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SUO/AADO/OPDO Combined Program

November 10th, 2018

Panelists: Laura Hetzler MD, FACS Eric Thorpe MD Ellen Deutsch MD, MS, FACS, FAAP, CPPS Ronda Alexander MD, FACS Vandra Harris MD Marita Teng MD, FACS

Onboarding: definition * Organizational socialization * Mechanism through which new employees acquire the necessary

knowledge, skills, and behaviors in order to become effective organizational members or insiders.

* Process of integrating a new employee into an organization and its culture

* Research demonstrates that socialization techniques lead to positive outcomes for new employees such as job satisfaction, better performance, better commitment, and reduction in occupational stress and intent to quit.

Mentorship Eric Thorpe, MD

Loyola University Medical Center

Program Director

“A mentor is someone who allows you to see the hope inside yourself”

* Oprah Winfrey

“We make a living by what we get, we make a life by what we give”

* Winston Churchill

Mentorship

*Vertical Mentorship

*Horizontal Mentorship

*Cultural Mentorship

*Systems Mentorship

Mentorship

*Traditional style of Mentorship *Usually faculty to resident

Vertical Mentorship

*Strengths *Tradition

*Respect

*Experience

*Noncompetitive

Vertical Mentorship

*Weaknesses *Can feel too formal

*May lack complete honesty

*Generational gap

*Peer to peer style of mentorship *Resident to resident

*Typically senior-junior relationship

Horizontal Mentorship

*Strengths *May feel safer

*More honest discussion

*No generational gap

*Fosters connectivity in the group

Horizontal Mentorship

*Weaknesses *Less experienced

advice

*May have competitive interference

* Challenges in cultivating relationship

*Culture *Shared values, principles and

traditions that influence the way the members of the organization act and distinguishes the organization from others

* In short “How we do things around here”

Cultural Mentorship

*Strong Culture *Widely shared

*Behaviors reflect the

shared values

*Often can tell stories about department history of people

Cultural Mentorship

*Weak Culture *Usually only shared by

those at the top

*Weaker less consistent messages

*Culture *The perception of the culture IS the

culture

*The culture is descriptive, should be able to be described in some way by members (don’t always have to like it)

*Must be shared by all members

Cultural Mentorship

*Institutional programs to help residents succeed *GME

*Academy

*Resident resiliency team

Systems Mentorship

References

* Johnson, K. (2017, May 12). The Impact of Improved Patient Experiences. In NRC Health. * K. Shadur and M. A. Kienzle, “The Relationship Between Organizational Climate and Employee Perceptions of

Involvement,” Group & Organization Management, December 1999, pp. 479–503

* Stellard, M. (2015, December 3). Top Healthcare Organizations Create Cultures of Connection. In hfma.org. * A. E. M. Va Vianen, “Person-Organization Fit: The Match Between Newcomers’ and Recruiters’ Preferences for Organizational

Cultures,” Personnel Psychology, Spring 2000, pp. 113–149 * Sherwood, R. (2013, October 30). Employee Engagement Drives Healthcare Quality and Financial Returns. In Harvard Business

Review.

* J. B. Sorensen, “The Strength of Corporate Culture and the Reliability of Firm Performance,” Administrative Science Quarterly, 2002, vol. 47, no. 1, pp. 70–91; R.

* Becker. (2015, August 13). 5 ways to improve your hospital’s culture and employee engagement. In Becker’s Hospital Review. * C. C. Miller, “Now at Starbucks: A Rebound,” New York Times online, www.nytimes.com, January 21, 2010

Have their been any changes to your institutions model of mentorship throughout your tenure?

Do you offer faculty development on the art of mentorship?

SIMULATION-BASED BOOT CAMPS TO ONBOARD RESIDENTS

Ellen S Deutsch, MD, MS, FACS, FAAP, CPPS Society of University Otolaryngologists November, 2018

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SIMULATIONS

Malekzadeh, Deutsch, Malloy. Laryngoscope, 2014; some images from SiTEL

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SIMULATORS

Image courtesy of Beth Rymeski, DO

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DOES SIMULATION WORK?

