NEWS BLOG
Engaging Remote Learners: Student Persistence
How can we improve students’ persistence & retention? We can improve students’ persistence in schools and colleges by analyzing the factors that cause students to start missing assignment-deadlines. And, more importantly, by providing quick, just-in-time, proactive support before the problem worsens.
Overall, graduation and retention issues can stem from several different factors. These factors include lack of adequate academic preparation; personal problems; work-study scheduling; and financial challenges, among many other issues. Below, I discuss some sample issues and practical solutions for online, remote learners, as well as for the student population in general.
Nowadays, most schools use Learning Management Systems (LMS) to support most, if not all, of their course offerings. Even if these courses are taught fully on-campus or in hybrid, blended or flipped (i.e., where students study and engage with the online instructional resources and then attend real-life on-campus sessions to work on individual or, better yet, collaborative activities to deepen the students’ understanding of the content).
One online solution could consist in tracking, identifying and implementing more opportunities for students at-risk of dropping out—including proactive online mentoring and tutoring---based on real-time data derived from the LMS and predictive analytics. These LMS systems record and track every single student outcome, quiz, exams, project and forum discussion. So, faculty can easily identify students that might be struggling in their classes by simply displaying their electronic grade book on the LMS. When they discover anomalies, they can generate an electronic message alerting the student of missing assignments or projects. The first author has used this technique with great results. And, surprisingly, the students in the class have provided evidence that they appreciate the early intervention (within the allowed ethical, privacy, security framework provided by the systems’ tools).
Issues and Solutions for Preventing Dropouts
Academic Preparation
Financial Resources
Work-Study Balance
Problem
Inadequate preparation for the rigor of college, either due to poor high school education or difficulties adjusting to the college workload.
Students and their families may not be able to afford to pay for tuition and books.
Many students are unable to regulate and balance work, life, fun, and study into their schedules. Students may not possess basic time-management skills or are simply working long hours (part-time or even full-time.)
Solution
Offer online tutoring- mentoring (provided by work-study students or retirees); create and offer personalized, and alternative assignments; require to complete prerequisites before each difficult assignment; and offer online/mobile prep learning opportunities for students that may be identified as at-risk.
Increase financial assistance and initiate micro-financing accessible to students from low income families or provide mini-scholarships for work-study students.
Provide online/mobile time management tools and just-in-time tutorials. Also, an interactive application that can assist students manage their time more effectively.
Track and intervene, based on timely data about the students’ progress, performance and outcomes.
Currently, many institutions with low-retention rates do not offer online tutoring and mentoring services for at-risk students, while they might already be providing mentorship programs for athletes and honor students. That is, not all students have access to or are aware of opportunities to have an online mentor. Online tutoring and mentoring can lead to a better feeling of belonging for students. In a study performed by Colvin and Ashman (2010), it was found that peer mentoring was a successful way to make students feel a sense of belonging (Colvin & Ashman, 2010). Peer mentoring was determined to be a motivating factor for students to stay and succeed at a university. In addition, tutoring is an excellent way for students to seek out help from other students who have already taken courses. Having a peer tutor helps students understand topics explained at their level. Both online peer mentoring and tutoring may be delivered cost-free (or minimal cost), as the tutors and mentors might already be compensated with service learning hours, for instance. And more work-study students might be able to participate from anywhere, anytime (even on weekends and evenings).
Whenever possible, university foundations may also help to implement further scholarships and financial assistance for students that are struggling to meet tuition rates. Many schools offer scholarships to students who excel in academics even when those students are less likely to drop out. But students who are struggling academically pose the larger impact on retention and graduation rates. Providing micro-financing tools for tuition payments and textbooks might be developed by partnering with private corporations or non-governmental organizations.
For those students who struggle with academics, the online mentors/tutors previously mentioned could help them submit applications for assistantships. Financial aid is already offered for students who cannot afford college by the university and by the state. Universities should simply make students more aware of the aid that is available and consider partnering with private companies to provide micro-financing when students are unable to qualify for current aid. More importantly, faculty could choose to utilize more open-source content. Rather than requiring expensive textbooks, professors can use online open-source textbooks and instructional materials. This would save students hundreds of dollars per semester and lead to overall improved student persistence and well-being.
TRIO (2018) Student Support Services is a federal outreach program designed to identify and provide services for individuals from disadvantaged backgrounds and offers many services including academic and career advising, tutoring, peer coaching, workshops, summer bridge programs, and computer lab to name a few. When students are accepted at a university as their college of choice, they receive an email from TRIO SSS stating that they could apply for the program. To be a part of TRIO SSS and use their service one has to either be a first-generation college student, be considered to have low income or have a disability. TRIO student support services include financial literacy, and financial workshops and some students receive a scholarship. The required advising meetings are personal, and the advisors are all equipped with knowledge of the university and are able to answer any questions. Further, they keep notes of the students on the computers and have access to the students’ grades.
Since TRIO SSS is federally funded program, statistics are gathered often, and a report showing the completion rate for student support service participants seeking bachelor’s degrees who were full-time, first-time first-year students at four-year institutions went from 42 percent to 51 percent (Ginder et al. 2015). This increase may not seem significant but TRIO SSS supported 103,691 students at four-year institutions and 101,065 students at two-year institutions, and the fact that these students even through adversity are able to graduate is excellent. With further studies in the program, there should be advancements in continuing to increase the percentage of graduates. Could a similar program be implemented online for all at-risk students?
