MTWebschool

Back to Education Page

Proposal: To enlist the help of experienced MTs to train new MTs, one at a time, in a manner that is efficient for both parties, to close the gap in the MT field between newly trained MTs and jobs requiring years of experience, and to improve the quality of all work.

Brainstorming and Experimenting:

1/25/97, from Jan WRevell, jrevell@cascade.net, Washington, Teaching MT in high school!
I hadn't heard of anything for high school students either until I became involved with this new skills center. Friday, however, we visited two other skills centers where "medical/legal" is taught. The one school that was open (ice conditions closed one) had a substitute teacher that day, who basically sat and read a magazine in the instructor's office while the class continued on its own. They were working with a self-regulated module. For the first nine weeks of classes, all the students learned medical terminology. At the end of that nine-week period, they chose to either continue with medical or change to legel.

The medical students then began typing "cases", each of which consisted of a different report (H&P, OP, etc.). The ones I saw were first-year students (juniors) and they were on their fifth case. One of the students, while I was there, was pleased to announce that she had just finished her 7th case.

As far as I know, our skills center will be the only one actually taught by an MT rather than a teacher out of education. My plan right now is to start them off with WP5.1 (they have keyboarding and English), using some donated JAMA and AMA Journal articles as their practice texts. Simultaneously, we will be doing A&P, with our very own Bucky Bones as class mascot. We will be using the text/software "Building A Medical Vocabulary" as our terminology program, and then we will go on to actual transcription. The hospital and clinic in town are working closely with us and have agreed to let us use some of their dictations (patient name removed, of course).

The other classes are manufacturing and bilingual specialist (Spanish), and together we will do the professional development classes: communication, resume, interview, office policies and procedures, etc. This year, the seniors only have from January 27 to July 6 or so, which really means 9 wks or 270 hours. Fortunately, the hospital and clinic are well aware that we cannot turn out qualified transcriptionists in that time. In addition, however, the community college is also working with us and those students who so desire will go on to a year of work-study at the college. There is some sort of federal funding to reimburse students for on-the-job training, so the students will learn and earn, the college gets their due, and the employers will also benefit. As is typical around the states, there are nowhere near enough MTs here for the work, so this is how our community is trying to meet that need.

1/97, from Sharon Thomas, thomas@dbtech.net
I work in an acute care facility and we still transcribe on-site and train folks as necessary. Training a transcriptionist is a lot of work, and I would love to be able to hire someone already trained. However, it is very unusual for me to get an applicant with any experience at all. Even if someone has limited experience or a good educational record, I will turn her down in favor of someone who puts the earphones on upside down and has to be shown how to use the foot pedal, depending on the results of a fairly simply aptitude test.

We have the same two reports that every applicant has typed for at least the past 15 years. The two reports are the same two reports that I typed when I applied 13 years ago. By sticking to the same two reports, we are able to compare the current applicant to successful applicants in the past. Neither report is very long or complicated or hard to understand. The candidate is not timed on this test, as she has previously taken a speed test at the employment office, and I know she can type at least 70 WPM.

The applicant is given the chance to read the report as he listens to the dictation. This gives him the chance to look at the correct spelling and hear the way it is pronounced. When he is ready, I take away the report and have him transcribe the report. I am still having folks take this test on an non-correcting typewriter. That way I can see the type of errors made and listen to the rhythm of the typing. I don't care about typos or strike-outs or poor formating. As a matter of fact, I have never seen a perfect report using this method. I am just looking for folks who are able to hear and type the words after they know what to expect.

I think you could say I am testing for "hand-ear coordination". I have always thought of it as looking for someone with good verbal recall and written-word memory. Some folks seem to think that with enough training anyone can learn this, and maybe that's true. It is much easier for certain people to learn, though, and since I have to train them as quickly as possible, those are the folks I am looking for.

After I select a candidate, the training process begins. If anyone knows of a way to train folks other than hands-on practice, I wish they would let me know. For the first six months (on average), every report is checked by me or a trained transcriptionist before it goes to the doctor. It is very time-intensive, but necessary. I wish I had time to check all reports for the first year, but it is not practical. Therefore, I try to get the transcriptionist to the point where she will know when to stop and ask for help. It sounds simple, but it takes time!

