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Mentoring Conversations: Reflective Writing Exercises for Interns

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Presentation on theme: "Mentoring Conversations: Reflective Writing Exercises for Interns"— Presentation transcript:

1 Mentoring Conversations: Reflective Writing Exercises for Interns
MAJ Jason Sapp, MD, FACP Associate Transitional Year Intern Program Director Madigan Army Medical Center Tacoma, WA 7 January 2015

2 Disclosure No conflicts of interest to report.
The views expressed are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.

3 Agenda “My Mistake” overview Milestone analogy
Mapping “My Mistake” to milestones Quality improvement opportunities “My Reflection” overview Mapping “My Reflection” to milestones

4 Poll Question 1 Does your program have a formal resident morbidity and mortality conference, or something similar to this? -Yes -No

5 Poll Question 2 Does your program have a quality improvement process tied to a resident-led morbidity and mortality conference (or something similar)? -Yes -No

6 “My Mistake” Project

7 “My Mistake” Project Second half of the academic year
Residents summarize a mistake they or their team made Written reflection Oral presentation and discussion My Mistake is a tool that is used to help residents understand how their interactions in the medical system can affect and improve patient care. It occurs in the second half of the academic year. Residents summarize a mistake they or their team made during the first half of the academic year by preparing a written reflection of the event using a template format in the MyEvaluations.com system. Each resident will present their mistake and lead a class discussion at one of the TY resident meetings which occur every other Tuesday at noon in the TY resident workroom.

8 “My Mistake” Project Give a brief description of the circumstances surrounding the mistake: What was your specific role in the mistake? What factors contributed to the mistake (i.e. fatigue, miscommunication…)? What did you do when you realized the mistake was made?

9 My Mistake Project Did you tell your team and how did they react?
Did you or someone from your team tell the patient (if a patient was involved)? How did the patient or patient’s family react (if a patient was involved)? What could be done to prevent others from making this same mistake?

10 Common Mistakes Sign out or transfer errors Order entry errors
Nursing interactions Examples of common mistakes include: sign out or transfer errors, order entry errors, and nursing interactions. Fatigue, miscommunication, and knowledge deficits are a few factors that can lead to errors.

11 Factors Leading to Errors
Fatigue Miscommunication Knowledge deficits My Mistake is a tool that is used to help residents understand how their interactions in the medical system can affect and improve patient care. The My Mistake project will occur in the second half of the academic year. Residents will summarize a mistake they or their team made during the first half of the academic year by preparing a written reflection of the event using a template format in the MyEvaluations.com system. Each resident will present their mistake and lead a class discussion at one of the TY resident meetings which occur every other Tuesday at noon in the TY resident workroom. Useful recommendations from this meeting are relayed to the appropriate hospital committee or department when applicable. At the conclusion of all resident presentations, residents will choose one topic and perform a group quality improvement project. This group topic is usually a patient safety theme that persisted throughout the resident presentations. Examples of common mistakes include: sign out or transfer errors, order entry errors, and nursing interactions. Fatigue, miscommunication, and knowledge deficits are a few factors that can lead to errors. A member of the TY faculty leadership (program director or associate program director) will complete a milestone-based evaluation of the written reflection and oral presentation. The evaluation includes milestones from the competencies of Interpersonal & Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems-Based Practice.

12 Milestone Analogy

13 Milestone Ambulate without assistance
Practicing physician Residency graduate TY graduate (12 months) Expert Half way through TY year (3-6 months) Proficient After medical school Competent Advanced Beginner The 5 Dreyfus Levels Novice Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in directed skill acquisitions. February 1980

14 Half way through TY year
Milestone Example SBP2: Works in interdisciplinary teams to enhance patient safety and improve patient care quality Dreyfus Level 1 Novice Dreyfus Level 2 Advanced Beginner Dreyfus Level 3 Competent Dreyfus Level 4 Proficient Dreyfus Level 5 Expert Recognizes failures in teamwork and communication in health care as a leading cause of preventable patient harm Works with other members of the health care team to identify system errors and areas of potential quality improvement Works in interdisciplinary teams to identify solutions (action plans) to identified system errors Analyzes team experience and works with the team to enhance patient safety and care quality in the specialty area Leads interdisciplinary teams to improve health care delivery systems After medical school Half way through TY year TY graduate Resident graduate Practicing physician

15 Milestones Milestone committees define levels
Practicing Physician End of PGY-3 Graduation Expert End of PGY-2 Year Proficient End of PGY-1 Year Competent Medical school graduate Advanced Beginner The 5 Dreyfus Levels Novice Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in directed skill acquisitions. February 1980

16 Mapping “My Mistake” to Milestones

17 Competencies Addressed
Systems Based Practice Practice Based Learning and Improvement Professionalism Interpersonal and Communication Skills A member of the TY faculty leadership (program director or associate program director) will complete a milestone-based evaluation of the written reflection and oral presentation. The evaluation includes milestones from the competencies of Systems-Based Practice, Practice-Based Learning and Improvement, Professionalism, and Interpersonal & Communication Skills.