With adequate funding, a similar program could be implemented online. But the school would have to find an automated way to identify students that fall into the at-risk category (i.e., the danger of potentially dropping out). Fortunately, as mentioned earlier, universities are already using big data and predictive analytics to analyze large amounts of data from former students’ records in order to identify those current students, many from low-income families, who seemed most likely to drop out of school. Although not a simple project, this could be implemented at scale by developing a machine-learning/deep-learning algorithm developed for this purpose. Of course, academic counselors might need to be retrained in order to evaluate their students and implement interventions. Proactive counselor meetings should be required every semester so that the students’ well-being is evaluated in addition to their curriculum pathway.
Of course, the new system would require personnel changes across the university. Since each department at the university may be affected by the others throughout the process, clear communication between stakeholders is essential. As shown in Figure 2, whoever makes executive decisions, usually, the President, Provost or Vice-President for Enrollment Management would have to initiate a restructuring or process re-engineering or develop the new system. Then the appropriate software would need to be developed or procured followed by extensive training. The software would be a large initial outlay of funds. But the cost may be recouped by the resulting increase the graduation rates since many schools are receiving performance-based funding.
Walter Rodriguez, PhD, PE
Faculty of Record and Founding Director
Coursewell.com
walter@coursewell.com
* Based on: Rodriguez, W., Bass, T., Souza, D., Lynch, J., Lystad, M., White, A. (2019). Ubiquitous Learning: Improving Persistence via Student-Support Applications. Ubiquitous Learning: An International Journal, 12(3), 19-39.
Additional Sources:
Adobe XD. 2018. “XD Video.” September 8. https://www.adobe.com/products/xd.html#hero-featured-video
Beckmann, E. A. 2010. “Learners on the move: Mobile modalities in development studies.” Distance Education, 31(2): 159–173.
Benson, V., and Morgan, S. 2013. “Student experience and ubiquitous learning in higher education: impact of wireless and cloud applications.” Creative Education, 4 (8a): 1–5.
Bland, T. 2016. “FGCU’s Graduation Falls, Board Disappointed.” The News-Press. April 19. https://www.news-press.com/story/news/education/2016/04/18/fgcus-graduation-rate-falls-board-disappointed/83082730/
Boden, G. T. 2012. “Retention and graduation rates: Insights from an extended longitudinal view.” Journal of College Student Retention, 13(2): 179–203. http://ezproxy.fgcu.edu/login?url=https://search.proquest.com/docview/885727626?accountid=10919
Committee on Institutional Cooperation (CIC). 2013. “CIC Online Learning Collaboration: A Vision and Framework.” Champaign, Illinois 61820. http://www.cic.net
Chen, Rong. 2012. “Institutional Characteristics and College Student Dropout Risks: A Multilevel Event History Analysis.” Research in Higher Education 53(5): 487–505. Doi: http://dx.doi.org/10.1007/s11162-011-9241-4
Chronicle of Higher Education. 2018. “The Future of Learning: How Colleges Can Transform the Educational Experience.” https://store.chronicle.com/products/the-future-of-learning-how-colleges-can-transform-the-educational-experience
College Factual. 2018. “Florida Gulf Coast University Graduation & Retention.” March 18. https://www.collegefactual.com/colleges/florida-gulf-coast-university/academic-life/graduation-and-retention/#chart-graduation-rate-first-full
Colvin, J., and Ashman, M. 2010. Roles, Risks, and Benefits of Peer Mentoring Relationships in Higher Education. Mentoring & Tutoring: Partnership in Learning, 18(2): 121–134. DOI: 10.1080/13611261003678879
DeNicco, J., Fogg, N., and Harrington, P. 2014. "Factors of One-Year College Retention in a Public State College System." Center for Civic Innovation. December 31. https://eric.ed.gov/?id=EJ1056244.
Faas, C., Benson, M.J., Kaestle, C.E., and Savla, J. 2017. “Socioeconomic
Success and Mental Health Profiles of Young Adults Who Drop out of College.” Journal of Youth Studies 21(5): 669–86. doi:10.1080/13676261.2017.1406598.
Fozdar BI, and Kumar LS. 2017. Mobile learning and student retention. International Review of Research in Open and Distance Learning. 8(2):1–8.
Ginder, S.A., Kelly-Reid, J.E., and Mann, F.B. 2015. “Graduation Rates for
Selected Cohorts, 2006–11; Student Financial Aid, Academic Year 2013-14; and Admissions in Postsecondary Institutions, Fall 2014.” https://nces.ed.gov/pubs2015/2015181.pdf
Haynie, D. 2015. “Experts Debate Graduation Rates for Online Students.” https://www.usnews.com/education/online-education/articles/2015/01/30/experts-debate-graduation-rates-for-online-students
Herrera, S. G., Morales, A. R., Holmes, M. A., and Dawn, H. T. 2012. “From remediation to acceleration: Recruiting, retaining, and graduating future culturally and linguistically diverse (CLD) educators.” Journal of College Student Retention. 13(2): 229–250. http://ezproxy.fgcu.edu/login?url=https://search.proquest.com/docview/885727470?accountid=10919
Himma, K. E. 2007. “Foundational Issues in Information Ethics.” Library Hi Tech 25 (1): 79–94. http://dx.doi.org/10.1108/07378830710735876
July Rapid. 2016. “Front End vs. Back End Mobile App Development: Learn What You Need to Know in 5 Minutes.” November 08. https://julyrapid.com/front-end-vs-back-end-mobile-app-development-learn-what-you-need-to-know-in-5-minutes/.
Kazmucha, A. 2014. “Best calendar apps for iPhone.” https://www.imore.com/best-calendar-apps-iphone-2014
Lenz, A. S. 2014. “Mediating Effects of Relationships with Mentors on College Adjustment.” Journal of College Counseling 17 (3): 195–207. doi:10.1002/j.2161-1882.2014.00057.x.
