Creating an effective orientation

UW Family Medicine Residency Network Webinar

August 2015

Creating an effective orientation

UW Family Medicine Residency Network Webinar

August 2015

Creating an effective orientationa kick-ass

UW Family Medicine Residency Network Webinar

August 2015

Creating an outstanding orientation

UW Family Medicine Residency Network Webinar

August 2015

Shannon U Waterman

Swedish Family Medicine Residency - Cherry HillSeattle, WA

“4 Sites: One Program” (soon to be 5 urban, underserved sites + RTT)

FacultyFormer Associate PD and Clerkship Site Director

Questions to answer

• What are our program’s goals for orientation?• How much time can we carve out of our

curriculum?• Is there benefit to a protected block of time

up front? • Are there developmental reasons to present

some content later in the year?

Would be helpful to know about your experiences:

Logistics POLL

Priorities POLL

Longitudinal POLL

Orientation Challenges

Barriers

• Time

• Faculty skills

• Service demands

• Geography – distant sites

Possible Solutions

• PD/AD commitment to protected faculty time

• Community resources

• “Super R1”• Hospitalists

• Start prior to first block• Dedicated clinic days

“What is lacking?” POLL

CHFM Orientation Goals

• Administrative (paperwork, badging, EHR)

• Orientation to curriculum

• Orientation to the communities we serve

• Skills development and reinforcement– Establish common knowledge base – Skills for high stakes situations

CHFM Goals• Get established in clinic • Cohesion and “bonding” of class– sociograms (3 hr) – intern/faculty lunch (3 hr) – yarn ceremony (45 min)– chief resident outreach/”buddy” systems

• Professionalism• Future: Early assessment - OSCE

Cherry Hill Experience

• 5 ½ weeks of orientation – Block 1 + week and a half

• No call. Mandatory participation. Predictable clinic days (Thurs PM/Fri all day)

• Dedicated faculty creates schedule, coordinates community resources

• Collaboration with residency administrator• Weekly evaluation (survey monkey)• No OSCE (understaffed)

Learner centered orientation

“Logical progression” of topics may not be helpful.

Be willing to START by addressing where each intern will go the first day of their first rotation (senior “buddy” to talk to about the rotation, review the syllabus), where to put their lunch, etc.

Some topics are best presented over time.

Electronic medical record longitudinal orientation

Professionalism

Professionalism• Interviewing skills– Screening for substance use– Intimate partner violence– Motivational interviewing/behavior change/BATHE– “Saying No”

• Self care and burnout prevention– Meditation and mindfulness practices modeled– Narrative medicine workshop– Longitudinal curriculum (Balint, R1 support group)

• Perfectionism – “The Imperfection Option” workshop (3 hr)

“The Imperfection Option”

– Pre-work: Watch Brené Brown’s TED talk “The Power of Vulnerability”

– Perfectionism: a habit of mind, gap between reality and ideal

– Alternative model: “Health Striving”

Hallmarks of Perfectionistic Mind

• Grandiosity• Focus on Product over Process • Focus on External Rewards over Internal Ones • Deprecation of the True Processes of Creativity and

Career-Building • Overly moralistic self-evaluation• Labeling• Hyperbole and generalization• Dichotomous thinking• An overly active system of self-commands• Procrastination

“The Imperfection Option”

• Explore 4 strategies for developing more helpful habits of mind. – Direct inquiry

• Radio stations metaphor – 3 other strategies– KGAP or KFKD – the Perfectionistic Station– Alternative “stations” – KLUV, KLRN, KHUM– Writing, drawing, read commentary from

artists/authors/scientists/spiritual thinkers– Exercises in self compassion

– impact on patients

Professionalism POLL

Questions to answer

• What are our program’s goals for orientation?• How much time can we carve out of our

curriculum?• Is there benefit to a protected block of time

up front? • Are there developmental reasons to put some

content later in the year?

Shannon U Waterman

Swedish Family Medicine Residency - Cherry HillSeattle, WA

Questions or comments?Please email me at:Shannon.waterman@Swedish.org

Mindy Udell MD

ORIENTATION

UW FAMILY MEDICINE RESIDENCYNETWORK WEBINAR

2015

Part of Community Health of Central Washington 10 – 10 – 10 Residency

8 – 8 - 8 Yakima 2 – 2 – 2 Ellensburg

Yakima Valley Memorial Hospital Yakima Regional Cardiac Center Yakima Neighborhood Health (Obstetrics) Memorial Pediatric Hospitalist Service Central Washington Family Medicine CHCW Ellensburg Senior Residential RCare

CENTRAL WASHINGTON FAMILY MEDICINE RESIDENCY PROGRAM

Admin Hospital Boot Camp

Clinic Boot Camp Practical Experience

ON YOUR MARK…

Orientation Clinic Teams Lead RN’s OB Team/OB triage skills GYN Clinic Manager Nurse Manager EMR systems Regional Hospital Memorial Hospital

Review Hospital H&P Admit orders Presentations SOAP notes

Resources Care

Coordinators/Community Resources

Behavioral Health Consults PAML lab Clinic Pharmacy RN teams

Education Hospital billing Clinic billing Core hospital disease

lectures Intro to hospital Pediatrics Top calls on Clinic phone call

(peds/adults) EKG’s Radiology review

Bonding time Resident Rafting Retreat Passing of the baton Senior Advice (prior to FMS) Day in the life of a resident Community service CWFM in review (skits from

each class and department) Clinic Scavenger Hunt Hospital Scavenger Hunt

Self Care Resident Fatigue Self Management Skills

Patient Centered Communication Dealing with diffi cult

patients Patient Centered

Interviewing Skills

Teaching Residents as teachers How to give SMART

feedback

GET SET…

Getting ReadyShadow ClinicsOwn ClinicOB clinicFamily Medicine Service Team

Paired CallHospital ServiceOB service

TestsNRPACLSHospital OSCEClinic OSCEPhysical Exam OSCE

GO!!!!

OSCES

Why are residents let go of a residency program?

POLL

POLL

What keeps Residency Programs from building standardized exams?

POLL

What does your residency program do with information gathered from orientation?

SCENARIO: RESIDENT WAS VERY RUDE TO THE STANDARDIZED

PATIENT AND NO RAPPORT WAS BUILT

THANK YOU Questions?