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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:[email protected]
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?