Re-Centering Clinical Documentation in the Age of AI Scribes: Four Aims of the Patient Chart Note.

Unlabelled: Clinical documentation is a foundational skill in medicine, developed during training and required in everyday practice. Historically, the chart note functioned as a clinician-centered cognitive tool for reasoning, teaching, and communication but has evolved into a multipurpose document shaped by administrative, regulatory, and financial demands, and is increasingly experienced as burdensome. The electronic health record, intended to improve efficiency, has introduced additional complexity and workflow strain, contributing to clinician burnout. Ambient artificial intelligence (AI) scribe technologies are rapidly being adopted to address these challenges, yet their implementation has outpaced evidence regarding their impact on learning, cognition, and clinical reasoning. We raise questions regarding the underexplored consequences of AI-assisted documentation, particularly cognitive off-loading and the potential for de-skilling, echoing historical concerns surrounding earlier cognitive technologies that externalized thought. We propose a practical framework that re-centers clinical documentation around four core aims: supporting clinical reasoning ("note to self"), facilitating communication ("note to others"), meeting medicolegal and billing requirements, and enhancing patient education in the era of open notes. Incorporating this framework into training may promote more intentional documentation practices before routine reliance on AI. We advocate for reframing the chart note to support clinician development and preserve its role in high-quality, patient-centered care.