Impact of Scribes Upon Emergency Physician Self Assessed Authenticity

1. Impact of Scribes Upon Emergency Physician Self Assessed Authenticity Lisa M.Brown1 Matthew J. Benage1 Andrew V. Tran1 Dane M. Chapman, MD, PhD2 12nd year medical students at the University of Missouri-Columbia School of Medicine, Columbia, Missouri 2 Faculty Mentor, University of Missouri-Columbia School of Medicine, Columbia, Missouri

2. 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

3. Objective • To determine the impact of implementing a scribe program upon academic emergency department (ED) attending self-assessed authenticity and job satisfaction

4. 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

5. Methods • Treatmentgroup (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.

6. 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) one-way ANOVA utilized to compare control and treatment groups

7. 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)

8. Results

9. 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