Malekzadeh, Malloy, Chu, Tompkins, Battista, Deutsch. Laryngoscope 2011

Epistaxis Intubation Mask DL, B Cric Fiberoptic Complex ORL Ventilation Laryngoscopy Airway Calls

Pre- Post- 6 mo Post

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DOES SIMULATION HAVE VALUE BEYOND IMPROVING LEARNER SELF-CONFIDENCE?

• Supports early acquisition of complex skills • Improves

• Procedural skills • Patient care practices • Patient outcomes

• Provides collateral benefits • Transfer of skills and knowledge to

other trainees • Reduced healthcare costs

• Wiet GJ et al. Laryngoscope. 2012 • Fried MP et al. Otolaryng Head Neck. 2010 • Draycott TJ et al. ObstetGynecol. 2008 • McGaghie WC et al. Acad Med. 2011 • Cook DA. Med Educ. 2014 • McLaughlin S et al. Acad Emerg Med. 2008 • McGaghie WC et al. Med Educ. 2014 • Cohen ER et al. Simul healthc.2010 • Scholtz AK et al. Simul healthc. 2013 • Barsuk JH et al. Acad Med. 2011 • Wolfe H et al. Crit Care Med. 2014

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SIMULATION DESIGN COMPONENTS

• Needs assessment • Learning objectives • Event planning • Immersive

participation • Debriefing

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WHAT’S DIFFERENT ABOUT A BOOT CAMP? 2018 ORL Emergencies Boot Camp, designed for 48 residents

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SUO SIMULATION TASK FORCE

• Surveyed 10 Regional Boot Camp programs • 8 are one-day • 6 are on a Saturday • 7 are “round robin” • Typical number of residents per group/station is 4-6 • Include a faculty orientation

Thank you to Brian Cervenka, MD

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MOST COMMON SKILLS FOR INDIVIDUALS

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MOST COMMON TEAMWORK SCENARIOS

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OTOLARYNGOLOGY ONBOARDING BOOT CAMPS ARE EFFECTIVE AND VALUABLE FOR RESIDENTS

• Residents perceive improved knowledge, technical skills, confidence and clinical performance

• Affective lessons • Improved patient care

and patient outcomes?

Malekzadeh et al. Laryngoscope, 2011; Tompkins. JAMA Oto HNS, 2014

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OTOLARYNGOLOGY ONBOARDING BOOT CAMPS ARE VALUABLE FOR FACULTY

• Faculty are motivated by

• Enjoyment of teaching and camaraderie • Benefit to residents, patients and themselves • Opportunities to learn or improve their own patient care

and teaching techniques

Deutsch, Orioles, Kreicher, Malloy, Rodgers. Laryngoscope, 2013

*Do you think the emphasis on simulation and/or bootcamps has been a natural transition or in any way facilitated by the change in ACGME requirements in the first year of residency?

*Is a lecture based bootcamp meaningful?

Resident Onboarding: Encouraging Teaching & Leadership Skills

Ronda E Alexander, MD, FACS Director Otolaryngology Residency Program McGovern Medical School part of UT Health (Houston)

Why bother?

• Attract *high-quality* medical students to the field • Cultivate a positive reputation in hospital • Improve patient education • Perpetuate positivity into the next generation

How do we learn to teach?

• Observation of direct models • Fantasy-based (TV, movie teachers) • Figure it out aka “Flailing”

• Direct Training

Foundations for teaching

• Who is my audience? • MS4, MS3, pre-clinical students • Each other • Other services

• Pediatrics, IM/FM, GS, • What do I know?

• More than the MS (usually) • What are my strengths? • What is the teaching environment?

Level-up!

Option A(CGME)

$1015 + travel + lodging + partial food Philly, Chicago, Hollywood (FL) only

Surgeon-Specific RaTs

1. 7 studies in surgery R/F ever…

2. Content delivered via lecture or online

3. Outcomes a. Alterations in teaching behavior b. Satisfaction with the program format

4. Take-home points a. Residents want to improve teaching b. Residents appreciate the effort c. They are willing (and able) to change!!!

