Facilitating the Success of International Family Practice Residents A Pre-Orientation Program Cheryl K.Seymour, MD & Karen Gershman, MD Maine-Dartmouth Family Practice Residency Program NE Regional STFM, October 2006

Objectives Discuss challenges faced by international medical graduates in FP residencies Review traditional strategies for facilitating success in our program and others Share our Pre-Orientation program Discuss your ideas and feedback

Barriers to Success Bias & Prejudice Residency faculty & Resident colleagues US Medical student applicants Hospital and office staff Patients Variability of quality of training Limited access to US clinical experiences

Facilitating Success Most interventions address prejudice Explore cultural differences Build relationships between co-workers Genograms, Family histories International dinner parties, Ropes courses

Facilitating Success Verbal communication skills Interviewing techniques Cultural differences in approach to the patient-doctor relationship Didactics Medical Knowledge Structure of US Health care system

Pre-Orientation Themes “The culture of medicine” Primary barrier to success is a lack of familiarity with the process of health care delivery These skills, unspoken rules, & traditions are “absorbed” and modeled in US third and fourth year clerkships.

Pre-Orientation Themes Clinical Coaching Real-time, interactive practice of care delivery Survival Skills Time and data management Self-Assessment Set personal goals, collaborative evaluation

Survival Skills Where is the bathroom? Online scavenger hunt Flow sheets and pocket books History of Maine-Dartmouth What is Osteopathy? Closed-door panel discussion

Clinical Coaching Experiential integration of clinical topic with specific skills of care delivery Chest Pain Interactive case presentation EKG interpretation Telephone call to consultant Writing H&P and admit orders

Clinical Coaching Real-time practice of challenging communication scenarios Phone calls – mothers, drug-seekers Real phones, no visual clues Approach to the office visit Sign-out rounds

Clinical Coaching

Self-Assessment Personal goal setting at beginning & end Review of In-training exam questions Summative feedback to facilitate development of individualized learning plan with advisors

Logistics One month, unpaid, voluntary No direct patient contact – no malpractice Clinical coaches: senior residents & faculty Integration with existing Orientation Binder of sample notes and orders, data flow sheets, review articles, goal worksheets

Positive Outcomes Improved rapport with faculty and senior residents, less fear of judgment Improved awareness of individual needs & strengths prior to officially starting residency Medical cultural norms and expectations clear and consistent from the outset

Next Steps How could we improve? Do these ideas resonate with your experiences with international medical graduates? How can you facilitate success in your own residency program?