Judy Muller and Philip Funnell JMO Unit, Hornsby Hospital
The Hornsby Hospital Intern
Orientation Programme 2012
Six years on: what have we
learned?
There’s a lot to do….
meet and greet
familiarity with key hospital programmes and
procedures
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:
lectures/demonstrations/assessments
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
(1)
NIMC on-line module
90 min. presentation by clinical pharmacist
completion of NIMC in test conditions
(2)
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?