18 TY Milestones

19 Milestone Evaluation 0 – No opportunity to assess these skills 1 – Not demonstrated 2 – Developing 3 – Consistently demonstrated

20 Milestone Evaluation

21 TY Milestones

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27 Family Medicine Milestones
This “My Reflection” curriculum is a quarterly learning activity to allow residents to reflect on a specific event, situation, or learning point they encountered during one of their rotations. The project does not need references, only the resident’s thoughts, self-reflection, and identification of strengths, weaknesses, and plan for improvement. Residents will complete four My Reflection projects during the academic year on the following topics: 1) Cost-conscious patient care 2) Patient diversity and vulnerable populations 3) Ethical dilemma and personal belief system 4) Managing personal wellbeing in the setting of clinical duties. The program coordinator will assign a MyEvaluations form each quarter which the resident will use to complete their quarterly project. The due date will be specified in an sent to the residents. Residents may choose to complete the topics above in any order they choose, but must do a write-up on each topic during the year. It is recommended that residents choose their topics based on situations they have encountered during their rotations. For example, if a resident experience an ethical issue during the first quarter, they should consider doing the My Reflection project on the “Ethical dilemma and personal belief system” for that quarter. If residents are not familiar with the topics above, it is recommend they read about the topics to gain an understanding before doing their write-up. These topics were chosen in order to gain insight into the residents’ understanding of these topics. These topics also relate to Transitional Year Resident Milestones. The projects will be graded by the program leadership using a MyEvaluations.com form and used to determine the developmental level of residents on these topics as they relate to the milestones. A copy of the evaluation form and milestones can be found on the TY SharePoint site at in the left margin under “Resident evaluation forms” and “TY Milestones & Requirements.” Projects will be due prior to quarterly counseling sessions so feedback can be given when residents meeting quarterly with their program leadership. Overall Goals  Using the My Reflection curriculum, residents are expected to demonstrate an ability to analyze their own practice for needed improvements through self-reflection.  Residents are expected to understand the interaction of their practices with the larger system, display knowledge of practice and delivery systems, and be an advocate for patients within the healthcare system.  Residents are expected to gain sensitivity to culture, age, gender, and disability issues through self-reflection of learning situations that may occur during each rotation.

28 Quality Improvement Opportunities

29 My Mistake Project Information/recommendations relayed to the appropriate hospital committee or department One topic  group quality improvement project Useful recommendations from the My Mistake presentations are relayed to the appropriate hospital committee or department when applicable. At the conclusion of all resident presentations, residents will choose one topic and perform a group quality improvement project. This group topic is usually a patient safety theme that persisted throughout the resident presentations.

30 “My Reflection” Project

31 Poll Question 3 Does your program have a means to capture and evaluate resident experiences and insight on topics such as cost-conscious/high-value care, vulnerable populations, ethical dilemmas, and/or personal well-being? -Yes -No

32 Question 4 How do you approach these topics with the residents?

33 “My Reflection” Project
Quarterly learning activity Reflection of a specific event, situation, or learning point during one of their rotations Written summary: Resident’s thoughts Self-reflection Identification of strengths and weaknesses Plan for improvement The “My Reflection” project is a quarterly learning activity that allows residents to reflect on a specific event, situation, or learning point they encountered during one of their rotations. The project does not need references, only the resident’s thoughts, self-reflection, and identification of strengths, weaknesses, and plan for improvement.

34 Topics 1) Cost-conscious patient care
2) Patient diversity and vulnerable populations 3) Ethical dilemma and personal belief system 4) Managing personal wellbeing in the setting of clinical duties. Residents will complete four My Reflection projects during the academic year on the following topics: 1) Cost-conscious patient care 2) Patient diversity and vulnerable populations 3) Ethical dilemma and personal belief system 4) Managing personal wellbeing in the setting of clinical duties. The program coordinator assigns a MyEvaluations form each quarter that the residents use to complete their quarterly project. Residents may choose to complete the topics above in any order they choose but must do a write-up on each topic during the year. We recommend that residents choose their topics based on situations they have encountered during their rotations. For example, if a resident experience an ethical issue during the first quarter, he or she should consider doing the My Reflection project on the “Ethical dilemma and personal belief system” for that quarter. These topics were chosen in order to gain insight into the residents’ understanding of these topics. These topics also relate to Transitional Year Resident Milestones.

35 “My Reflection” Questions
Summarize the case or experience you will reflect upon: Briefly describe why you chose this case or situation to reflect upon:

36 “My Reflection” Questions
Self reflective statement: Identify individual deficiencies or strengths, system deficiencies or strengths, and/or areas of varied practitioner approach as they pertain to your case. Devise a plan for improvement of self or the system if needed. Assess what you learned from this case / experience and how it will change the way you practice medicine in the future. If applicable, devise a plan for improvement / future learning.

37 Mapping “My Reflection” to Milestones
The projects will be graded by the program leadership using a MyEvaluations.com form and used to determine the developmental level of residents on these topics as they relate to the milestones. Projects will be due prior to quarterly counseling sessions so feedback can be given when residents meeting quarterly with their program leadership.

38 Competencies Addressed
Systems Based Practice Professionalism Interpersonal and Communication Skills

39 TY Milestones

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45 Family Medicine Milestones

46 Summary “My Mistake” overview Milestone analogy
Mapping “My Mistake” to milestones Quality Improvement Opportunities “My Reflection” overview Mapping “My Reflection” to milestones

47 Questions? jason.e.sapp2.mil@mail.mil


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