Judy Muller and Philip Funnell JMO Unit, Hornsby Hospital

1. The Hornsby Hospital Intern Orientation Programme 2012 Six years on: what have we learned? Judy Muller and Philip FunnellJMO Unit, Hornsby Hospital

2. There’s a lot to do…. • meet and greet • familiarity with key hospital programmes and procedures • learning personal coping strategies

3. Meet and greet… • Network 6 staff • staff of clinical departments • fellow interns • Term 1 teams and supervisors

4. Key hospital programmes & procedures: On-line modules: • Blood safe • Between the flags • eMedical orientation • NIMC

5. Key hospital programmes & procedures: lectures/demonstrations/assessments • medical documentation and certificates • Between the Flags • blood transfusion • safe prescribing • EMR • cannulation and venipuncture • infection control and theatre scrub • fire training

6. Personal coping strategies: • “managing your day” • “surviving your internship” • “taking care of yourself”

7. 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)

8. Six key elements: • a six station skills training: CODE RED • allied health EXPO • safe prescribing • EMR training • venipuncture and cannulation • personal survival skills

13. 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

14. 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

15. 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

16. 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 • discussion of high risk drugs

17. 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

18. 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 • additional IT programmes for ED and OT

19. 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 • including a follow-up session after 2 weeks work

20. 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 • considerable ongoing potential for injury and sepsis

21. 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

22. 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 • www.jmohealth.org.au

23. 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

24. 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?