Consensus Model for Teaching “Teaching” • Train

• Didactics • Simulation

• Observe • Dedicated session • Simulation +/- distractors

• Provide feedback • Medical Students • Peers inside program • Outside services

Our GME Team’s solution

• Developed by Faculty • Resident consultants • Local University resource • Focus on educational

philosophy development

• Obvious weakness…

Take a step back

• Do your Faculty know how to teach effectively? • Do your evaluations of Faculty (by Residents) assess

teaching skills?

Cultivating Faculty Teaching Culture • Office of Educational Programs

• Academy of Master Educators • Health Educators Fellowship Program • Programs with local University

• Certificate in Integrating Innovative Technologies in Health Science Education (2-3

semesters; ~$8K)

• Masters of Education in Curriculum & Instruction with an Emphasis in Health Science

Education (5-6 semesters; ~$18K)

• Executive Doctorate in Professional Leadership for Health Science Education (7

semesters + intersession work; ~$60K)

Resident Leadership??

Closer to home

Why bother?

• Analagous to “real” life • 1:1 correlation

• requirements during training: realities of life thereafter

Ideal Result

Medical Knowledge

Surgical Procedural Knowledge

Business of Medicine Awareness

Self-awareness/Wellness

Teaching Skill

Leadership/Participation

The primary priority

Selected Resources

• https://acgme.org/Meetings-and-Educational-Activities/Other-Educational-Activities/Courses-and-Workshops

• https://resident360.nejm.org/content_items/1969

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Is this a two fold education process for faculty and residents?

Is one more important than the other?

RESIDENCY WELLNESS:

MAINTAINING PHYSICAL & MENTAL HEALTH DURING RESIDENCY

VANDRA HARRIS, MD PGY-5

JOHNS HOPKINS DEPT. OF OTOLARYNGOLOGY – HEAD & NECK SURGERY

• Results:

• Surgical residents worked more hours per week (70 vs 58 hrs ;p=0.02)

• Surgical residents had higher BMI (25.7 vs 23.5 ;p=0.01)

• However, this does not have to be you!

REASONS TO STAY FIT

• Exercise and meditation can act as a stress reliever (FYI residency is stressful!)

• Endorphins and improved mood

• Better sleep

• Improved work performance

• Promote healthy lifestyle to patients

Perrin, et al. Can J Surg, Vol. 61 Oct. 2018

MAINTAINING A HEALTHY DIET

• Managing blood sugar levels for more even energy

• Consider intermittent fasting

• Pack your lunch

• Trader joes

• Sandwiches

• Pre-cut fruit and vegetables

• Water bottle to fit in white coat

• Leave your money at home

MANAGING YOUR SCHEDULE

• Sleep Hygiene • Calm app: Sleep stories and meditation • However, don’t be a hermit

• No need to exercise all at once • Start simple: 30 minutes 3 x per week • Do the exercise you like

• Lifestyle changes • Take the stairs • After dinner walk • Weekend warrior –

• improve overall fitness minutes https://www.kevinmd.com/blog/2017/09/want-stay-shape-residency-heres.html, https://www.health.harvard.edu/blog/underappreciated-health-benefits-weekend-warrior-2017021611167

DELAYED GRATIFICATION

• Prime time

• Late 20’s and early 30’s peak years of life

• Establishing fitness routine now will help in later years

• Never regret a workout

• Life only gets busier

*

Are you using innovative models for wellness in your program?

Is our current tremendous focus on wellness uniformly a positive thing?

Transitioning into Residency: Generational Considerations

Marita S. Teng, MD, FACS

Associate Professor & Residency Program Director

Otolaryngology – Head & Neck Surgery

Icahn School of Medicine at Mount Sinai

November 10, 2018

Adapting to Millennialism

Millennial Qualities

▶ Socialized by supportive parents to be successful hardworking and goal-directed

▶ Numerous academic, extracurricular, and service pursuits

▶ Hectic lives structured time, schedules, and rule-following

▶ Tend to be both generous and practical ▶ Group project-driven team spirit, socially networked,

able to organize and mobilize ▶ Gadgets and tech keen mastery of multitasking ▶ Accustomed to being assessed, receiving focused

feedback

Howe & Strauss, Millennials Rising, 2000

Possible Millennial Deficiencies ▶ Overinvolved parents, excessive praise (helicopter

parents, “peer-enting”) tendency toward narcissism, requirement for constant recognition?

