Results: The areas in which the trainees were shown to need more improvement were proper use of pauses during dictation, appropriate use of dictation function, and appropriate dictation speed. Investigated items included pronunciations, appropriate dictation speed, provided case identifiers, proper use of pauses during dictation, appropriate use of dictation function, following the standard dictation protocol, dictation manner, spelling of unusual words, appropriate signoff, using standard setup phrases, and correct use of working group-approved coded comments. Trainees were not aware of the evaluations and the study. The names of the trainees were not revealed to the MRs. The checklist was distributed among MRs, who evaluated the dictations independently. Dictations of nine of our trainees, which included senior residents and fellows, were chosen for analysis. Methods: In the current study, we analyze the dictation quality of trainees in order to help them dictate efficiently and accurately, and facilitate communication among MRs, trainees, and pathologists. In addition, the efficiency of dictation leads to reduced waiting time and waste of motion, and better communication among team members. Objectives: When dictation is used, the process of producing accurate medical records depends on the pathologists’ dictation and the work of the medical transcriptionist (MR).
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March 2023
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