I really wish that the transcription schools would develop a true aptitude test for transcription. If I could call up a school knowing that their students have not only had wonderful training, but were pre-screened for an aptitude for this work, I would certainly do it.

If you have any questions or suggestions or comments about training or aptitude testing, you can e-mail me. I have no openings at present, however, and am not authorized to take applications from the internet.

8/30/96, from Mary Morken
Training Pilot Project Evaluation

Having completed the training of one intern and well on the way with two others, here are my thoughts after three weeks of this project:

1. E-mail is the best way to transfer files between intern and mentor, with password-zipped files, using pkzip -s____ (password) (name of file) and unzipping with the same password.

2. "Compare files" mode in WP5.1 is the best way to send detailed feedback via E-mail. With corrected copy on the screen, press alt-F5, 6, 2, then enter name of original file, to see changes highlighted. This third 'compare' file can be saved. This saves the mentor from having to spell out the corrections verbally or by email, as they are very obvious. The mentor can send the corrected copy into the company's system directly, and it will go directly into the deliveries to the hospitals, if the mentor's number is entered after the intern's number.

3. Interns are slow enough that letting them go at their own pace does not overload the mentor, as long as there can be efficient exchange of files over E-mail. However, they could be limited to 1-3 documents per load if the mentor needed to limit the time.

4. Interns are required to read the corrections of their past work before doing new work, sending one or two files at a time, but these exchanges can be done more than once per day as time allows.

5. Examples of work for the specific account being done greatly aids in faster learning. Providing 50 examples is recommended.

6. Learning takes place by leaps and plateaus, so evaluation of the intern's work should not be done until 2-3 leaps have been seen, usually within the first five days.

7. Interns perform much better with positive encouragement and empathy, with help to keep their perspective while receiving 30-40 corrections per document at first. Mentors can give corrections of style and preference as well as required standards, with greater detail than QA feedback, but this must be understood by the intern as "piggybacking" rather than failing.

8. Repetition is necessary before details become habit; at present I estimate that 50 documents are necessary before the intern can be expected to be consistent in format and content.

9. Social situation and personal attitudes can be understood and addressed as a "peer counselor" mentor; these factors can affect learning greatly.

10. Communication via telephone, voice mail and email can improve understanding of corrections and establish an effective "teaching bond" between intern and mentor; however, none of these can be guaranteed to prevent misunderstanding, so care must be taken to reassure and recheck clarity of understanding on both sides.

11. Giving the intern frequent feedback on progress is as important as pointing out errors, with estimates of when the intern will be ready to pass QA.

12. Giving the intern support via telephone for blanks and questions for a time once they are graduated to QA and beyond will ensure that they can gradually make the transition to working independently.

13. Two to four weeks is recommended as the duration of training while being paid, for the sake of all parties.

14. Working closely with QA is important to clarify ambiguous rules and ensure that the intern is being taught correctly.

15. Training of current MTs could also be done, when they are assigned to new accounts or new specialties.

16. Mentors could train other mentors from the excellent MTs at on different accounts.

8/30/96, from Velon Magar, mtsah.4@ix.netcom.com:
I just finished a three-week training with an online MT mentor for a specific hospital account. Here are my suggestions:

1. The student always needs positive reinforcement. Learning a new account is very stressful; therefore, someone who can give you positive motivation is a MUST!

2. The student must not get discouraged on hard days. This is how a student learns better. The mentor must have patience. The student must continue on, even if they feel down because as my mentor said to me: "One step back and two steps forward!" I cannot stress how important it is to have a mentor who is very positive thinking and willing to work with you.

3. I had the advantage of using Smartype, which I think is very, very important in training. You have a constant dictionary opened up in front of you; this comes in handy when you have no idea of what the doctor is saying, so you put the words in phonetically, and then Smartype shows you a list of words that you can choose from where your spelling would be correct. I found it extremely useful and would not want to have trained without it. It does pay for itself.

4. My mentor wanted me to do several types of reports (CN, DS, and OR). I think that this is important because when the system is backed up on a particular type of report, anyone can transcribe those reports. It gives more versatility. I believe it is to the company's advantage. Everyone should be familiar with the variety of the specific account macros and how they are supposed to look.

5. The compare function on WP51 was very useful. I was able read my documents, after the mentor had corrected them, and see what I had done wrong.

