1. Residency Orientation Janet Albers, MD Anna Mies Richie, MD Harald Lausen, DO Southern Illinois University - Springfield

2. New People New Place Different Backgrounds

3. Orientation Objectives Recognize the Challenges –Different backgrounds Ethnicity Age Family Training –Medical knowledge –Clinical skills –Communication skills Address the Challenges –Assessment evaluations Strengths/weaknesses –Team Building –Individualize the curriculum for the resident

4. So much to do… So little time One month –Become a Resident –Become a ‘Family Physician’ –Meet and Greet –Certifications –Assessment –Policies & Procedures –Practice Management –Clinical Operations –Computer Training –Clinical Review and Education

5. As a Resident Responsibility Documentation Learning Teaching Presentations Recruitment Relationships

6. You had a calling to be a physician; there was an even higher calling to be a Family Physician. But what is a Family Physician?

7. Family Residents – SIU We care for more children than pediatric residents We deliver more babies and OB care than OB residents We manage more hospital medicine patients than internal medicine residents

8. Patient Pyramid of Care 250 see a Family Physician 9 see a consultant 5 hospitalized 1 seen at an Academic Medical Center

9. Zoom Zoom in and out of the patient encounter. Approach the patient from all angles Approach the patient plan from all angles. Look at the patient from different angles.

15. Zoom Zoom in and out of the patient encounter. Approach the patient from all angles Approach the patient plan from all angles. Look at the patient from different angles.

16. Meet and Greet People –Faculty (his/her area of expertise) –Class Mentor, Individual Mentor –Residents –Dean –Administrators/Staff –Nurses Places (scavenger hunt) –Clinic –2 hospitals –Call rooms –Springfield

17. Certifications ALSO NALS PALS ACLS BLS

18. Assessments Medical School Performance Self Assessment Multiple Choice Exam Simulated Patient Visits Clinical Skills Competency Assessment

19. Self-Assessment Interests Strengths/Weaknesses –Clinical Disciplines –General Knowledge/Skills –Exam Skills –Office Skills & Procedures –Laboratory –Common Problem Management Learning Style Long-term Goals

20. Multiple-Choice Exam Problem-Solving/Clinical Judgment Basic Medical Knowledge Knowledge of Discipline Diagnosis and Patient Management

21. Simulated Patient Encounters History and Physical Exam Diagnosis and Management Oral Presentation Problem-Solving/Clinical Judgment Knowledge of Discipline Patient Rapport/Professionalism Direct Feedback from Observers and Patients

22. Simulated Patient Encounters Professional Development Lab Two faculty observers –Physician and Behavioral Scientist 2 cases –health maintenance exam – complete H &P with risk factor assessment and patient education skills. –geriatric patient accompanied by her daughter emphasizing interpersonal skills in a difficult interview situation.

23. OSCE Stations Obstetrics perform vaginal delivery review tracing Annual exam history and perform pelvic/pap Gyne questions Peds inpatient admission orders MCQs Ortho knee exam and history MCQs Internal Medicine Admit orders for Chest pain Read ECG MCQs Geriatric Community Medicine Patient Education role playing General Surgery Abdominal pain DDX MCQs Head to Toe Exam

24. Policies & Procedures SIU/Hospitals Curriculum Evaluation Core Competencies Research Project Roles and Responsibilities Sick Time/Vacation/Education Residents as Teachers Duty Hours/Time Cards

25. Practice Management Billing & Coding Referrals Phone Triage Scheduling Reception Medical Records Clinical Performance EHR

26. Clinical Operations Community Agencies Anti-Coagulation Clinic SAC (Senior Assessment Clinic) Diabetic Education Group Classes Mental Health Off-Site Clinics –Gateway, Hope School, OB/Gyn clinics – Girard, Beardstown, and CCHC

27. Computer Training Electronic Health Record Hospital Computer Training x 2 Recording Procedures (New Innovations) PDA Passwords And more passwords

28. Clinical Review and Education Shadowing Hospital paperwork: H & Ps, SOAP notes, discharge summaries, admit orders Fluids and Floor calls ECG reading OB stations ICU/IM review Clinic paperwork: referrals, scripts Surgical Skills Pediatric Physical Exam Skills Ortho stations Evidenced Based Medicine Procedures/Ultrasound/Spirometry

29. OB stations AROM – (water balloon and sock) Cervical Dilation/Effacement Delivery Suturing Episiotomies Triage Situations

30. Shadowing Hospital –Family Medicine Teaching Service –Call with PGY-2/3 OB floor –With PGY-2/3 Clinic –With Faculty

31. Healthy Physician, Healthy Patient Overall Wellness: physical and mental Wellness Activity: –BP, Weight, BMI, Bone density Burnout Sleep Deprivation Impairment/Substance Abuse Goal Setting Stress Level

32. Bonding/Teamwork Dinners Cultural Competency ROPES Course Scavenger Hunt Ballint Group Pool party

33. Professionalism Interpersonal Skills Core Competency Cultural Competency Videotaping Self-assessment Case Examples – role playing

34. 2 nd and 3 rd Year Orientation Triage Nursing Home Residents asTeachers Senior Responsibilities Practice Management

35. Overview of a Day AM –Hospital rounds Noon –Orientation lecture »Clinic ops, practice management, clinical education PM –Certifications, clinic shadowing, assessments or clinical education

36. Overview of the Month Orientation Day Certifications – ACLS, ALSO, NALS, BLS In-service exam and self assessment OSCEs Scavenger hunt Simulated patient assessment Clinic operations, policy and procedures, practice mgmt Computer Training Hospital rounds daily Clinical learning activities – OB, Peds, ICU, Ortho, ECGs, IV fluids, surgical skills, paperwork Clinic shadowing Common Problems Presentation

37. What to do with the assessment data? RESIDENT FACULTY/MENTOR CURRICULUM

38. SUMMARY Time and resource intensive First step of many steps Valuable investment - individual resident and program development

39. If we always do what we’ve always done Then we’ll always get what we’ve always got. Wisconsin Factory Worker We continue to change the orientation as needed.