The potential of medical clerks to further enhance headache team care

Abstract

　Background: In headache practice, detailed history-taking based on ICHD-3 is essential for accurate diagnosis; however, the associated documentation burden can prolong consultation times and increase physician workload. To address these challenges, we implemented a real-time electronic medical record (EMR) documentation system supported by a structured training program for medical scribes.
　Methods: We developed a three-stage training system—Basic, Intermediate, and Advanced—designed to transition inexperienced staff into effective clinical assistants within three months. The curriculum included standardized manuals, mock-patient simulations, and multi-shadowing of experienced scribes. In the Advanced stage, scribes further refined their skills by creating personalized manuals incorporating individual insights and physician-specific workflows. Clinical efficiency was evaluated by comparing three phases: early implementation (2016) , stabilization (2019) , and current practice (2024) , focusing on patients seen per hour and consultation time per patient.
　Results: The average number of patients seen per hour increased markedly from 10.2 (2016) to 12.9 (2019) and 16.2 (2024) , representing an approximately 60% improvement in efficiency. The average consultation time per patient decreased by approximately 2 minutes. In addition to these quantitative improvements, physicians reported a reduction in physical burden associated with documentation, such as tenosynovitis and dry eye. A survey of four medical scribes showed that all participants reported high job satisfaction and a strong sense of professional contribution, which may be associated with the autonomous learning process in the Advanced training stage.
　Conclusion: A structured and progressive training system for medical scribes enables rapid skill acquisition and supports high-quality team-based care. By reducing documentation burden, this approach improves clinical efficiency and allows physicians to focus more on patient-centered interactions, suggesting its potential as a sustainable model in specialized outpatient practice.