6. The student must study their documents every day while in training. This will get them familiar with the terminology that the specific hospital account uses, and the way the document is supposed to be set up. The mentor should also give the student example documents, so that they can read over these too.

7. I found that email was extremely important because you were able to get feedback on documents via the computer screen. I do not like to get feed back over the phone. This does not help at all. Documents can be transferred via email, corrected, and sent back via email with the corrections. I need to SEE my mistakes, rather than to hear about them.

8. Taping dictation onto a cassette definitely decreases the quality. I am still looking for a quality recording device that sounds like live dictation. It makes it really discouraging if one cannot understand what the doctor is saying because of poor recording. It does not compare to live dictation.

9. After the student has graduated, the mentor should be available to give advice, and to listen to dictation that the student is having trouble with over the phone. Maybe the company could have an 800 number where transcriptionists who are having difficulty with a word or cannot find a word, could call this number and receive listening help.

I have found that my overall training has been very rewarding! Thank you for the opportunity to train with a wonderful mentor! It was well worth the time and the company will benefit!

8/27/96, from Gisele Dubson, Gdubson@aol.com
Need examples of using examples to train new MTs on jobs: When I have had accounts of my own, I have usually kept a sample tape or two of a doctor's dictation, plus a printout of the transcription that I produced. I found that when getting people to sub for me while on vacation, this was the fastest way to let them know about the level of difficulty of the dictation, let them see what the doctor's most usual phrases were, and so on. Now I work for a service and don't have to provide my own cover when I'm away. Also, now that I work on a digital system, I'm not sure how I would save the dictation so that the sub could practice on it, or listen to it while reading my transcription. I guess one would have to do some re-recording onto tape in that case.
8/27/96, from a new MT:
I've been preparing for this new temporary account for almost a month now. The MT saves me a tape of the work she completes and makes photocopies of what she did. I read her transcription first, and then listened to the tapes, following along as I read to get accustomed to the dictators. Two have accents and one has a habit of speaking too fast, so she wanted me to try them before I committed to taking the job. I also did some actual transcribing of the first tapes I got, before I looked at the copies. I only referred to the copy if I wasn't sure about a word or phrase, either because it was new to me, or because of the dictator's speech. I've already created some "macros" of the stuff she's been giving me each week. She still uses a word processor, not a computer. Well, she has "normals" on sheets of paper, and she gave me copies of them. I already input them into a little expander program I'm trying out, and it seems to be working so far. She says these doctors say pretty much the same thing, so it should help to have the expander. I guess there's nothing left but to do it.

8/24/96, Kathy Downey, daughter of Vi Foulks:
Mary wrote: "What's it like to do MT with a mom doing it? I ask because I'm hoping to train my daughter soon. She's 29 and has four children under 8."

Your question could have been "What's it like to do MT with a mom doing it, and what's it like to train a daughter?" My daughter is only 15, but she has spent the summer learning how to transcribe for one of my easiest clients, a pediatrician who is very repetitive and doesn't get too technical. Her goal, though, is to be a vet and this job is only to pay for goodies for her horses.

I started working for my mom at about the same age. I started with (yuk!!) copy typing standard records, which my mom thought were rather yuk, too. Progressed to doing some of her easier stuff at home nights and by the time I was a h.s. senior I worked part time and went to school part time. There were many times I would have loved to quit and would have if it weren't my mom I was working for. That was only the first few years, though, because it didn't take too long to realize how lucky I was to get the training I did. What's it like with my mom? I have the best mentor there is, I know, for free!!!! Even after 20 years, I still use her.

Your daughter would be lucky, too. I don't know how old her kids are, but to me it doesn't much matter, anyway. I have worked at home since mine were born (4, also) and I wouldn't have changed anything. I did go a little bonkers sometimes, but I am raising them myself (okay, my husband helps a little) but no daycares or baby-sitters for me (except to go out to lunch or just get away).

Oh, yeah, maybe you have had to try this already, but it does work to hold your earphone up to the speaker of the phone receiver for someone to listen for you. We've been doing it for years.

