MT Education

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At Seminole Community College, Sanford, Florida, we teach medical terminology, college credit and vocational, to students of all health majors--physical therapy, physician assistants, pre-med, medical transcription, medical assistant, coders, and the ubiquitous LPN and RN wannabes. No one has ever called our terminology classes boring; we have a lot of fun. I throw in as much humor as I can (for example, perineal and peroneal mnemonics: perINeal is IN between the legs and perONeal is ON the leg); the medical word for pain in the buttocks (pygalgia), etc. Also, did you know the origin of the word Testify? It comes from "testicle." In ancient times, the Greeks would hold their testicles as they gave an oath. We also give a quiz every week, which isn't much fun but keeps the students on their toes.

We teach our terminology sections in once-a-week, three-hour blocks, and five of the sections are nighttime ones. So I have to work hard to keep them awake, but awake they stay. The best way to do that is to get the class involved. So we have the students do group presentations each week. This counts for 10 percent of their grade, which can make a big difference. It forces them to get to know each other and work together, forming little study groups and making friendships that last throughout their respective educational programs.

And it also keeps the class from being a boring recital of Susan's bad jokes. (They can only take so much of me!) The presentations can be humorous or academic, skits or games. They must deal with one of the chapters of The Language of Medicine, and they are coordinated with the week that we cover that chapter. Two weeks ago, we had a group do the urinary system with a bingo game. (I think they called it Urine-Go.) Different questions from the chapter were called out, and class members thumbed through their book to find the answers. The group first gave a little presentation where they talked about the urinary system, showed a model of the kidney that they borrowed from the anatomy department, and served Urine-aide, which was just very yellow Country Time Lemonade. It got us in the mood. They passed around a kidney stone that was actually a wad of yellow-tinted rock candy (everyone was supposed to eat some of it.) Sounds disgusting, but it was fun.

Another group last semester did a video skit presentation to cover the male and female reproductive chapter. It was a professionally produced video called "The Andy and Opie Show," which we all referred to as "Opie Gets Nookie." It was a scream!

The presentations (in groups of 3 to 5 students) only take about 15 to 25 minutes. Then I cover the chapter required, so the important medical stuff still gets covered. I have a collection of old video presentations that I show on the first night of class to give the students ideas.

I've been told by education teachers that this method is not pedagogically correct, and is of dubious academic value. I disagree. My pedagogal friends have students dozing in the aisles; mine go home and talk medical terminology to their husbands and wives: "Not tonight, honey, I have cephalgia."

From Gisela Angelina:
Being homebound due to neurological disorders, I also was looking for a medical transcription correspondence course, as I had heard being an MT was something that could be done at home and I would be able to finally get off disability. I checked around a bit, took At-Home Professions MT course. I've been working for 16 surgeons, 3 PTs, 2 GPs and one D.O. for six years now. The course was well rounded, offered medical terminology for all specialties; SOAP, H&P, intake, discharge summary, surgical, etc. formats; physiology and chemistry basics; MT as business studies, billing, etc.; and many tapes of actual dictation from various doctors/specialties (lots of foreign docs). Dorland's Medical Dictionary came with course, and recommendations for buying other references. Course is divided into chapters, each is sent in and graded, sent back with many helpful notations, phone link with live professional for help, advice, questions, etc., and reasonable price for all (I paid $9 down and $39/month, and the total was around $350-400 (I forget) back in 1989. They also offer legal transcription which I checked into, very intensive. Checked in my area and there was no market for this, so never took this course.

The most important experience I had as an MT was the "MENTOR-DISCIPLE" relationship that I experienced with my MENTOR.

The very first job I had transcribing was in a psychiatrist's office. It wasn't what I would consider "real" transcription because most of what we did was re-dictated summaries of previous reports dictated by the historian before the psychiatrist interviewed patients. It was a good learning experience, enough for someone to ask me to come work in a newly opened Transcriptions Limited office.

For a year I worked in the office for TL. I know I was a burden to the experienced MTs around me. They rarely ever let their irritation with me for asking questions show, but occasionally it did come through. It was a hard year because I went from making $10/hr to $1.65 a page and rarely did over 30 pages a day. Still, I struggled on because I felt that there would be a future in this field for me.

One evening, I met a transcriptionist who worked at home normally but had come into the office to cover stats. We got to know each other over that year and then one day she asked me if I'd like to come work for her at home. She was so warm and friendly and kind that I took the plunge and went home to work for her.

Well, this woman was my MENTOR. She scrutinized my work carefully and at first sent back a lot. She always had constructive comments to make about it. If I had done something well, she let me know, too. I could call her at any time to ask her to listen and she never got irritated or impatient with me. Because she took the time with me, I began to become a real transcriptionist.