▶ Over-reliance on communications technology stunted interpersonal skills?

▶ Multitasking shortens their collective attention span impatient & demanding?

▶ Curricula have unintentionally encouraged rote learning less critical thinking, introspection, and self-reflection?

Howe & Strauss, Millennials Rising, 2000

Is Millennial criticism fair? Narcissism - Counter-theory: all young people? Need for recognition, praise and promotion Over-reliance on communications technology

Are we blaming Millennials for the technology that happens to exist right now?

Scott Hess, SVP of human intelligence for SparkSMG TedX speech, “Millennials: Who They Are and Why We Hate Them” http://www.nytimes.com/2013/08/06/science/seeing-narcissists-everywhere.html?pagewanted=all&_r=0

What is Millennial Learning?

▶ Interactive teaching with technology – Hands-on, simulations, group

discussion

▶ Collaborative learning

▶ Immediate feedback within a practical context

▶ Close relationship with authority figures/mentors

Eckleberry-Hunt, Tucciarone, J Grad Med Ed, 2011.

Millennial Medical Education

▶ Dearth of research on this topic ▶ Most literature focuses on undergraduate medical education,

largely questionnaire and test-based – They like hands-on learning, clinical applications of content – They worry they are proficient at rote learning but won’t be able to think

through clinical problems – They desire regular, personalized feedback – They are high-achieving and goal-driven, but also at higher risk for

stress, anxiety, depression, burnout than previous generations

Training the Millennial Resident – GOOD NEWS! ▶ Millennial learning attitudes fit with

residency – Students engaged/motivated to learn when

provided with authentic learning experiences instead of “lecturing the facts”

▶ And possibly even more with surgical

residency! – Knowledge is no longer perceived to be the

ultimate goal (its half-life is short) – Doing is more important than knowing – Results and actions are considered more

important than the accumulation of facts

Residency

Millennialism

Surgical Training - Recommendations

1) Be a good example – People’s behavior influenced by the culture they live in, not their

age/demographic • “Children have never been very good at listening to their elders, but they have never

failed to imitate them.” - James Baldwin, American author, 1950-60’s

– Put away our phones – Recognize that we are all the same

• Upset not getting recognition (bonus, promotion?) • Prefer TED talk or a dry Grand Rounds?

Dhaliwal G, editorial in JAMA, Dec 2015.

Surgical Training - Recommendations

2) Change lecturing styles – Decrease number of lectures – Consider lecturing to small groups

divided by training level – Pictures/video >> Text – Attention span limitations

• Adult 10-15 min • HS student 1-5 min

Hart D, Soc Acad Emerg Med, vimeo.com/24148123

Surgical Training - Recommendations 3) Use technology, consider gamification

Surgical Training - Recommendations

3) Tech/ Crowd Sourcing

• Pulse QD

Surgical Training - Recommendations

4) Maximize trainer/ trainee closeness

Millennials work/learn better when relationship with authority is good

– Department gatherings, informal events

– Relatability & work/life balance

Surgical Training - Recommendations 5) Use the Operating Room!

– Millennials like to be challenged, they value “doing” and the “activated learning state”

– What better place than the OR? • Socratic teaching • Reading suggestions before case • Task-oriented challenges

Surgical Training - Recommendations

6) Define the team & roles • Millennials struggle on teams where their role is limited due to

rigid hierarchy • Work towards inclusiveness, ensure that students have sense

of purpose & clear learning objectives appropriate to their training level

Roberts DH et al, Medical Teacher, 2012.

Surgical Training - Recommendations

7) Peer interactions and feedback can help us deliver a message – Train our trainees to give regular and

personalized feedback • They find peers most credible

– Senior resident mentorship • Natural: on floors, in OR • Structured: research buddies system

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