8/23/96, Name withheld:
Where I live, not much attention has been paid to quality of transcription or doing it following any certain standards. It's slowly (and I do mean SLOWLY) changing. I want quality and I want standards to be followed for the work that goes out of my office, but I get people who come in to test for me who think they are doing just a fine job because they've been working for Dr. So-and-So for 15 years and he thinks the work is great. And yeah, that's okay if Dr. So-and-So likes it, but to me it looks like a mess with nothing done according to any kind of standards. These people seem to have a real difficult time comprehending WHY they should change anything that they're doing to meet some quality standard that they've never heard of before they walked into my office. (Groan.) So to even try to start most of these people is a waste of time. They have no desire to change.

It's just very hard to find good transcriptionists here, and the reason for my original questions about pay plans is that I want to be sure to compensate well the ones who DO care about the quality of their work, and to hopefully provide a monetary incentive to those who don't have that "built-in" quality ethic.

From Mary:
I've begun training three MTs with some prior experience on general hospital transcription for the same hospital work I do. I've given them examples and carefully corrected their work, including grammar, sentence structure, formating and accuracy. For now, I'm asking them to conform to the standards of our company AND my style on optional matters, since I sign off on their work and take responsibility for it. I'm asking them to imitate my examples and my corrections in detail. They are finding the compare feature on WP5.1 that Kim told us about very helpful to see exactly where I made changes. When I am confident they are consistent, they will send their work to our QA staff who will give the official approval for them to get regular pay and join the pool of MTs whose work is spotchecked, and they will still rely on me to help them with blanks or questions for a time. My role is coach and trainer; QA is like the referee or tester.
From Kim Randall:
Here's my 2-cents worth (considering I was only a 12-month old MT myself at the time) when I ended up in a position to implement training for new MTs. I was doing primarily account-specific training where digital voice dictation files were in use, and we found that this approach seemed to work well in this particular setting:

I was able to save specific voice files for each account and retain them on the dictation system, make note of the job numbers, and save the corresponding transcripts. The new MT was first given what we called the "IQ File" on the account, which gave specifics on the account, included samples of previous reports, as well as a "word list" specific to that account (unusual or difficult terms, proprietary, etc.) Then they were given some of the transcripts along with the specific job numbers and access to the system for pulling up those specific dictation jobs. The first step was to "read along while listening" in order to get acquainted with the voice, style, terms, etc. The second step was to then go back and try transcribing the same dictation on their own, then self-review/compare with the original transcript provided. Next they were given additional "saved" (old) dictation job numbers (without benefit of the transcript) to try on their own. This was subsequently reviewed by me in order to assess how they were coming along. I compared their transcripts with the actual transcripts I had (so I didn't have to listen the actual dictation in order to review). They were then sent corrected copies of their transcripts and instructed to use WordPerfect's Compare feature to see where the differences were, noting whatever was noteworthy. Using WP Compare saved time on my end and put "the monkey on their back" so to speak, and then they could ask for specific feedback/clarification where needed. At some point (hopefully!) they were considered to be doing well enough to start handling that account's "real" dictation, but the first few jobs were still reviewed until it was demonstrated that they "had the account down."

I believe that even examples without benefit of the actual dictation are still extremely helpful in terms of specific accounts, and have also found them extremely helpful when transcribing other physicians with the same specialty. Basically, I live and die for examples whenever I find myself transcribing in unfamiliar territory (which is too often!).

To use Document Comparison in WP51 for DOS:
To compare a document on screen with another document on disk:
The MTs wanting to compare their documents with the corrected versions should first retrieve the document representing the corrected version. Then:

1. Alt-F5 (Mark Text)
2. 6 or G (Generate)
3. 2 or C (Compare Screen and Disk Document and Add Redline and Strikeout)

The following will then appear on screen: Other Document: -file name- The file name showing will be the same file name as the original document retrieved and needs to be modified to the file name of the document you are wanting to compare to (the original report submitted by the MT). Then press Enter.

