The Hornsby Hospital Intern Orientation Programme Six years on: what have we learned?

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Judy Muller and Philip Funnell JMO Unit, Hornsby Hospital

The Hornsby Hospital Intern

Orientation Programme 2012

Six years on: what have we



There’s a lot to do….

meet and greet

familiarity with key hospital programmes and



Meet and greet…

Network 6 staff

staff of clinical departments

fellow interns


Key hospital programmes & procedures:

On-line modules:

1. Blood safe

2. Between the flags

3. eMedical orientation


Key hospital programmes & procedures:


1. medical documentation and certificates 2. Between the Flags

3. blood transfusion 4. safe prescribing 5. EMR

6. cannulation and venipuncture

7. infection control and theatre scrub 8. fire training


Personal coping strategies:

“managing your day”

“surviving your internship”


A brief history…

 from 2007, a new programme based on Box Hill Hospital Amazing Case Race, involving teaching and interaction with senior interns and team-based exposure to clinical scenarios: CODE RED

 an EXPO involving contact with allied health

professionals, based on a programme operating at Sir Charles Gairdner Hospital, Perth

 from 2010, a “safe prescribing” component (see S Hilmer et al: IMJ 2009)


Six key elements:

 a six station skills training: CODE RED

 allied health EXPO

 safe prescribing

 EMR training

 venipuncture and cannulation


What have we learned?

 an excellent and time-efficient means of introducing multiple relevant skills

 delivered by trusted senior interns

 team-based approach less stressful

 highly regarded by new interns in formal feedback +++ in terms of relevance and usefulness

 individual participation validated by “passport” entry

 stations require ongoing fine-tuning with regard to changing policy & procedure


Allied Health EXPO

all hospital departments represented at

stalls in a central location

intern ‘colour’ teams visit each station to

obtain information re departmental services

a quiz and prize regarding the information

gained at stalls


What have we learned?

 an excellent way of introducing interns to relevant departments and personnel

 active participation encouraged by a quiz and team prize

 needs to be conducted in a large room over a fixed time

 it may be preferable but is in fact difficult to have teams visiting actual departments


Safe Prescribing: 2 steps


 NIMC on-line module

 90 min. presentation by clinical pharmacist

 completion of NIMC in test conditions


 return of “marked” NIMCs

 review of common errors


What have we learned?

On-line module + pharmacist presentation +

“test” +

2 weeks work experience + error review =

very low rate of initial prescribing errors

high intern rating of this training because of

lack of prior prescribing experience and the

potential for patient harm


EMR training:

 an essential component of intern skill set

 difficult to know individual competence levels

 difficult to provide comprehensive large group tuition during orientation week: time consuming


What have we learned?

 highly variable levels of intern IT competence

 interns need to be competent with ordering

investigations, accessing test results and creating discharge summaries

 intern dis-satisfaction with 2012 IT training

 the need for development of relevant real-life case-based EMR training with IMT department, and


Accreditation of technical skills:

venipuncture and cannulation

 widely different levels of competence and patient/intern safety & sepsis

 cannulation usually assessed by ED staff, while venipuncture usually assessed on wards by JMOs and blood collectors

 little opportunity for remediation in time available


What have we learned?

 some interns are unsafe due to poor previous training/lack of practice

 good venipuncture and cannulation skills are essential, and

 have to be observed and credentialed by qualified staff during orientation and before ward exposure

 ? compulsory on-line cannulation module + observation & formal credentialing during orientation


Personal coping strategies:

 a huge transition from student to doctor/employee

 variable levels of readiness in terms of self-organisation and professional behaviour

 current practice: 45 min presentation and Q&A delivered by senior intern, and

 30 min presentation by senior medical staff on general self-care, with 1 hour follow-up session mid-year


What have we learned?

 high acceptance of intern presentation on practical issues such as handover, preparation for ward

rounds, prioritising tasks, using the job book, nurse liaison, managing pathology requests and results, and the “little black book”

 good acceptance of interactive presentation by senior medical staff regarding self care


What are we thinking for 2013?

 how can we avoid the “overload” of orientation week?

 what is essential and what can be left to later mandatory training?

 at 6 month audit, strong intern preference for peer-led, ‘essential skills’-based orientation activities: how can we best meet these expectations?

 how can we ensure that interns are safe to

undertake procedures such as venipuncture & cannulation?