To addend or not to addend? Exploring medical student and resident perceptions of the use of student notes for billing purposes

Abstract

Background: Clinical documentation is an essential skill for which medical students are often not prepared. Changes in documentation rules for medical students allow the utilization of student notes for official billing purposes, which requires investigation for possible educational intervention. Potential benefits to medical learners and impacts on feasibility and workflow must be explored. Methods: Pediatric clerkship students were randomly assigned to one of two inpatient hospitalist teams: control group students wrote daily notes that were not addended or used for billing; study group students’ notes were used for billing after being addended by resident and faculty members. At the end of the clerkship, residents and medical students completed surveys and focus groups. Results: In surveys, residents from both groups reported similar satisfaction with medical student documentation. Study group students spent more time reviewing notes, found the feedback from residents beneficial, and felt their experience with documentation was more valuable than control group students. Focus group themes included: educational value for learners, increased student engagement, possible negative impact on workflow, inherent feedback in reviewing edits, the importance of clear communication, and minimal effects on patient care. Conclusions: Our results highlight the potential educational benefits of using student notes as official documentation and provide evidence that this practice may not negatively impact resident learners.