Mashburn, A.J. 2001. “A Psychological Process of College Student Dropout.” Journal of College Student Retention 2(3): 173–190. http://ezproxy.fgcu.edu/login?url=https://search.proquest.com/docview/196728231?accountid=10919
McMurtrie, B. 2018. “The Future of Learning: How Colleges Can Transform the Educational Experience.” Chronicle of Higher Education. https://www.chronicle.com/
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Pechenkina, E., Laurence, D., Oates, G., Eldridge, D., and Hunter, D. 2017. “Using a gamified mobile app to increase student engagement, retention and academic achievement.” International Journal of Educational Technology in Higher Education 14(1):31.
Rodriguez, W. E., Huynh, N. N., Fernandez, A., Royal, J., and Fernandez, V. 2015. “Developing a Mobile Learning Environment: An Axiomatic Approach.” Journal of International Technology and Information Management 23(3/4):45–60.
Savvy Apps. 2018. “How Much Does an App Cost: A Massive Review of Pricing and Other Budget Considerations.” https://savvyapps.com/blog/how-much-does-app-cost-massive-review-pricing-budget-considerations
Schwartz, A., Peterson, D., Rodriguez, W. 2017. “Investigating the Effectiveness of Ubiquitous Learning Environments.” Ubiquitous Learning 9(4): 55–71.
Stevenson, J.M., Buchanan, D.A. and Sharpe A. 2007. “Commentary: The Pivotal Role of the Faculty in Propelling Student Persistence and Progress Toward Degree Completion.” Journal of College Student Retention 8(2): 141–148.
Smith, B., & Bland, T. 2017. “FGCU president says better ‘amenities’ for students may help grad rate. News-Press. https://www.news-press.com/story/news/2017/10/18/state-sen-lizbeth-benacquisto-grills-fgcu-over-dismal-grad-rate/777077001/
Talaviya, G., Ramtekte, R., and Shete, A.K. 2013. Wireless Fingerprint Based College Attendance System Using Zigbee Technology. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.673.9548&rep=rep1&type=pdf
TRIO. 2018. “Fast Facts Report for the Student Support Services Program.” Fast Facts Report for the Student Support. https://www2.ed.gov/programs/triostudsupp/sss-fastfacts2016.pdf
The Condition of Education. 2018. https://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2018144
Van Stolk, C., Tiessen, J., Clift, J., and Levitt, R. 2007. “Student Retention in Higher Education Courses: International Comparison.” https://www.rand.org/content/dam/rand/pubs/technical_reports/2007/RAND_TR482.pdf
Wischusen, S. M., Wischusen, E. W., and Pomarico, S. M. 2011. “Impact of a short pre-freshman program on retention.” Journal of College Student Retention 12(4): 429–441.
Woods, C. S., Park, T., g Hu, S. and Jones, T.B. 2018. “How High School Coursework Predicts Introductory College-Level Course Success.” Community College Review 46 (2): 176–96. doi:10.1177/0091552118759419.
Walkington, Candace A. 2013. “Using Adaptive Learning Technologies to Personalize Instruction to Students Interest: The Impact of Relevant Contexts on Performance and Learning Outcomes.” http://psycnet.apa.org/record/2013-31544-001
7 Career Skills You Need to Succeed, in Times of Disruption. And How to Develop Those Career Skills.
by Walter Rodriguez, PhD, PE
Admittedly, for the last five decades, I have been studying self-help books --- as a way to improve both myself and my teaching and entrepreneurship career. In reading those books, I have learned "critical success factors (CSF) and Key Performance Indicators (KPI)" as well as the career skills necessary to succeed in both life and business.
From teaching and interacting with students at a 2-year public community college early in my career; to teaching and research at top graduate schools for several decades, I have learned seven (7) key career skills we need in order to succeed in the information-age. Better yet, I also learned how to develop and teach those critical skills to my students. Below are the 7 key career skill that are essential to our success:
1. Confidence - According to Dr. Ivan Joseph, confidence (or rather, self-confidence) is "the ability to believe in yourself to accomplish any task, no matter the odds, no matter the difficulties, no matter the adversity." Fortunately, self-confidence is a "learn-able" skill. You may develop confidence through consistent participation in sports or hobbies or anything you can become good at or passionate about to persist despite challenges. Reason: Building confidence takes "repetition, repetition, repetition." For instance, if you like to learn how to shoot a 3-pointer, you practice consistently using the 3-point technique. [This is related to what Malcolm Gladwell's calls the "10,000-hour" rule --- which we will discuss in Skill # 7 below).]
2. Collaboration is the ability to "work together to a common purpose to achieve business benefit." Anya Kamentez's "How to Raise a Brilliant Child, According to Science" states that "collaboration is everything from getting along with others to controlling your impulses so you can get along and not kick someone else off the swing." Yes, she is referring to kids, but haven't you observed and become frustrated by adults or coworkers or friends behaving a similar manner? I have experienced this at all levels during my long career (but I better stop there before I get in trouble.)
3. Communication includes exchanging data, information, knowledge and wisdom in both verbal and visual form. In the information age, learning how to use productivity office software (spreadsheet and presentation tools) is almost as relevant as: speaking, writing, reading and, more importantly, listening. In fact, listening is an absolutely essential ability to building long-lasting relationships, as further discussed in Skill # 6 below.
4. Systems Thinking (and critical thinking) involves the use of framework and models. This requires a full blog article. But, the video below is a great start!
5. Creative Innovation is absolutely essential to our career growth and development. It is not "the left-brain/right-brain binary that we've come to believe."Fortunately, creative innovation can be learned, since it's essentially a process. It's about being willing to explore tens or hundred or thousands of ideas that may ultimately fail. It involves being willing to seek solutions, after having failed and failed until you find a working idea.