I would have worked for her forever, but her business folded, and I had to move on. But I look back on what she gave me and will never forget her. She didn't have to train me. But she saw something in me that would someday develop. She took a chance on me. She never talked down to me or treated me like an inferior. We had a lot of fun together and good times. The only way I found to repay her was to take on a trainee myself, my friend Maggie Bryan. I did my best to give back to her what Ruth gave to me and pass on the relationship. That's why I stress so much the importance of a Mentor. There is no substitute for a one-on-one relationship with a kind and generous MT sponsor.

I recognized this problem years ago. I have been an MT for 10 years now. Before I stumbled into this career, most MTs were "trained into" the field on the job. This was a pretty basic situation: a position needed to be filled, a person was asked to fill it and was trained by an experienced MT. This was probably the best way to enter this field; however, does this opportunity still exist?

Then vocational schools began to offer medical transcription programs. Unfortunately, when I attended school certain programs were not available, and what was available was of poor quality. In any event, you completed the course and then what? The same problem that exists today: No one wanted to hire you because NOTHING in the world would take the place of on-the-job training. And, you all know the problem with that: Who is going to allow you the opportunity for on-the-job training? It was a vicious circle when I graduated in 1985 and it is still a vicious circle, only now it seems compounded by the fact that there are many, many more people wanting to go into this field than ever before because of the push towards at-home careers today. I recognized the problem and decided that I would make an honest effort to be part of the solution. When I felt that my skills in this profession were at an adequate level and above, I began to help others into the field. It hasn't always been easy, but there is nothing so rewarding as knowing that you made the difference for someone, and they are flying because you helped them to fly.

As early as 1970, transcription supervisors in hospitals were griping about the shortcomings of transcription schools. But the job applicants from these schools were few and far between, and when one had to be hired, plans were made to incorporate the necessary proofreading/editing/training time into the supervisor's schedule. This should have given us a clue of what was to come down, but I guess it didn't. Twenty years later, these applicants have multiplied alarmingly, and the problems are still the same; however, they now have to be dealt with in the context of budgetary cut-backs, hiring freezes, managed care, utilization review, JCAH accreditation, state and federal reviews, and the turnaround/accuracy crunch increases. Now there is little or no training time available. More and more hospitals are using transcription services, and now we are feeling the crunch, and can't find help any better than they did, unless we train our own.

This presents a problem for every transcription service who does not utilize employees. The 20 factors used by the IRS to determine employee/contractor status of individuals PRECLUDES training or control of any type, among other things. The penalties imposed if a contractor is later determined by the IRS to be an employee are prohibitive and "business wrecking," and can be levied on any hiring person including transcription services, doctors' offices and hospitals. So where does that leave us? And where does that leave the newcomers who readily admit they plan to learn as they go but want to work as an independent, home-based MT? By IRS criteria, it is very difficult for a newcomer to even qualify as an IC. Do the schools address this? Newcomers ask why they can't get clients. We are accused of creating a monopoly. Much bitter frustration is expressed about the experience trap.

The marketplace is a great leveler; survival of the fittest, I think it's called in nature terms. But when we are losing possibly as much as 50% of these graduates, doesn't that indicate that something is wrong; especially when people like me are crying for help, and we have to turn down business because there is just no human way to do it all? Somewhere in that 50%, there have to be people with excellent potential, who have never been given a chance to prove what they can do, and just throw up their hands and give up. In spite of the difficulty with placement of all these students, the schools continue to take their money and turn them out in huge numbers to make room for a new batch with more money. These schools may have been started with sterling intentions, but are really seeming to take on the appearance of mills. If we truly have empathy for the newcomers, we should be supplementing our sympathy and encouragement with a little action to provide some remedy for this unhappy situation.

I don't know what the answers are, but I can give some topics for future discussions:

1. What are the chances of posting the contacts to some of the better schools and training programs which we already know about on the Web, which can be accessed by potential students? If word of this gets out there, schools might submit applications to be included on this list, and could be evaluated one by one.

2. Is there any viability to the thought that perhaps transcription services can train, or supplement the training, of these students on a more formal basis than is being done now?

3. What can be done about creating more entry level jobs?

4. Perhaps we should be working on a more prominent outreach program to get these prospective students' attention before they make a decision about school so that options can be evaluated more realistically.

5. Perhaps we should carefully listen to the questions and observations from a newcomer's point of view, which might make it easier to identify and address some of the problem areas in the future.

6. We must be realistic with newcomers. Of course independent study and success can be achieved, and the people who can accomplish this are to be congratulated. But realistically, this is the exception rather than the rule. There has been inaccurate information about earning potential, the personal investment of time, work and money necessary to attain peak potential, the certification process, the low number of jobs currently available to school graduates, the reasons for that, and other things.

