Advice for aspiring scribes

I’ve written about Scribes before, and I love ’em all.

I got an interesting email today that got me recommending my usual lament, that scribes “don’t get it” until they get ‘the buffer’, which I described as such:

[T]he one skill that makes a good scribe is a 2 to 3 sentence
brain buffer. That means, the ability to save in your head 2 or 3
whole sentences, then play it back to write down or act on.

Nearly everyone who starts wants to act on the first 6 words, starts
doing, and loses all that follows the first little bit.

So, there’s your key. Watch tv, listen to 3 sentences, mute the tv and
write them out. A little practice goes a long way.

I base this on watching 8 years of scribes train, progress, and move on, and my own personal experience as a medical student.

Repeat yourself enough as a practicing EM doc using scribes, and you notice when scribes ‘get it’, get that ability to hear everything you say and incorporate that into the record.  And it’s the buffer that does it.

When I was in Med School I got that buffer, a life skill that serves me well to this day.  We didn’t have a note service, or copies of the profs’ PowerPoints, we had paper, pens, and what we wrote down from the lecture.  I wrote a lot, and fear of failure will stimulate the brain.

At my MS2 peak I had about a 5 sentence buffer, and I and my row-mates would be writing long after the lecture ended.

This ability to hear things and keep them in brain-RAM drove my then-new wife nuts; I could watch TV and ‘hear’ her, but when she would say “You didn’t hear a thing I said, did you…” I could very easily repeat her last sentence or two and answer her question.  I still have some of it, though atrophy hits everything not exercised…

So, learn to listen, not just hear: there’s your key.


  1. nurse1961 says:

    Develop your own shorthand, especially if the professor is one that rarely takes a breath between sentences. Saved me many a time, and also made some money on the side selling my notes. More than one person passed pathophysiology on my notes.

  2. MYScribe says:

    Having trained 100% of the last 3 months- I think this is a GREAT point and one that I will DEFINITELY consider in the last few weeks of my career teaching scribes. Can’t wait to see you in a little over a week, GruntDoc! Miss the home ED, but happy to be where I am. Cheers!

  3. TxTechMSIV says:

    I get that “you weren’t listening” speech all the time! The training really does serve a life long purpose (Drives her crazy too when I repeat it verbatim). Plus the whole experience lets you almost skip over learning the whole “reporter” mentality and go straight into “interpreter/manager”. At least it did for me.

  4. As a scribe-trainer in my ED group, I absolutely LOVE this advice Allen!. Can’t wait to put it to use.
    The other thing i use a LOT for my new scrubbies as I call them-to focus on the five document points for billing and forget the rest until the doc tells them to write down this, leave out that…So for say a painful condition-where is the pain, when it started, waxing waning constant, severity, exacerbating/alleviating factor and previous history of same. The best scribes can pick that out of the worst historian. For complicated medical stuff, I usually have a hand signal to not write hx until after I am done talking to the patient-that is usually evident to me in the first 20-30 seconds of history taking.