6. Reading peoples's emotions is a key to enduring relationships and successful negotiations, according to Roger Fisher and Daniel Shapiro ["Beyond Reason: Using Emotions as You Negotiate"]. For instance, "expressing appreciation," that is, finding and showing value in what others say, "think, feel, or do" is a powerful tool. If you meet what seem to be a seemingly stressed-out colleague, ask: What do you think your colleague is thinking? Is it better to leave him alone, or ask him/her if everything is okay? or try to identify what worries him or her, based on what you know about this person and his/her family? How do you think they feel, and will it be better to wait and comeback later?
7. Specialty Content Knowledge - The last (but essential) career skill is the specialty content knowledge; that is, being an expert in your selected career. According to Malcolm Gladwell, it takes "10,000 hours of practice to achieve mastery in a field."Surprisingly, "natural talent" is not as important--and that's good news for the rest of us. Content knowledge building on the other six skills. Initially, when you start learning a difficult or tedious subject, you/we may feel inclined to abandon. But, ask yourself: How come many other folks in this field really like it. The answer is that they persisted until they became comfortable with the subject and finally love it. A career is like marriage or long-term friendships, you have to be patient and work at it every day, persistently.
Job Preparation and Certification Training Programs Deliver Good Jobs
The Christian Science Monitor (Shekhtman, L., 2016) indicates that "a growing body of evidence is showing promising career results for people who train in moderately technical skills that employers in manufacturing, IT, and healthcare say they desperately need."
Job preparation and career certification training in computer, technical and business skills, particularly, in IT and healthcare is an efficient and effective way to get ready for a good job. Reason: There are not enough technically-skilled workers to fill the many jobs available in the marketplace.
That’s why about half of the states are sponsoring training programs that bridge the knowledge and skills gaps in the local labor markets. This approach is gaining popularity at the regional, national and state level. But these programs are very expensive and cumbersome to manage.
In response to the skill-gap need, Florida Gulf Coast University’s Institute for Technological Innovation has developed a low-cost ($100/year) job preparation and career certification program in partnership with business and industry. This program provides online computer, technical and business skills training and may be viewed on a mobile device or computer from anywhere, anytime. The objective is to reach as many students and other community participants as possible by providing accessible and inexpensive training--including video lessons and self-assessments.
References
ASEE (2016). “ED Announces Pilot Allowing Financial Aid to Innovative Coursework Partnerships.” American Society for Engineering Education. Retrieved August 17, 2016.
Shekhtman, L., (2016). "Training programs promise good jobs without college degrees. Can they deliver?" Christian Science Monitor. Retrieved August 16, 2016.
"Job Training Works." But Can It Also Help Retain At-Risk Students?
A recent article in the New York Times titled "Job Training Works. So Why Not Do More?" applauds the success of in-demand career certification training programs, such as Information Technology certification in computers and networking (i.e., CompTIA A+ and Network+), among several others.
The article focuses on the merits of a "Women in Technology" job-training program sponsored by a non-profit organization in New York. The success of job-training programs has been further replicated and validated by WorkAdvance --where a variety of organizations created experimental in-demand training programs spanning from IT to healthcare. This real-life "experiment" demonstrated that job-training participants were able to increase earnings. Further, many participants felt very hopeful about their career path and future earning potential.
So, Job Training Works. But, as the article asks: why not do more?
Job or career training has also been used very effectively to retain employees in their current jobs or to promote employees within their firm. Employees value these types of on-the-job-training as much as their salary & benefits. And employers value the industry-based certification training credentials that participants obtain. So, everyone wins.
But, now, can career training programs also help retain and persistently engage students? In my experience leading and offering in-demand career training, sponsored by the Department of Defense, National Science Foundation and private foundations, I have witness how these types of job-related, practical training, can improve student retention---even when these extracurricular programs are not generally being regarded as a genuine academic pursuit for faculty.
During the last twenty years, I/we have been incorporating practical training exercises in my online business courses at Florida Gulf Coast University (from CompTIA A+ and Excel training to e-commerce and webpage development exercises) with great success. Essentially, close to 100% of the participants and students have passed our courses with at least a C+ average and the general class average has been around B+.
I believe it's time to try this practical approach with the general student population, particularly with at-risk students (or courses, where their is a high dropout rate.) In general, I have found that we can retain students by using the following strategies:
- Use engaging activities and exercises that mimic real-life (and involve their peers)
- Focus on in-demand courses and programs related to what (at-risk) students do well
- Provide pre-tests for the content or knowledge area to be discussed as well as tests and post-tests, after students have reviewed the materials and obtained feedback, respectively
- Monitor students' progress using technology (such as, Learning Management Systems' analytics)
- As the system analyzes and uncovers a problem (i.e., missing tests or low performance), seek early intervention (i.e., what's up?; why did you missed the pre-test?)
- Provide in-demand practical skills that at-risk students feel they can use to find a future job and improve their financial situation. Relevance is key!
- Implement individualized, self-paced career training experiences and programs in the student's area of interest.
- If a student is going to drop (or it's being forced to withdraw for a semester or year, due to low grades), provide an alternative short career path, for instance, a one-semester career certification training program. It's a very practical and inexpensive way to keep at-risk students engaged and hopeful about their futures!
Medical Administration & IT Careers: Health Informatics Training
Contact: Walter Rodriguez, PhD, PE at wrodrigz@fgcu.edu
Target Audience: Healthcare and administration professionals looking to understand health care information systems.
Tuition: $4000
Financial Assistance: Funding for this program would come directly from participants through tuition. Check if your employer is offering tuition assistance to employees interested in this training.
Duration: 16 Weeks
Online, Self-Paced Modules:
Module 1: Understanding EMR/HER; AHIMA focus geared specifically toward electronic medical records and technology; Health Information Management (HIM) practices being replaced by technology.
Module 2: Understanding the interdependency of Revenue Cycle Informatics on Clinical Informatics and Clinical Care.
