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CMS Says Multiple Students Can Participate in Patient Care and Documentation

STFM Proposes Scenarios for Further Clarity of Student Documentation Guidelines

May 15, 2019—On April 26, CMS issued a new transmittal, R4283CP, to "clarify existing manual language to bring the manual in line with current payment policy for teaching physicians providing evaluation and management services."

Specifically, the transmittal replaced the word "student" with "students," putting to rest any question about whether multiple students can be involved in a patient's care and documentation. The transmittal also has new language stating, "The patient medical record must document the extent of the teaching physician’s participation in the review and direction of the services furnished to each beneficiary. The extent of the teaching physician’s participation may be demonstrated by the notes in the medical records made by physicians, residents, or nurses."

On May 15, STFM responded to a request from CMS for information on any ongoing member concerns or confusion about interpretation of the student documentation guidelines. STFM noted that there are various interpretations of "physical presence," and a lack of clarity about resident involvement when a student is also involved in patient care. In some cases, this confusion has hindered implementation of the guidelines. STFM proposed several scenarios that would provide clearer interpretation.

STFM also encouraged CMS to change its policy regarding the inclusion of Advanced Practice Nurses/Physician Assistant students AND preceptors. 

Read Proposed Scenarios
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AI Chatbot Tips

Tips for Using STFM's AI Assistant

STFM's AI Assistant is designed to help you find information and answers about Family Medicine education. While it's a powerful tool, getting the best results depends on how you phrase your questions. Here's how to make the most of your interactions:

1. Avoid Ambiguous Language

Be Clear and Specific: Use precise terms and avoid vague words like "it" or "that" without clear references.

Example:
Instead of: "Can you help me with that?"
Try: "Can you help me update our Family Medicine clerkship curriculum?"
Why this is important: Ambiguous language can confuse the AI, leading to irrelevant or unclear responses. Clear references help the chatbot understand exactly what you're asking.

2. Use Specific Terms

Identify the Subject Clearly: Clearly state the subject or area you need information about.

Example:
Instead of: "What resources does STFM provide?"
Try: "I'm a new program coordinator for a Family Medicine clerkship. What STFM resources are available to help me design or update clerkship curricula?"
Why this is better: Providing details about your role ("program coordinator") and your goal ("design or update clerkship curricula") gives the chatbot enough context to offer more targeted information.

3. Don't Assume the AI Knows Everything

Provide Necessary Details:The STFM AI Assistant has been trained on STFM's business and resources. The AI can only use the information you provide or that it has been trained on.

Example:
Instead of: "How can I improve my program?"
Try: "As a program coordinator for a Family Medicine clerkship, what resources does STFM provide to help me improve student engagement and learning outcomes?"
Why this is important: Including relevant details helps the AI understand your specific situation, leading to more accurate and useful responses.

4. Reset if You Change Topics

Clear Chat History When Switching Topics:

If you move to a completely new topic and the chatbot doesn't recognize the change, click the Clear Chat History button and restate your question.
Note: Clearing your chat history removes all previous context from the chatbot's memory.
Why this is important: Resetting ensures the AI does not carry over irrelevant information, which could lead to confusion or inaccurate answers.

5. Provide Enough Context

Include Background Information: The more context you provide, the better the chatbot can understand and respond to your question.

Example:
Instead of: "What are the best practices?"
Try: "In the context of Family Medicine education, what are the best practices for integrating clinical simulations into the curriculum?"
Why this is important: Specific goals, constraints, or preferences allow the AI to tailor its responses to your unique needs.

6. Ask One Question at a Time

Break Down Complex Queries: If you have multiple questions, ask them separately.

Example:
Instead of: "What are the requirements for faculty development, how do I register for conferences, and what grants are available?"
Try: Start with "What are the faculty development requirements for Family Medicine educators?" Then follow up with your other questions after receiving the response.
Why this is important: This approach ensures each question gets full attention and a complete answer.

Examples of Good vs. Bad Prompts

Bad Prompt

"What type of membership is best for me?"

Why it's bad: The AI Chat Assistant has no information about your background or needs.

Good Prompt

"I'm the chair of the Department of Family Medicine at a major university, and I plan to retire next year. I'd like to stay involved with Family Medicine education. What type of membership is best for me?"

Why it's good: The AI Chat Assistant knows your role, your future plans, and your interest in staying involved, enabling it to provide more relevant advice.

Double Check Important Information

While the AI Chat Assistant is a helpful tool, it can still produce inaccurate or incomplete responses. Always verify critical information with reliable sources or colleagues before taking action.

Technical Limitations

The Chat Assistant:

  • Cannot access external websites or open links
  • Cannot process or view images
  • Cannot make changes to STFM systems or process transactions
  • Cannot access real-time information (like your STFM Member Profile information)

STFM AI Assistant
Disclaimer: The STFM Assistant can make mistakes. Check important information.