A Unique SCRIBING Model: The COMET Fellowship for College Graduates

Steven Lin, MD, has the help of scribe Kevin Lee (left) during a patient encounter. 

Like many of her recent college graduate peers, Cat Carragee was unsure how to get from here to there. There was a job in the health professions, perhaps as a doctor, but here wasn’t where she needed to be.

Here was work she was doing as a scribe in the emergency department at O’Connor Hospital in San Jose, California, for minimum wage. While she was getting some exposure to clinical medicine, she wasn’t really learning clinical medicine. “As a scribe I was there to help the doctors,” she says. “Any clinical learning was just a sideline.” She also knew that she needed research experience to strengthen an application to medical school, but to get such a job would require years of experience including work in the field.

Then a friend told her about COMET, and her life changed.

COMET (Clinical Observation and Medical Transcription Fellowship) is the brainchild of Steven Lin, MD, a clinical assistant professor of primary care and population health, who proposed a scribe service model with a twist.

Lin was interested in scribing after seeing his colleagues burn out from what he describes as “an explosion of administrative work being put on the shoulders of primary care physicians, plus frustration with the inefficiencies of electronic health record [EHR] systems like EPIC.”

But he also knew that many scribes are interested in a health career, perhaps as physician assistants, doctors, or nurse practitioners. He thought that having a longitudinal relationship with one or more providers would be valuable in the eyes of admissions committees, as would “opportunities to stand out and get experience.”

Scribing, he thought, “was an obvious place to go to, but I wanted to do it in a way that was a win-win-win scenario. Could we provide an experience that would benefit the scribes so they could go on to achieve their dreams of working in the health profession?” At the same time, could this model “be of tangible help to our primary care physicians, be meaningful, and decrease their work responsibilities in terms of charting and the EHR so they could spend more time with their families?”

Lin further describes COMET: “That’s how the post-baccalaureate scribe fellowship came about. In our unique model a mentoring relationship is central. We’re committed to the scribes and their education. They work with one to three physicians for an entire year. These are faculty members who mentor them, teach them at the bedside, do scholarly research projects with them that scribes then present at national conferences. We write recommendation letters for them and mentor them on their applications and their career development. It’s been a really good experience for both our scribes and our providers.”

Carragee could not agree more. After being one of the two pilot COMET fellows in 2015, she spent an additional year as chief scribe, orienting and supporting the incoming class of six fellows and finding ways to expand COMET to more clinics. She’s finished with that now, though; in September 2017 she started medical school at University College Dublin. She has reached her there.

As for the providers, Lin reports that “the scribes relieve the documentation burden. They increase our physicians’ ability to complete their charts on schedule. They can go home on time and have weekends free with family. It’s really been a great benefit to them.”