Module 3: Differences between Health Informatics requirements for the Hospital, Outpatient, and Ambulatory (Physician Office) settings.
Module 4: Considering deployment methods; HIM/HIS practically applied in the LMHS work environment.
Module 5: Healthcare IT (EHR, single sign-on, meaningful use, PCMH, joint commission, CPOE)
Module 6: Key Topics and Assignments from the textbook below.
Textbook:
Wager, K.A., Health Care Information Systems: A Practical Approach for Health Care Management 3rd Edition. Participants will directly purchase or rent the textbook at http://www.amazon.com/Health-Care-Information-Systems-Management/dp/1118173538/ref=pd_sim_14_6?ie=UTF8&dpID=51AkSEdY4JL&dpSrc=sims&preST=_AC_UL160_SR130%2C160_&refRID=1GYQVR9HSVM33GNAZ9TA
Medical Administration Careers: Medical Scribes Can Learn About Sepsis and SIRS by Watching Videos and Discussing Scenarios
Medical Scribes can learn medical terminology and familiarize themselves with medical procedures by watching videos and discussing scenarios like the one below.
By Walter Rodriguez, PhD and Valerie Weiss, MD
“Sepsis and SIRS are severe conditions that require interventions to counteract. If not treated properly, then multiple organ dysfunction syndrome (MODS) and death may occur.””
Lesson: What is Sepsis? Sepsis is the presence in tissues of harmful bacteria and their toxins, typically through infection of a wound (Ref. https://vimeo.com/129916157). Check also: SIRS
Scenario
Pedro Ramirez is a 67-year old retired veteran who had a routine prostate biopsy in an outpatient hospital facility on Thursday. He was released in the late afternoon and went home with his wife, Gladys. Pedro had a heavy dinner and watched TV with Gladys in their family room. Pedro complained of feeling “crummy” but nothing that a little rest couldn’t fix. Gladys went to bed at 9:30 p.m. leaving him alone. When she awoke at 6:00 a.m. on Friday, and he wasn’t in bed beside her, she went downstairs and found him lying on the family room floor. He was extremely drowsy, shivering, and had urinated on himself.
Gladys called 911. The local EMS arrived and asked his wife what happened. She told them about the prostate biopsy, and that he was fine before she went to bed. She reported that Pedro had taken pre-operative antibiotics, but she didn’t know the name of the antibiotic or dosage. She wasn’t sure which medications he took regularly, as there were many bottles on his dresser.
“Post-operative infection is a broad term which applies to several types of infections a patient can experience as a consequence of undergoing surgery.””
Symptoms of Sepsis
Pedro was drifting in and out of consciousness and was only able to answer the question pertaining to his name. He was taken by ambulance to the local hospital (different than the hospital affiliated with the outpatient facility). The EMS professionals told Gladys to get dressed and meet them at the hospital. Once in the ER, the attending nurse tried to get some pertinent information from Pedro. Unfortunately, all he recalled was his biopsy. Pedro’s vital signs showed:
Temperature of 102.5 degrees F
Blood pressure 88/68 mmHg
Pulse of 122 beats per minute
Respiration rate of 32 breaths per minute
His blood pressure was dropping--he was going into shock.
Coordination of care
Gladys arrived and was told that her husband would be fine; she did not need to worry. However, she was unable to provide any more insight or a list of his meds. She did not know his baseline vital signs. It was Pedro’s first ER experience in this hospital so he had no prior records on file. The ER doctors determined he was in septic shock and once stabilized would be moved to a critical care unit for recovery. Once stabilized, Pedro was able to provide a list of his meds to the nurses. The hospitalist came to see Pedro who said he would contact his primary care physician (PCP) to provide an update. During the next two days (the weekend), numerous tests were administered to Pedro to test for the function of his heart, kidney, liver, etc.
The hospital staff was unable to gain his medical records from the outpatient facility where the prostate biopsy was performed because it was done in another hospital system. On Monday, they were considering a pacemaker because his heart rate was so low. Frustrated by all of the uncertainty, his wife Gladys called the PCP and asked why she wasn’t involved. Dr. de' Medicis, the PCP, said the hospitalist never notified her that her patient of 15 years was in the hospital. She also told Gladys that Pedro had a very low resting heart rate when well and that his current heart rate was normal! At that moment, Dr. de' Medecis (PCP) stepped in and coordinated Pedro’s care with the hospital.
Discussion Questions:
1. How would Electronic Medical Records (EMR) and Electronic Health Records (EHR) help in the above scenario?
2. How would a Medical Scribe assist the Hospitalist and/or the PCP in this scenario?
Healthcare Jobs: Understanding the Difference between Medical Scribes, Medical Transcriptionists, and Medical Billers & Coders
“A medical scribe partners with the physician to perform documentation in the electronic health record.””
By Valerie Weiss, MD
The role of a Medical Scribe
The medical scribe’s primary role is the generation and maintenance of the patient’s medical record, which is created under the supervision of the physician. The medical scribe shadows the physician and documents the patient’s story through the physician’s interaction with the patient. The scribe will also document any procedures performed and the results of any laboratory studies. Scribes document the roadmap of the patient while under the direct care of the physician. A well-written medical record will result in smoother claims processing and provides a medico-legal resource as to the care provided. Because the medical scribe’s role is clinically-focused on observing and documenting the patient’s encounter, many scribes use this invaluable experience as a stepping-stone to further their own education in the health arena.
“Medical scribes become well versed in Medical Terminology as well as Anatomy and Physiology.””