Here's my story: I am a product of the 60's who came from a medical family, attended college for 2-1/2 years (education major) and dropped out because I fell in love. Back in those days it was still possible to get a job right off the street, which I did, starting in an oral surgery office. Discovering that there may be some future there, when various other doctors in the clinic came to my desk with tapes in hand (I remember well how I labored over the word "dyspnea"), I embarked on a course of well-selected specialties with each job change. After 7 years of this I was accepted for full-time, hospital medical transcription and worked in-house for four more years.

With this background and a daily production of 1600 lines, I decided in 1972 to try home-based work, signing up with a transcription service who had some really prime accounts. My first home-based account was Stanford University Hospital, and I went from thinking I was terrific to feeling I was back in kindergarten in the course of my first 30-minute tape, which took me eight hours to transcribe. But I hung in there, and the next four years of doing Stanford was the most wonderful thing that ever happened to me. After that, everything else was a piece of cake in comparison, but I still enjoy learning, and medical transcription continues to give me that opportunity. I have continued home based except for a three-year hiatus when I worked as one of the supervisors for a transcriptionist service in the San Francisco Bay area. The Loma Preita earthquake in 1989 sent me home to the hills, where I continue home based today. So I made it with no formal MT courses, but it took me 11 years to build a sufficient foundation to go home based. I am a firm believer that a little formal school plus on-the-job assistance offers a way to achieve this goal in much less time and still be able to earn enough for life's necessities while you are learning. Comparing then to now, we had it MUCH easier than today's newcomers, even with their access to better schools.

In a way I am envious of these new MTs because they do have it so much easier than I did. Those who have AOL have access to a world that we didn't have when we started out. They have access to drug/terminology updates, book reviews and where to buy them, networking with colleagues all around the country and medical terminology advice from people so willing to give of their time and money to share it and so many other things on the WWW that are now starting to unfold for us. So, in a way many of them will develop the skills much faster than some of us did because they have access to so many more reference materials that we never had.

Maybe some of us should take the time and money to develop a mentoring program. I think this is a wonderful idea for those on both sides who might be interested and I would be willing to participate if anything ever gets started. I think it would be great to match someone new with someone more experienced who works in the same setting (transcription service, hospital, clinic, independent, etc.). Maybe some of these people would like to occasionally communicate in a more personable, one-on-one manner.

I think a mentoring program would help us feel more like a team, that we are in this together. I also think that we could learn a thing or two from them. It would be a great partnership all around.

Since I have a bad memory, I found it helpful as a new trainee to take notes. This helped prevent me from asking too many questions over and over again. Another tip for the new MT is to go through the whole report first. If you don't understand a word, use some unique string such as "!!!" to designate the spot where the question is and keep typing. Then back up the tape and go through it again. It's amazing how much you can understand the second time through after you have got the hang of the doctor's speech patterns. If you still can't fill in the blank, that is the time to ask for help. This way you can search for the "!!!" strings and listen all in one "interruption" instead of causing the helping MT to jump up numerous times to help with one report.

There is something very WRONG with any system, whether hospital or service, that does not provide extra credit to any MT who is assigned to help train a trainee. If this problem were handled correctly in the first place, there would be much less resentment. If MTs are assigned to handle phone calls, etc., they should get credit for that, too. This is one reason I did not like the idea of incentive pay for lines only. If our job description called for more than just typing, then whatever we were supposed to do should be given credit.

Again this is a problem of the employer. If the pay and benefits are good enough, I think most MTs would probably be happy to continue working there. If working from home is a primary goal of the new MT, then perhaps working as an employee at home could be arranged later on after the new MT has become an asset.

I found that a bigger problem was the new employee who has worked at another facility and comes to work at your facility. We had some who constantly talked about "over at x, we did it that way" and go on and on. Well, we old-timers would feel like saying to the new person, if things were so great over there, why did you come over here?

If you are new at a place, it's a good idea to keep low-key and just try to go with the new situation for a while. Then later if you do have a suggestion about how we can improve things here, you can suggest it in a very nice way, not in a way that makes it sound like you think this place is stupid for doing it this way.

If anyone here is a service owner or supervisor, I would strongly recommend making sure that MTs who are asked to help train other MTs be given credit for that according to the pay policies at the facility. If that means being given credit for extra lines for every hour an MT is assigned to help the new person, then do it that way.

Also, it's a good idea to keep on hand plenty of good samples of reports, even from specific doctors that the new person can use as a guide. This may be enough help so that less time has to be spent asking for help from another employee. With today's more powerful computers, some of these samples might be kept on disk for easy reference.