1 INTERNAL MEDICINE INTERNAL MEDICINE BEGINNING YOUR RESIDENCY July 16, 2014 G. Fitzgerald-Codd Academic Skills Coordinator UCI, School of Medicine

2 “Change Points” ? Points during their medical education experience when Medical Students and Residents must adapt: New study/learning strategies New study/learning strategies New perspectives re: their Time Management and Organizational Skills New perspectives re: their Time Management and Organizational Skills New test-taking approaches and strategies New test-taking approaches and strategies

What Do New Residents Encounter? New environment New environment New culture New culture New schedule New schedule New routine and rules New routine and rules 3

4 Research on Transitioning from Medical Student to New Resident Literature is replete with information on various transition points, difficulties, tips to survive the transition year Literature is replete with information on various transition points, difficulties, tips to survive the transition year Following information taken from Yao & Wright (Journal of General Internal Medicine 2001: 16: ) Following information taken from Yao & Wright (Journal of General Internal Medicine 2001: 16: )

5 Why Resident’ Problems Arise Literature confirms 3 distinct causative areas : Literature confirms 3 distinct causative areas : Insufficient use of time (44%) Insufficient use of time (44%) Insufficient knowledge (48%) Insufficient knowledge (48%) Poor clinical judgment (44%) Poor clinical judgment (44%)

Demands of a Resident’s Schedule Results in: New stressors and challenges New stressors and challenges Need to do more Need to do more Need to read and study more Need to read and study more Less time to accomplish it all Less time to accomplish it all 6

Lack of Time Results in: Less time for things that make you unique Less time for things that make you unique Personal neglect Personal neglect Inability to keep pace with studies Inability to keep pace with studies Sleep deprivation Sleep deprivation 7

Coping With Stress Physical and mental stressors in residency training can contribute to a resident’s poor performance (Firth-Cozen, Morrison, 1989) These stressors can be further delineated under 3 areas: situational, personal, and professional (Resident Services Committee, Association of Program Directors in Internal Medicine, 1988)

9 STRESSORS Situational: starting a new job, moving to a new environment, sleep deprivation. Situational: starting a new job, moving to a new environment, sleep deprivation. Personal: family situations (e.g., marriage, parenting) or financial issues (e.g., educational debts) Personal: family situations (e.g., marriage, parenting) or financial issues (e.g., educational debts) Professional: more complex situations, difficult patients, and career planning issues. Residents have noted that factors such as excessive workloads, chronic fatigue, and frequent on-call responsibilities contribute to their lack of psychological well-being (Butterfield, 1998). Professional: more complex situations, difficult patients, and career planning issues. Residents have noted that factors such as excessive workloads, chronic fatigue, and frequent on-call responsibilities contribute to their lack of psychological well-being (Butterfield, 1998).

Cognitive Impairment Kahn & Addison (1992) define cognitive impairment as “a state in which the resident’s ability to care for self or others, particularly patients,, is hampered because of stress, emotional illness, or substance abuse.” Small ( 1981) described 7 features of house-officer stress syndrome; four occurring in most residents and the remaining three being more suggestive of serious impairment.

Four Dimensions of Stress 4 features of stress syndrome found occurring in most Residents (Small, 1981): Episodic cognitive impairment (due primarily to sleep deprivation) Chronic anger Pervasive cynicism Family discord

12 Sleep Deprivation Manifests in several ways: Poor judgments Poor judgments Poor organizational skills Poor organizational skills Poor time management skills Poor time management skills Poor planning Poor planning

My Role Academic Skills Coordinator Academic Skills Coordinator Conduct assessments Conduct assessments Consultation/conference Consultation/conference Assist with organizational skills, test-taking strategies and time management Assist with organizational skills, test-taking strategies and time management 13

14 Main Reasons Residents are Referred Main Reasons Residents are Referred In-Service Training Exam (ITE) performance In-Service Training Exam (ITE) performance Step 3 Board score failure Step 3 Board score failure Test-taking strategies Test-taking strategies

15 Process When Referred Resident sets up appointment/s for: Assessment battery Assessment battery Consultation/conference Consultation/conference

16 Possible Problematic Areas Test-taking strategies, organizational and time-management concerns Test-taking strategies, organizational and time-management concerns Sleep deprivation Sleep deprivation Knowledge gaps Knowledge gaps

17 Time Management Need to manage your time differently, effectively, and efficiently. Ask yourself 4 questions: How do you use your time? How do you use your time? Have you devised a new study plan? Have you devised a new study plan? Do you have a daily schedule? Do you have a daily schedule? Do you keep a daily schedule? Do you keep a daily schedule?

18 5 Categories of Problems Residents May Encounter Category 1: Medical Professionalism: Category 1: Medical Professionalism: Reynolds (1994) defines medical professionalism as: “serving the interests of the patient above one’s own interest. Professionalism aspires to altruism, accountability, excellence, duty, service, honor, integrity, and respect for others” (Reynolds, 1994). Reynolds (1994) defines medical professionalism as: “serving the interests of the patient above one’s own interest. Professionalism aspires to altruism, accountability, excellence, duty, service, honor, integrity, and respect for others” (Reynolds, 1994). Yao & Wright (2001), further add: “While there is little evidence about the best way to teach professionalism to residents with a deficiency in this area, role modeling by faculty and resident colleagues is believed to be important.” Yao & Wright (2001), further add: “While there is little evidence about the best way to teach professionalism to residents with a deficiency in this area, role modeling by faculty and resident colleagues is believed to be important.”

19 Category 2: Emotional Impairment “Emotional impairment, including depression and post-traumatic stress disorder symptoms, is not uncommon during residency” (Samkoff & McDrmott, 1987; Klamen, Grossman, & Kopacz, 1995). “Emotional impairment, including depression and post-traumatic stress disorder symptoms, is not uncommon during residency” (Samkoff & McDrmott, 1987; Klamen, Grossman, & Kopacz, 1995). Situational, personal, and professional domains of stressors may also overlap. Situational, personal, and professional domains of stressors may also overlap.

20 Preventive Management Some things you can do to maintain homeostasis as you begin your residency: Set up a new schedule template Set up a new schedule template Stick to your new schedule; tweak as needed Stick to your new schedule; tweak as needed Importance and necessity of sleep should not be underestimated Importance and necessity of sleep should not be underestimated Exercise Exercise Set aside some downtime Set aside some downtime

Maintain Personal Wellness Wellness is a state of psychological & physical well being: It helps you to maintain balance between your residency and life It helps you to maintain balance between your residency and life It makes you a better person, doctor, partner, and friend to others and self It makes you a better person, doctor, partner, and friend to others and self It enhances your general happiness, work, relationships, hobbies, & other interests It enhances your general happiness, work, relationships, hobbies, & other interests 21

Q & A Q & A ANY QUESTIONS? ANY QUESTIONS? 22

Contact Information Phone: (949) Medical Education Bldg. UCI, School of Medicine Irvine, CA