The role of a Medical Transcriptionist
In contrast, a medical transcriptionist, while also in the healthcare field, does not see the patient alongside the physician. Typically, the medical transcriptionist works in a quiet office setting removed from the workflow of seeing patients. The medical transcriptionist’s job is to listen to a physician’s voice dictation and convert that into a written report. A growing trend in medicine is for a physician to utilize voice recognition technology while dictating. The software will convert the physician’s spoken word into a written record. Often, some of the dictation is lost in translation or interpreted incorrectly by the software. A medical transcriptionist’s role, in this case, is to review and edit these medical documents.
The role of a Medical Biller
Even though medical billing and coding are often lumped together, they are actually two distinct jobs. Essentially, a medical biller is a healthcare worker who is tasked with making sure everyone is billed correctly. A medical biller may talk to patients as well as health insurance companies to make sure all invoices are paid correctly and in a timely manner. A medical biller needs to understand coding language and how to read medical invoices.
The role of a Medical Coder
In contrast to a medical biller, a medical coder, does not have communication with the patient or insurance company. The medical coder spends time assessing the medical chart to make sure it is coded with the correct medical codes. Coders must be accurate. Medical coders employ the International Classification of Diseases or ICD. The World Health Organization periodically upgrades the ICD. The current model being used is ICD-10.
Medical Administration Careers: Medical Scribes Understand the 3 Hidden Benefits of Electronic Medical Records for Enhancing the Healthcare of Patients
“Research suggests the importance of accurate and timely patient information to ensure proper care from a quality and safety perspective.” (Broekhuis & van Donk 2011) ”
By W. Rodriguez, PhD [Extracted from: Carstens, D.S., Rodriguez, W. and Wood, M.B. (2014) ‘Task and error analysis balancing benefits over business of electronic medical records’, Int. J. Electronic Healthcare, Vol. 7, No. 4, pp.331–348. The paper was co-authored with Drs. Carstens (FIT) and Wood (Mayo Clinic).]
Background: Amazingly, healthcare spending represents 18% of the U.S. gross domestic product (GDP), and is projected to be 20% by 2020 (Seiden 2012)! And while Information technology (IT) is widely used in everyday life, it is estimated that only 8% of the 5000 hospitals and 17% of the 800,000 physicians in the U.S. use an EMR (Electronic Medical Record) system (Goldman, 2009). Based on a national survey of physicians in 2008, only 4% had a fully functioning EMR and only 13% had a basic system (Mallon, 2009). It is curious that healthcare information technology systems haven’t seen enthusiastic and widespread adoption in an industry, that is, as information and data intensive as healthcare.
Reason: Physicians and hospital administrators simple do not have the time to analyze and implement EMRs in practice. Further, healthcare systems may appear complex and not easily understood at first glance (Mehrjerdi 2013).
Fortunately, Medical Scribes can serve as the link between physicians and this seemingly complex EMR software technology. Medical Scribes can help physicians during the EMR implementation (transition) and beyond.
A study performed by Chircu, Gogan, Boss and Baxter (2013) suggest that during transition times, 40 percent of medication errors, 20 percent of which cause harm, occur from staff miscommunication. Well-trained Medical Scribes can assist physicians reduced medical errors by communicating effectively and recording the physician directions and allowing them to focus on the patient rather than on the technology.
Decrease medical errors: Despite the above challenges, research suggests the importance of accurate and timely patient information to ensure proper care from a quality and safety perspective (Broekhuis & van Donk 2011). Studies provide data that Computerized Physician Order Entry (CPOE) which is another aspect of EMRs enhances patient safety by decreasing medical errors (Krohn 2003). CPOE eliminates illegible orders and most notably the names of drugs, dosages, dosing units, and administration frequency and routes. When associated with decision support function (DSS), alerts for allergies, drug interactions or inappropriate dosing occur in real-time. CPOE with DSS can provide alerts for duplicate tests or inappropriate tests based on a patient’s diagnosis or portfolio of existing test results. Brigham and Women’s Hospital in Boston implementation of a CPOE led to an 81% decline in medical errors, mainly related to decreasing adverse drug events and duplication (Krohn 2003). New York’s Montefiore Medical Center had a 50% decrease in prescribing errors and a 60% improvement in delays between prescription writing and medication administration. Clinical Documentation is another key module of an EMR as it can be designed to permit access to authorized providers involved in the patient’s care useful as a tool for integrating care between multiple different physicians, nurses, therapists and others to include record sharing.
Reduce Cost and Duplication: Cost barriers remain a hurdle associated with EMRs although HIS (Health Information Systems) will decrease global healthcare costs through minimizing duplication, enhancing appropriate test and therapy selection, improving care continuity, integration of services and decreasing avoidable medical errors and accidents (Schmitt et al. 2002; Poon et al. 2004). The difficulty is that patients and payers receive benefits yet the providers of care (doctors and hospitals) are responsible for costs making the “business case” for HIS challenging. Established ROI methodology specifically for IT has been difficult to apply to HIT because of difficulty labeling the benefits with financial metrics but reports suggest EMR improves revenues and reduces costs (Cresswell 2004; Menachemi et al. 2006; Mildon et al. 2001). David Brailer, former National Coordinator for HIT in the Bush administration suggested that a computerized health record system could save $200-300 Billion/year across the U.S. healthcare sector (Goldman, 2009). Hillestad, et al. (2005) by extrapolating the impact of IT from other industries estimated potential national savings of $81 Billion/year by full implementation of an HIT.
Wang, et al. (2003) studied a primary care physician practice that reported an annual financial benefit over a five year period of $86,500 per physician due to cost savings from decreased drug costs and x-ray utilization. Barlow, et al. (2004) reported over five years a cost savings of $140,000/physician due to decreased costs related to transcription, paper chart management and reimbursement recovery. Schmitt, et al. (2002) estimated that the installation and support costs over seven years were $19 Million without quantifying the temporary decrease in physician productivity. By year three, the financial saving exceeded the cost to date, and by year seven, there was an annual savings of $7.5 Million/year related to decreased time processing orders, decreased drug costs and costs due to adverse drug events, transcription costs, chart management costs and increased charge recapture.
