Analysis for Racial and Gender Disparities in the Stanford School of Medicine Clerkship Evaluation System

Stanford School of Medicine completed an analysis of our assessment system, the Criterion-Based Evaluation System (CBES), from 2011-2019, investigating for gender- and race-based disparities. Since January 2022, the USMLE Step 1 examination is now pass/fail2. In January 2021, Step 2 Clinical Skills was eliminated3. With these two changes, accurate clerkship assessments will be playing an increased role in residency applications. Concurrently, several medical schools have presented their findings on disparities and bias within their systems of medical student evaluation4,5,6. Medical schools nationwide must re-examine their methods of assessment of medical students

Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial

PurposeScribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency.MethodsWe conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians' perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close.ResultsScribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values <.001). Scribes had no effect on patient satisfaction. Scribes increased the proportion of charts that were closed within 48 hours (OR =1.18, P =.028).ConclusionsTo our knowledge, we have conducted the first randomized controlled trial of scribes. We found that scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout