1. A Day In the Life A simulated reality experience in family medicine residency orientation Timothy Pieh, MD and Cheryl Seymour, MD Maine-Dartmouth FMR STFM Annual Conference, May 2009

2. Introductions Who are we? Who are you?

3. Today’s objectives…  Understand our rationale for trying something new in orientation  Review the detailed schedule, objectives, curriculum, video and feedback for A Day In The Life  Reflect on the use of this type of experience in your residency

4. Tell us about your interns…  What are they most anxious about?  What are their clinical learning needs in orientation?

5. Tell us about your orientation…  What are you trying to accomplish?  What are the clinical components?  Does it meet intern’s needs?

6. Orientation at Maine-Dartmouth  Meet & greets  Admin & logistics  ACLS & NALS  2 weeks neonatal  2 or 3 “calls”  One OSCE Too long and boring!

7. Our dilemma and our idea… How to engage interns clinically during a mind-numbing orientation? We have: Limited time, no money 2 part-time junior faculty Many roadblocks to using the “real” inpatient environment for learning

8. Our dilemma and our idea… We want: High impact, high energy Efficient use of time Maintain interns as a group Impart culture & skills Simulated reality

9. A Day in the Life Goals 1  Foster a sense of individual empowerment and manage anxiety about starting internship  Create a sense of trust and collaboration among intern class  Familiarize interns with logistics & “cultural norms” of executing common tasks in the inpt setting

10. A Day In the Life Goals 2  Briefly review medical knowledge and clinical skills relevant to key inpatient FM topics  Integrate knowledge and skills from orientation tours, lectures and EMR classes into “real-life” format  Generate enthusiasm for the practice of family medicine

11. A Day in the Life What we actually did  ER evaluation  Admission orders  Attending presentation  Labor evaluation  Mother phone call  Nursing home phone call  Floor call “pandemonium”  Cross-cover note  Resident sign-out  CCU transfer  Consultant presentation  CODE 99

12. A Day in the Life What we simulated  Hectic pace  Constant interruptions  Frequent uncertainty  Complex communication  Need for team-work  Emotional context of work In a safe environment with a pause button…

13. A Day in the Life A few highlights  The day begins…  Attending phone call  Use of “real” order & triage forms  Use of actual EKGs, CXRs, FHT  Models for cervical exam, code  Consultant call & code (with family)  Floor call pandemonium

14. The simulation in real time…

15. What did the residents think?

16. The anonymous survey says… 47114711 After “A Day in the Life” I felt less anxious about starting internship.

17. The anonymous survey says… 6767 “A Day in the Life” brought us closer together as a class.

18. The anonymous survey says… 373373 I was adequately introduced to the norms and duties of the inpatient service.

19. The anonymous survey says… 382382 This workshop made me feel excited about family medicine.

20. What we would do differently…  More incorporation of EMR  Use of yellow pads to maintain flow  Meeting diverse individual needs but maintaining a cohesive group experience  Continued investment of time and energy in the details of orchestrating the simulation – the more “real” the better.

21. Could this work for you?