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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
*
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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