California Health care Foundation studied the economic benefit of a fully deployed EMR, and reported a payback period of 2.5 years and thereafter an average gain of $23,000/year/physician despite a decline in productivity initially (Goodman, 2009). Kaushal, et al. (2006) suggested in a hospital setting that ten years of spending $11.8 Million resulted in a savings of $28.5 Million for a net 10 year benefit of $16.7 Million due to drug cost savings, nursing time and the avoidance of adverse drug events. Poon, et al. (2004) reported a net operating benefit by seven years following implementation. Kuperman and Gibson (2002) reviewed reports on the value of CPOE and concluded that it reduces costs but ROI analysis is challenging because baseline costs of key processes are difficult to calculate and several benefits cannot be measured financially. Frisse (2006) suggests that financial ROI analysis of CPOE is inappropriate because “the ROI is measured in safer and more effective medical care.”
Improve Quality of Care: Carroll (2004) suggests that the EMR financial return to a doctor’s practice is lacking. Hamilton (2008) suggests that although EMRs save money it doesn’t go to those that pay for it. Clear recognition of the disconnect between those incurring the cost and those reaping the benefits will be a major step for the widespread adoption of HIT in this country. Moreover, presidential leaders promote a “carrot and stick” approach to finance HIT. The “carrot” is the “HIT for Economic and Clinical Health (HITECH) Act” described by Centers for Medicare & Medicaid Services (2013) and the Congressional Budget Office (2013) which provides a $44,000/physician over a 5 year period for Medicare as an incentive for practices to implement and meet meaningful use standards. The “stick” is that physicians who don’t transition to using an EMR system will see Medicare payments reduced after 2015. Taner, Sezen & Atwat (2012) conducted research where the hospital organization successfully from a financial standpoint implemented technology due to optimizing efficiency through process and workflow improvements. Therefore, process improvement research may help an organization realize savings despite the expenses related to technology such as the EMR as it is essential to understand the operational impact electronic records as hospitals invest in information technology to lower costs and to improve quality of care (Mitchell, S. & Yaylacicegi, U. 2012).
Conclusion: Although EMR implementation is challenging, Medical Scribes can be instrumental in supporting physicians during the transition and beyond.
Medical Administration Careers: 15 Reasons Why Medical Scribes are Valued and Appreciated by Doctors
By Walter Rodriguez, PhD and Valerie Weiss, MD
More and more often, medical scribes are being recognized by physicians in all healthcare settings. Physicians are becoming more aware of the Medical Scribes' qualifications and how they can assist them in their medical practice.
Medical scribes allow for a dynamic conduit between a tangible record and a patient encounter, including the care provided. The role of the medical scribe is more than relevant because physicians are traditionally trained for direct patient care rather than for clerical work.
Below are fifteen (15) reasons why Medical Scribes are valued and appreciated by primary-care clinics, hospitals, healthcare administrators, physicians and specialists.
1. Medical scribes are able to navigate electronic medical records (EMR) with ease, while shadowing a physician. In this way, the physician can focus on the patient, rather than on a computer screen.
The scribe is able to record the physician’s interaction with the patient, including all of the following: physical exam findings, medical decision-making, laboratory results, radiological reports, clinical re-evaluations, consultations, and dispositions. Medical scribes are given unique logins and passwords.
2. Scribes are intimately familiar with HIPAA regulations. In this way, they can maintain the patient's privacy and the institution's security. The federal Health Insurance Portability and Accountability Act was passed in 1996 with a primary goal is "to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs."
3. Scribes understand the flow of information and the function of the various medical departments in a variety of healthcare settings. i.e., hospitals -- including ED (emergency department) or ER (emergency room).
Scribes are being employed in many arenas of the healthcare field including primary care clinics, hospitals -- including the ED (emergency department) or ER (emergency room), and urgent care centers.
4. Medical scribes understand basic medical terminology and can converse with other members of the medical staff--including hospital administrators, physicians, pharmacists, nurses, medical coders, and so on. If they work with a specialist, they quickly learn highly specialized terms.
5. Scribes become versed in general anatomy and physiology. In their formal certification training, medical scribes are introduced to all of the major organ systems of the body. They understand the "roadmap to the body" and how the organs function. This knowledge provides them with an appreciation of the human body and its complexity.
Many scribes use this knowledge and invaluable experience as a stepping-stone to further education and training in any health-related field.
For example, some medical scribes go on to study nursing or medicine. And some leverage their medical scribe's experience (shadowing the physician) in their application to medical school.
6. Medical Scribes fully understand the methodology of writing of the HPI (History of Present Illness). For instance, scribes are able to record a chronological description of the development of the patient's illness from the first sign and/or symptom or from the previous encounter to the present--including the following elements: location, quality, severity, duration, timing, context, modifying factors, and associated signs and symptoms.
7. Scribes are aware of billing codes and principles as they pertain to the medical chart.
A well-written medical record will result in smoother claims processing and provides a medico-legal resource as to the care provided.
8. Medical Scribes are familiar with common medications and will become familiar with specialist's medications, as they go on rounds with physicians.
9. Scribes understand information systems technology, including flow and control of information as well as the technological platforms available.
“they allow for physician to leverage time and see more patients or spend more time with individual patient as less time is spent doing clerical work ... the record may actually be more complete with scribe completing and adding more text or completing ‘meaningful use’ boxes required by third part payers and therefore coding may be more consistent with submitted bill therefore shorter time for reimbursement by the insurance company because chart meets criteria for submitted bill ... lastly, data is better able to be mined and queries submitted which allows for greater chance of meeting quality metrics”
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10. Medical scribes communicate effectively and are able to use correct medical terminologies. They efficiently take medical notes and accurately record doctor’s patient interaction using electronic tools available.