This checks the document on the editing screen against the "other" document. It compares "phrases" in the two documents and automatically indicates any discrepancies between the two by "marking" the document on your screen, adding phrases as either "redline" or "strikeout" text -- including any punctuation marks, hard returns, hard page breaks, Footnote and Endnote codes, etc. Note that it does NOT note discrepancies with respect to the UNDERLINE code (why, I don't know). I'm not sure how WP defines the beginning and ending of a "phrase" and so they often come up looking really strange. It's important to have Reveal Codes turned on in order to note the discrepancies with "hidden codes" in particular (otherwise you won't be able to see those), and also to determine whether the "marked" text is either "redline" or "strikeout" until you are familiar with how each appears on your screen. If phrases that don't exist in the "other" document have been added to the document on screen, WP "redlines" the text in the screen version. If phrases that exist in the "other" version no longer exist in the document on screen, the program marks the text as "strike out". If phrases have been moved in the document on screen from their position in the other version, WP inserts THE FOLLOWING TEXT WAS MOVED on a line before the text and THE PRECEDING TEXT WAS MOVED on a line after the text.

The document you see on screen ("compared" version) can be saved if you like, but be sure to give it a new name. If you just save it with the default file name, it will overwrite the original file you pulled up (the "corrected" version). Whenever I saved them (for instance, I did the comparison but didn't really have time right then to analyze it) I usually just gave them an extension of .cmp or something like that (avoid using .com extension because of association as "com" files!)

1. You basically start off with two documents, but end up with three separate documents -- original (MTs first document sent in), corrected (the one you originally retrieve for comparison purposes), and compared (the one that ends up on screen). It's important, but sometimes frustrating, to keep straight on which one is which.

2. It can actually be fairly "cryptic" running comparisons within WP51 -- not ideal, but once you get the hang of it you can generally figure out what you need. For instance, blocks of text containing several or many words will appear highlighted as either "redline" or "strikeout" but the only actual discrepancy might be just a comma for instance. Thus, you have to look closely for the reason it came up marked as either "redline" or "strikeout".

3. If available and possible, I preferred to run comparisons within Windows WP 6.1 because then you are able to specify comparison to be by "word" rather than "phrase" so you don't have to look through blocks of phrases for the one little thing that was the discrepancy. They are also just plain easier to read in Windows version. The "redline" appears as red text. Strikeouts appear as true strikeouts (black text with hyphens through it, literally marking through words). Just plain easier to analyze.

From Mary: Here's a possible plan that I think would work with MTs who have finished a course or had one year of experience:

1. Give MT 50 samples of mentor's own work to study, from specific account chosen.
2. Let them listen to 10 jobs the mentor has transcribed, then read the transcription while listening.
3. Let them transcribe 10 jobs the mentor has transcribed that the mentor chooses, probably CNs or DSs, correcting their own work with my documents.
4. Let them do 10 new jobs over a few days, the mentor proofread and send in. Give MT feedback.
5. Let them do 2-3 jobs a day, mentor proofread (30 minutes a day) while listening to dictation.
6. Over the days, judge the amount of time it is going to take, how fast they are learning.
7. If they are doing well, expect 12 weeks of this kind of thing, then graduate to:
8. Company's QA taking them on 2-3 jobs per day, proofreading as they do new MTs. Hopefully they would be on their own after 2 weeks as most MTs are.

From Burt: Great exposure, right? It's like an intensive mentor period without the pressure of real work. Should offer the right persons with innate abilities to catch on and deal with language facilely a great opportunity to focus. Of course they could always do supplemental reading/coursework/exercises on medical terminology, abbreviation expanders, etc. Pick and choose from the wealth of material available at various web sites, all part of the webschool.

Say, can we have a school that is not a school? That is, without state license, accreditatation, certification, etc.? Just an informal area of learning - maybe the Montessori MT Division of MT Daily? It would be a way for all MTs, no matter where they train or how they train, to have available informal training that would really help in their work? CMT or not. Experienced or newbie. You could slowly build the various divisions - Cardiology, GI, OB/GYN, etc. over time. Got a new job in Cardiology? Beef up your skills on the Internet!

One important thing I think is using Smartype with abbreviations. This will make the proofreading job easier, the learning swifter I believe. We will get more ideas on how to make Smartype better for interns (MTIs).

from Burt: This is something that could be done on a larger scale also, with different experienced MTs contributing a sampling of their reports, which are posted on MT Daily and then maybe copies of tapes available. Of course all identifiers would have to be deleted. ALso, it would be similar to the Operation Report home page recently created but it would have the advantage of having the sound. Maybe we can do sound files which would be downloadable? The technology is catching up with us!
MT Daily Homepage