In their essay, the authors propose several recommendations to avoid the unintended outcomes. They suggest that action teams “troubleshoot problems and concerns in real time, and programs should share descriptions of local implementations broadly. Multi-institutional groups of faculty members, housestaff, students, and billing experts should develop best practices and identify common problems.”
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They encourage all stakeholders to monitor the quality of life and workloads of teaching physicians, residents, and students and aim to maintain the balance between teaching the writing of clinical notes and teaching the provision of quality clinical care.
“I suspect that it will take some time for academic medical centers and their partners to figure out how to try to implement this (revision) and then for strategies to arise to address any of the concerns we have raised,” Dr. Cassese said. “Physicians will be responsible for implementation and assessment of this change at the ground level. This means that physicians have to understand the change in regulation, feel comfortable assessing student notes in a novel way (for billing purposes), and then trust in the CMS process to submit their billing after attesting to a student note.”
“Many academic health centers have put together committees or ad hoc working groups to create local implementation policies and work flows and then other groups to help get the word out,” he said. “I have no doubt that a physician interested in helping with this effort would likely be a welcomed addition to such a committee or ad hoc working group.”
- Cassese T, Sharkey MS, Pincavage AT, et al. Avoiding pitfalls while implementing new guidelines on student documentation. Ann Intern Med. 2019 Jan 15. [Epub ahead of print]