Hospitalist Resident Education Reclaiming the Golden Apple Simulation HAR AT & Float

1. Hospitalist Resident EducationReclaiming the Golden Apple Simulation HAR AT & Float

2. Simulation

3. % of Participants Who Agree or Strongly Agree with Each Statement

4. % of Participants Who Agree or Strongly Agree with Each Statement Significant improvement from prior years! Still room for improvement in orientation.

5. Self-reported competency to accomplish goal pre and post simulation % reporting agree or strongly agree that they’re competent

6. Nice increase in subjective pre/ post competency for all learning objectives. Highlighted areas have room for improvement. Ideas include: Change question on eval to “initial management of shock” Provide focused take home points verbally and in writing at end of cases.

7. ChangesMoving sepsis to Orange for larger impactAll in sim center until tech hiredInitiativesTake home point handouts in sim center folders - Elena, AnuBehavior change eval 1st to 4th quarterAttendings presence at fellow-led sessions Fellow feedback & team assessment*Reminder, please collect evals*

8. Group DiscussionHow to improve orientation – see facilitator guide for topics to cover, tell them how long the scenario will run for (5-7 minutes), ask the tech to set manikin to “normal” mode and let them examine, orient to wall, supplies in drawers and monitor. Consider removing code cart from room. Give them an idea of expectations during the debriefing.

9. Hospitalist Admitting Resident

10. Not bad compared with other difficult rotations.

12. Goal violations = 0. If Bed Czar will be late, please call resident and arrange for contingency plan with PHAST AM or other senior/ attending.

16. InitiativesSupport Orientation Q Monday at 5:30 in doc box regardless of whether this is their first rotationDaily huddle at 5:30 in doc box w/ Bear Direct and Bed Czar. – will create checklist based on suggestions from meetingFeedback Med Hub on the fly evals x2/week, Discuss verbal feedback & feedback from day attending? Will discuss with PHAST docs at next meeting. AT 4 Process Consider reviewing with residents to see where we can clarify. Night PHAST NP Sun/ Mon when most likely to be activated.

17. Academic Teams

18. Overall evaluation yellow = <80%Overall 4.19/5Attending availability 4.54/5Educational interactions w/ attendings 4.40/5Did teaching occur 3 times/ week? 1.83/2Quality of teaching rounds 4.1/5Patient care related teaching - quantity 2.35/3Patient care related teaching – quality 4.18/5Independence 4.35/5Involvement as team member 4.51/5Procedural experience 3.35/5Achieving stated rotation goals 2.38/3

19. Duty HoursSeniors leave late beginning of year: plan to help observe sign out week 1 of intern block.Late intern sign out : Interns update sign out when run the list at 3pm. Everyone must sign out at 5pm. Weekends: Post-call intern must leave at 9:30 am (even if rounds aren’t finished). Day intern leaves late. Run the list early to help with tasks and encourage enforcement of sign out time.

20. Duty Hours – from ACGME if interestedYellow italicized items are most likely to be violated during our rotationsMax hours/ week – 80 averaged over 4 weeks (including all inhouse activities and moonlighting)Mandatory time off – 1 day in 7 averaged over 4 weeksMaximum shift length – PL1 16 hours, PL2 and higher 24 hours (w/ strategic napping after 16 hours) + 4 for transition of careMinimum time off between shifts – Should have 10 hours, must have 8 hours. 14 hours off after 24 hour call. More flexible for PL3 “to prepare for future duties”.Night shift frequency – no more than 6 consecutive shiftsCall frequency (PL 2 and greater) – no more than Q3days averaged over 4 weeks. At home call – does not ascribe to call frequency rule. Does count in total duty hours.

21. StrengthsFellows & attendings committed to teaching “I’ve learned the most on this rotation out of any I have encountered so far.” “Running the list in the afternoonSharing work “Discharge assistance on weekends” Fellows & attendings willing to do scut work Autonomy in patient care “opportunity to do admissions and think through problems …”Attending contact “Most attendings would call during the night to run the list, which I appreciated.”Feedback “productive feedback” “most useful feedback on nights was emails re: my H&Ps”Busy rotation “Pushes resident to become efficient clinicians and diagnosticians”

22. Weaknesses Lack of awareness of resources/ teaching calendar ResidentBook, information in roomsPatient volume “Too high patient volume”Attending continuity “It would’ve been great to have 2 attendings for 2 weeks rather than 3 attendings . It takes some time to get acclimated to the workflow of an attending and figure out their other functions.”Senior autonomy “With some attendings it is very difficult for seniors to feel like they’re leading the team”“Weekend days are overwhelming”Metabolism teaching“Sign out is not a protected time”Separate room for AT 1 OSCE – procedures, handoffs, PE teaching

23. Resident suggestions for improvement“Earlier disposition planning” (!!!)“Afternoon mini-rounds”“Stop FCR at 10:15 [then remainder of the list in conference room]. “Designate which patients will have FCR (new patients, sick patients, and those with PE findings”“Define teaching topics and times early in the week”

24. Planned InitiativesRoom décor & clarify information on the wallsPE teaching Fellow teaching on calendar, FCR in rooms, SCO Goal: minimum 1/ intern/ week, Float intern 1-2 SCO/ week.Web-based metabolism prep module by Jamie FraserHandoff feedback Prompt intern to update written handoff when you run the list at 3pm, strict 5p handoff time, 1st quarter – senior and/ or attending observe handoffs until competent, Goal: minimum 1 Med Hub intern handoff feedback per week in 1st week of each block.Rotation discharge focus Monday theme of FCR = discharge, enforce use of DC portion of progress note, Med rec during rounds near DC for medically complex patients, attending/ fellow edit DC summary before day of dischargeSenior resident noon lunch orientation

25. Please email Aisha Davis and Jeremy Kern with any & all suggestions.