quizlet has some/all of those! After you've studied and if you feel prepared to be tested on the material, search for the chapter(s) with/without the book name on Quizlet. You'll probably find multiple decks of flashcards pertaining to the information you'll be tested on. There were a couple times when I saw the same questions that I had studied on Quizlet appear on the exam. Fair warning though... don't go into your exams after just glancing at these flashcards without really understanding the material. You may pass the exam but you will still need to know the material for the NCLEX and as practicing RNs. 

2. Saunders Comprehensive Review for NCLEX-RN 

I know... you may be in your 1st semester and the last thing you want to think about is the NCLEX. But, this book honestly saved me and helped me get better at answering those dreaded NCLEX style questions. The information is extremely condensed and to-the-point. There are even questions to assess your understanding of the material at the end of each chapter! The entire book is divided into sections that will pertain to what you're studying in your semester (i.e. Fundamentals, Pediatrics). If you're having trouble grasping the main concepts or just need more resources to help with studying, I would definitely check out this book here. Plus, you can always use this as a resource when studying for the actual NCLEX. 

3. YouTube

YouTube is great for everything and social media can be your friend, sometimes. Most of the channels I utilized on YouTube were: RegisteredNurseRN, Osmosis, Khan Academy and... Nurse Blake (because you need some humor to get through the rough times). I mostly used Osmosis during my pediatrics rotation. They have a website as well but why pay when you can watch their limited videos for free? I found their videos to be extremely helpful because they broke down every diagnosis, symptoms, and interventions in a very-easy-to-understand kind of way. As for RegisteredNurseRN, I passed my critical care exams solely because of her! I didn't even look at my powerpoint notes for that class because my professor was all over the place. With RegisteredNurseRN, she breaks down each topic (i.e. COPD) down to the T and explains everything including nursing diagnosis, treatments, and nursing interventions. There are certainly more channels so just feel free to search whatever you're looking for! 

4. ATI

Ah, the dreaded ATI. Anyone else get major anxiety from taking those ATI Proctored exams as much as I did? 🙋 But, now that I look back, ATI was extremely helpful. We were given ATI as part of that 3 grand package so I utilized it as much as I could. To prepare for the proctored exams, I studied mostly from their mini-quizzes/assessments and practice proctored exams. I would only read more about the questions I missed instead of reading the entire book from front to back. I even ended up using ATI while studying for the NCLEX. 

5. My Notes

It seems like a no brainer, right? But, I used my notes a bit differently. I used my notes in a 2-step process. I would have the powerpoints up in front of me during the lecture and I'd scribble the most important information stated by the professor (like when they would say "this is going to be on your exam"). After coming home, I'd condense my notes into this Q&A format. If I found corresponding Quizlet flashcards, I would even include those in my notes (as shown in the first 2 questions) so I could get repeated exposure to the NCLEX style questions. I've been studying with this method for about 5 years and it has been working really well for me! RachelP on YouTube has done a video on how she used a similar method to study during nursing school so definitely check it out!  

A Little Bit About Me

So, 2 facts about me: I used to be that student who would a) hide in the bushes and then join everyone at the end of a mile run, and b) rather do anything other than writing a paper. Now that I've apparently grown up, I grudgingly "run" a mile but other things still haven't changed. I still dislike writing on a very real level and yet... here we are!

I started this blog for many reasons: to document my journey, share experiences, help others, the list goes on. However, the biggest reason I wanted to start this side hustle was to build a close-knit and supportive community of individuals who are on the same path as me. When I made the final decision to pursue higher education by becoming a doctor, I faced a lot of criticism. Even my numerous Google searches didn't lead me to someone who was currently a nurse and aspiring to become a physician.

Now that I am a Registered Nurse with an acceptance to a Pre-Medical Post-Baccalaureate Program, I finally feel confident enough to step out of my comfort zone and share my journey. With my successes, setbacks and any advice/resources that I may share, take it with a grain of salt. I hope that it helps!