Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Emergency Medicine Resident: "Scribing Is the Best Preparation I Could Have Had For Medical School"

7/25/2016 12:27:16 PM | 1 comments

Dries Van Dyk, DO, has become a bit of a fixture in the Kaweah Delta Medical Center ED. 
 
It all started with two years of job shadowing emergency physicians in high school. After college, he returned as a scribe for three years. And in 2016, he started his emergency medicine residency in the same department.
 
In today's post, Van Dyk describes how scribing prepared him for the rigors of medical school, while CEP America Regional Director Joseph Ginejko, DO, shares the attending physician's perspective.
 
Perspectives:
Dr. Van Dyk, can you tell us a little about your journey?
 
Van Dyk:
I was born and raised in Visalia, home of Kaweah Delta Medical Center. I actually shadowed in the ED in high school.
 
After college, I wanted to take a few years to gain some clinical experience before medical school while my wife finished her degree. CEP America was just starting its scribe program at Kaweah Delta. I didn't really know what a scribe did — it was still pretty unusual at the time — but I thought it sounded interesting. So I ended up scribing for three years, and along the way became a scribe manager and trainer.
 
Ginejko:
Around 2011, many CEP America hospitals were turning to us for help starting scribe programs. So the Partnership handpicked four top scribes, including Dries, to travel to the sites and work with the physicians. Dries helped us roll out the program at Madera Community Hospital when I was ED medical director there. He was just outstanding.
 
Perspectives:
Dr. Van Dyk, how valuable was your scribe experience in preparing you for medical school?
 
Van Dyk:
Really valuable. First and foremost, I was there to document. But the doctors knew I wanted to go to medical school, and they made an effort to help me learn. They would describe what they were doing, and even question me as if I were a medical student.
 
Once, for example, a patient came in having a heart attack. I was typing in the EKG read for the physician, and he described the abnormalities he was seeing. He said it looked like the patient had a blockage in a specific vessel on the right side of the heart. I was amazed he could tell all of that from a few lines on paper.
 
Having some experience made my medical school learning more meaningful. It wasn't just about memorizing ideas and concepts. I’d seen the pathology. I had an idea how patients are evaluated, which labs get ordered in certain situations, what the providers are looking for, and how the team comes together.
 
Ginejko:
I'm curious. A few former scribes have told me that their professional school interviewers didn’t really know what a scribe was or why it would be a benefit. What was your experience?
 
Van Dyk:
A few years ago when I did my interviews, scribing wasn't as common as it is now. I remember explaining very carefully what I did, how I was not just assisting with documentation but working one-on-one with physicians, observing patient interactions, and so on.
 
On the plus side, scribing gave me a lot to talk about. One of the interviewers asked about how I'd handled a difficult situation. And I was able to talk about the day a pediatric patient came in with a stroke and how I dealt with that personally.
 
Perspectives:
So you finished medical school and returned to Kaweah Delta for an emergency medicine residency. Was that intentional?
 
Van Dyk:
Well, I did try to keep an open mind. As a fourth year medical student, you do what's called audition rotations where you spend a month working at potential residency sites. It's a way for both you and the team to get to know each other and whether it would be a good fit.
 
I did my first audition rotation back at Kaweah, and then went on to a Level I Trauma Center in Vegas and a regional hospital in Fresno. Of the three, I felt best about Kaweah. I really enjoyed every minute that I spent there.
 
Perspectives:
What made it your favorite?
 
Van Dyk:
A few reasons. There's an opportunity to see some interesting pathology and work with great attendings, And the nursing staff is amazing. They really set the tone of that department. They're excellent, they're engaged, and they have a positive partnership with the physicians. That was something I first observed as a scribe, and its held true as I've moved into a provider role.
 
Perspectives:
What's it like working with scribes as a resident?
 
Van Dyk:
As residents, we don’t work with them one on one, but just their presence is helpful. One thing that's struck me is how much our scribes know about the department and how things get done. Of course, they're the go-to experts for charting and EHR questions. But they'll also tell me who I need to call to get a patient admitted and how to contact a certain doctor.
 
Perspectives:
Dr. Ginejko, as a leader in CEP America who has watched the scribe program grow, what were your thoughts when you heard Dr. Van Dyk was coming back as a resident?
 
Ginejko:
Well, to be completely honest, my first thought was, “How old am I?”
 
And then right after came the realization that, Wow, what an incredible foundation for a medical career. Scribes get a chance to work side by side with multiple physicians, observe their decision-making processes, their diagnostic skills, and their interactions with patients. Really, scribes have multiple years of training and forming bedside personality before medical school even begins. I’ve always argued that the scribes get that extra boost — leaps and bounds above any other experience.
 
Perspectives:
I realize it's probably a little early to ask Dr. Van Dyk about his future career plans. But assuming he were interested in joining CEP America after residency, what are some of the benefits for new Partners?
 
Ginejko:
The recognition CEP America gives the brand new doctors has always amazed me. We're not a Partnership based solely on seniority but rather on equality and transparency. It's a true partnership in the sense that from day one, you’re treated like everyone else. You’re not stuck on all the night and weekend shifts, and you don't cover a certain percentage of the holidays. It’s fair from the beginning, and I think that’s why from the second year on, our retention rates are incredibly high.
 
I’ve said to recruits before: it’s not a job we’re offering you. We’re talking about a lifetime. We’re talking about a career. That’s what we want to help you build.
 
Perspectives:
Well, you've both been very generous in answering my questions. Anything else to add before we wrap up today?
 
Ginejko:
A reminder to all our Partners: be nice to the scribes and teach them well. In a few years, they could be a Partner working right next to you.
 
Van Dyk:
I just want to underscore what a great opportunity scribing is. I don’t think I could have had a better job before medical school. And returning to Kaweah Delta has just been awesome. I’m really glad to have come full circle.


Comments
John Hipskind
As part of ED faculty, I can saw we are proud to have Dr. Van Dyk return to our ED as one of our new EM residents. We are all looking forward to his continued growth in his new role as a physician. Our scribe program is top notch. We look forward to its continued growth and hopefully more of our prior scribes like Dr. Van Dyk returning back to us in the future!
7/26/2016 8:01:30 AM