Digitising paperwork helps train next generation of doctors

Doctors, nurses and clinicians have rightly been hailed as ‘everyday heroes’ during the COVID-19 crisis, as they continue to work to keep Australians healthy, even while putting themselves at risk.

Beyond looking after the health of Australians, these staff also play a key role as teachers — working closely to aid in the education of the next generation of Australian healthcare professionals.

Monash University Central Clinical School (CCS) is one of the largest undergraduate medical schools in Victoria. The school is consultant-driven, giving undergraduate medical students a live experience engaging and providing care to patients in hospitals and care facilities across the state.

At any time, CCS has approximately 350 clinical students completing six-week rotations across four major, geographically remote health services throughout Victoria: Alfred Health, Peninsula Health, Cabrini Health and Epworth Healthcare. These rotations are key to the students’ education — and to their grades. Clinicians’ assessments of students’ rotations not only directly inform students’ success, but also offer a key feedback mechanism to identify and document areas for improvement.

“Medicine is a lifetime of training,” said Anne Powell, director of medical student programs at Monash CCS.

“We make sure we provide the infrastructure to provide our clinicians on the ground the best-quality education.”

Digitising student–clinician feedback

As a consultant physician in the Department of General Medicine at Alfred Health, Daniel Fineberg deals with a significant number of students on a daily basis. Yet supervising that number of students, organising feedback across multiple consultants and registrars, and collating paper-based documentation was becoming unwieldy.

“We see about 10 new students every six weeks from the Monash CCS, and each of my students will get feedback from between five and 10 different doctors. The way we were doing this before was incredibly fiddly,” Fineberg said.

Monash CCS had introduced an electronic assessment system, but its complexity led many clinicians to revert to paper-based solutions to save time. School administrators then had to subsequently collect and input assessments into the system, leading to significant delays. Even once assessments had been fully entered into the system, it was sometimes weeks or months later that documentation would be released to the clinical dean or to the students themselves.

“The ultimate effect was on the time it took to provide good assessments. As clinicians, [we] were wasting time on paperwork we could have been spending on patients. And because the process needed to be streamlined, the university wasn’t getting feedback in a timely fashion that could be quickly communicated and remedied,” Fineberg explained.

Those challenges were only exacerbated by the onset of COVID-19.

“Paper doesn’t work well in a pandemic,” Powell said.

“We couldn’t manage using the same processes we had before. We had to find another way.”

That’s when the Monash CCS turned to DocuSign.

A solution

Monash CCS worked with DocuSign engineers to begin integrating student assessment forms into the DocuSign eSignature platform. In just 10 days, the team had digitised the key forms and began rolling out new processes to administrators, the clinicians and to the students themselves.

DocuSign offered a centralised, secure platform to streamline the student feedback process, mitigate infection risk and keep sensitive information stored safely.

Clinicians are able to access the assessment system with a single click, providing feedback directly into the DocuSign form. Once complete, the form is forwarded to the clinical dean to make sure the feedback is complete and appropriate, before being released to the student immediately. This led to the students receiving their feedback usually on the same day it was completed by the clinician.

The implementation of DocuSign came at an opportune time for the clinicians at Alfred Health.

“As COVID-19 began to hit us, it became clear that doing anything that involved a lot of physical paper wasn’t going to work right now,” Fineberg said.

“Within our departments we’ve come to the conclusion that keeping everything electronic is the way to go. We’ve had to be focused and adaptable to ensure our patients get the right care through COVID-19. While there was a lot of negative feedback about how we used to do things, since we’ve introduced DocuSign the silence has been golden.”

The results

Before DocuSign	After DocuSign
The prior system for clinicians providing medical student assessments was complex, leading to clinicians reverting to a paper-based system.	DocuSign has simplified the feedback process to streamline and speed up how clinicians complete student assessments.
School administrators had to input paper assessments, resulting in responses being received up to eight weeks later.	A better learning experience for students with a simple process to provide same-day feedback.
COVID-19 has seen the hospital move away from shared documentation.	DocuSign enables a zero-touch, paperless process to minimise the amount of contact required.

Student experience

The implementation of DocuSign hasn’t only benefited clinicians and administrators.

Clinical students get the benefit of instant feedback on their rotations. While the legacy assessment system could take as long as eight weeks to process feedback, the DocuSign system sees clinicians digitally prompted — and reminded — for feedback, before it is reviewed by a supervisor and sent on to the student. These days, students receive assessments on their rotations on the same day, enabling them to identify areas for focus and have more opportunity to improve.

Matthew, a final-year medical student currently studying at The Alfred, summed it up.

“In the past, I had received assessments midway through another rotation, and I was not able to promptly act on the feedback,” he said.

“Being able to assess what I have done well and, conversely, what I need to improve on for the next one will allow me to set clear goals to work towards to help better prepare me for next year as an intern!”

DocuSign benefits administrators by cutting through bureaucracy without impacting legal obligations, providing a simple audit trail for feedback and improving quality assurance. Administrators have been able to save time in ensuring information is correct and changes are reflected consistently across the system so they only have to be made once.

“There used to be a lot of red tape around our processes, though a lot has been removed due to COVID-19,” Powell said.

“Simplifying our systems without impacting those legalities is really important, and it also has the effect of making the assessment process much smoother for time-poor clinicians.”

Another reason for the solution’s success may be its ability to mitigate a stereotypical complaint about doctors: their handwriting. By digitising the assessment process, feedback legibility has improved significantly.

Ultimately, the most important thing is improving the care patients receive today — and how well tomorrow’s clinicians have been trained to continue that level of care.

“The Clinical School has really proven how DocuSign and a fully digitised process can improve outcomes for clinicians, for students and for university administrators,” Powell said.

“We’re even looking into an expansion into consent forms and other potential uses as we speak.”

Image caption: Anne Powell, director of medical student programs at Monash CCS.