Exploring the Value of a Systematic Approach to Orienting New Interns Deborah Taylor, PhD Donald “Raj” Woolever, MD Central Maine Medical Center FMR WELCOME TO OUR FAMILY

Bringing New Members into our Residency “Family” The Mandate –ACGME and AOA requires? The Literature List-serve Survey says….. Our “Wheel” –The “Central Maine Way” How does ours compare to yours?

Literature Review 3 major articles –1 in 1991, 2 in 1999

Ideal Orientation Goals (per the literature) Hospital Services & Administration Office and Rotation Functions Group Cohesion Night Float & Call Duties/Responsibilities Individual Support Services Clinical Skills Assessment and Preparation Grover, M & Puczynski, S. Residency Orientation: What we present and its effects on our residents. Family Medicine, Nov-Dec 1999: 31(10), pp )

Literature Review 3 major articles –1 in 1991, 2 in 1999 Many changes since then…. –EHR/EMR inpatient & outpatient –Patient Centered Medical Homes Team Based Care Asynchronous –Duty Work Hours Requirement for curriculum re: fatigue, impairment, etc.

The “Central Maine Way” Embedded in Rot 1 – Family and Community Medicine 2000 – decided to create a curriculum vs “winging it” – the former CM way! Re-invented a wheel (we now realize) Faculty Defined Goals Evaluation Feedback (focus group) –Made adjustments to subsequent year

Our Curricular Goals Intro to Family Medicine Get to know the FMR Get to know the FMC Community Orientation Hospital Orientation –Certification Classes Computer Training –e-learning resources Patient Care Wellness/Self-Care

Intro to Family Medicine Didactic Discussions –The Core Values –Choosing Wisely –Contextual/Patient Centered Care –IHI Triple Aims –Caring for the Elderly & Those at End of Life Genogram Workshop Values Clarification

Get to Know the FMR Nuts and Bolts (resident manual, policies, etc) Call Schedule Portal and Portable Resources Challenger, New Innovations, Self Directed Learning Competencies - Milestones/Portfolios Mtgs with Academic Advocates (advisors) Welcome Lunch for New Interns with FMR Teaching Skills Curriculum Intro to the WIMPs Intro to RSP expectations

Get to Know the FMC EMR (Centricity) Training Orientation afternoon to the FMC Team Desktop Mgmt/Charting/Coding Special Populations Patient Care (four ½ day sessions each) Office Visit Stations afternoon* Office Procedure Skills Workshop Wendling, A. & Baty, P. A Step Ahead-Evaluating the clinical judgment skills of incoming interns. Fam Med, Feb, 2009:41(2): pp

Community Orientation Community Service Day (Interns only) Community Service Afternoon (in teams) Mtg with Jen Fish (an “old fashioned” SW) Walking Tour Local Community Agency Lunch Fair Photos/Publicity

Hospital Orientation Hospital Tour geared to Interns Certifications (BLS, ACLS, NRP) IT –Health Info Mgmt Orientation –EMR-Cerner Orientation –CPOE Library Orientation Benefits Mtg Mtg with Organizational Leadership and Key Dept Heads Daily 30 minute “morning report” of intern topics (flr/call prep) Rotation Orientation (1/2 day – w#4) Scavenger Hunt (w#4)

Wellness/Self-Care/Group Cohesion 1 st year lunch Day 1 All resident lunch Day 2 Evening at PD’s house with families (w#2) Intern Retreat Evening (BH faculty & chiefs) Resident Weekend Event – chiefs plan (w#3) Faculty Pot Luck Week (w#4) “SIT” Intro to Wellness (assessment, buddies, etc) Coffee and Logowear

Setting The Tone: a critical orientation “mission” Patient Centered Contextual Care Maintaining Empathy (loving the unlovable) Professionalism Team Spirit – Power of Positive Intention Importance of Communication Value and Expectations of Their Work “Family”

Our CQI Process Secure feedback each year –focus group format Based on literature search –should include 6 month focus group Examples of feedback –Positive – what facilitated the interns’ competence or experience –Needing Correction – what was not timed properly or delivered by the right person and what was not helpful at all and why

In Summary – the ABC’s Advocate for the creation of a formal Orientation curriculum with agreed upon goals and objectives Be sure to not only immediately measure your curricular success but also do a repeated measure to assure value Critical to set the tone/create the culture you wish your new residents to embrace during their 3 or 4 years with you

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