11. Medical Scribes know the medical scribe tools and information systems available for improving efficiency and effectiveness and healthcare decision-making. They are able to recognize characteristics of various medical scribe systems. In addition, scribes can recognize benefits from various medical scribe systems and understand the cost and issues of various medical scribe systems.
12. Medical Scribes recognize the sources of system threats and ethical implications associated with patient information security and privacy issues, and explain how organizations can address these issues.
13. Scribes recognize network and mobile technologies used in medical practice as well as the issues associated with network and mobile technologies.
14. Medical Scribes can also describe the sources of information security and protection in medical information systems.
Medical scribes recognize the importance of an electronic health record that is connected to the Internet. Thus, they understand the vulnerability of the patient’s chart and the importance of preventing a breach in security.
15. Finally, scribes recognize or describe approaches and technologies that could be used by hospitals to meet the information privacy regulations and standards (technologies and employee training, etc.). They recognize information privacy regulations and standards with which health care facilities must comply. And, more importantly, they recognize the ethical implications of medical scribe information systems.
Medical Administration Careers: 3 Tricks Medical Scribes May Use to Confront Daily Challenges
by Walter Rodriguez, PhD
Eleanor Roosevelt famous quote, “Do one thing every day that scares you,” challenges us to do things that may be uncomfortable at first.
I recalled Eleanor’s advice the first time I found myself looking for a job, after being laid-off from a part-time weekend job … where I traveled throughout Florida helping stage healthcare training seminars. Although the job was very demanding, I thought “I really need to work those extra hours” in order to make ends meet and support my young family.
At the time, I was just in my early 30s, a graduate student at University of Florida, and the father of a 6-year old daughter and a 1-year old son.
By heeding Eleanor’s advice, I was able to confront my fears … rather than despair, I viewed my situation as another challenge. I also made a mental inventory of my skills. For instance, I still had my experience conducting seminars and I was a fairly good learner and teacher.
Well … that’s the short story about how I confronted my challenge, after being fired. The happy ending is that I later graduated from UF and found a great job as an assistant professor. And I am still enjoying what I have done for over 30 years: teaching and trying to help others in similar situations.
Below are three tricks you may use to confront a daily challenge:
1. Visualize yourself being on your desired situation
By using your imagination, you can prepare yourself for success. For instance, if you are looking for a job, you may close your eyes and visualize yourself being on an interview and answering questions with confidence. You imagine talking about your life and work experiences and showing that you enjoy learning new things. Imagine yourself being confident and friendly and visualize your interviewer shaking his/her head in agreement.
2. Find a mentor or adviser or coach
Accept yourself: both your strengths and weaknesses. We all have them. And think “I don’t have to solve all the problems by myself.” You can usually find an experienced friend, family member, mentor or adviser to guide you and help you navigate the rough times. You will be surprised how many people want to help you and your family. Finally, look for challenges and opportunities in your field*.
3. Consistency of Purpose
Once you decide what you want to do, keep doing it every single day, consistently. For instance, if you are looking for a job, keep refining and posting your resume every day. Consider volunteering to work in the community and seeking contacts that will help you with your job search. Of course, if you find yourself lacking the right skill-set and academic preparation, you should consider matriculating in a community college, vocational school or online training program in a high-demand area that you would enjoy.
*What are the Medical Scribe Challenges and Opportunities?
Source: Extracted from a Medical Scribe course developed by Valerie Weiss, MD
"Challenge of Regulatory Requirements: In the medical practice, there are a burdensome amount of documentation requirements (i.e., data, information) that must be entered into a myriad of computer information systems. These system involve a series of complex processes that are employed in hospitals nationwide.
Challenge of Continuous Change: Within each hospital, there are additional frequent changes to what needs to get documented and how. There is so much constant change and mounting documentation responsibility levied on the medical provider that the traditional paradigm of the medical provider who performs his or her own unassisted documentation or dictates into a recorder has proven to be uneconomical, inefficient and unsustainable. To thousands of health professionals who have been chiding at the forced changes to their medical record documentation practices, the silver lining in acclimating to this struggle is scribes.
Job Opportunities: The medical scribe industry has exploded in growth, thanks to the regulatory requirements and changes affecting medical records. For instance, in 2008 there was only 1 medical scribe vendor at the American College of Emergency Physician’s annual conference and approximately 500 scribes nationally. This year, there are 8 vendors and approximately 6,000 scribes. With tremendous growth, comes a natural need to regulate performance. Today, we have the opportunity to do so. If we are to remain in control of our destiny as an industry, we have to establish minimal performance requirements and advocate for compliant practice of appropriate scribe use among medical providers, individual scribes and scribe vendors. If we do not act responsibly with this opportunity then the medical scribe industry will be contaminated by the unscrupulous practice of those who wish to call themselves scribes while engaging in unsupported behavior. By obtaining your scribe certification through the Medical Scribe Certification & Aptitude Test you are distinguishing your training and practice, ensuring that employment as a scribe continues for you and is available for future generations aspiring for a career in the health-related sciences. Certification matters.
Work Environment: The scribe-provider work relationship is a familiar experience to medical providers who were initiated as medical students who learned to work with interns, who likewise learned to work with residents, who likewise learned to work with attending physicians. There are 2 major differences however. Scribes are strictly non-clinical, documentation assistants, and the medical provider is not responsible for teaching the scribe medicine. Notwithstanding the differences, scribes learn a great deal of clinical medicine simply by witnessing and documenting the provider’s interaction with patients. For these reasons, being a scribe is the best job any pre-health major could have."