Setting and Problem
Onboarding new residents at the beginning of the academic year requires orientation to a wide variety of general employment, accreditation-related, and specialty-specific educational program policies and procedures. Due to the volume of information to be presented, and the abstract nature absent relevant context (residents are unsure how content may apply to them personally), this material is often dull, and residents are less than enthusiastic in their reception of this information. Retention and application of the material when needed at later dates is often suboptimal.
Intervention
Selected policies and procedures were identified for inclusion in an interactive, case-based workshop. Topics included:
Competencies and milestones
Point-of-care learning resources
Supervision policy
Change in patient status policy
Work hour rules
Vacation policy
Sick leave policy
Academic deficiency
Disciplinary actions
Physician wellness/loss
Impaired physician
Hostile work environment
Hypothetical but realistic “cases” were created for each topic area, with 1 to 3 discussion questions per case. Stations were created for each case around the conference room, with each case assigned a particular space. Case folders were created and identified by playing card suit (hearts, diamonds, spades, or clubs) on the “Rules/Order of Play” instructions posted on the front of each folder. Case folders were distributed across table groupings in the conference room. Residents can be randomly assigned to small groups by distributing 1 playing card to each resident.
The interactive activity is conducted as defined in the Rules/Order of Play, as follows:
Find the group table that matches the suit of the card you drew. Complete the pretest.
Each table contains a file folder with several cases to solve as a group. Write in the answers to the questions posed.
Locate a gallery space and post your cases with the answers.
When all cases have been posted, go on a “Gallery Walk”: go around the room and read responses to cases from other groups. Add comments and clarification if desired. Collect a sticker from each case on your exit ticket.
When you have collected a sticker from each case, return to your seat.
Graduate medical education leadership and administrative staff will lead a group debrief and answer remaining questions.
Complete your posttest, and then bring your exit ticket, signed “House Staff Manual” receipt, and posttest to the session leader.
The workshop concluded with residents reconvened in the large group for a lively question-and-answer session.
Outcomes to Date
This workshop has been administered in 2 consecutive academic years. Data presented are aggregated across the 2 resident cohorts.
Pre- and posttest questions were identical. Residents responded to each statement by selecting 1 of 5 options, ranging from strongly disagree to strongly agree. Residents demonstrated marked increase in their understanding of the various policy and procedure topics, as evidenced by comparison of pre- and posttest responses (figure).
The question-and-answer conclusion to the workshop resulted in a much more robust discussion of topics and further potential application scenarios generated by residents than seen in previous years with the more traditional didactic review of policies and procedures.
Feasibility: presentation of policies and procedures during orientation for new residents can be effectively delivered in a case-based, interactive format. There is minimal cost for supplies and approximately 1 hour of staff time to prepare materials for the workshop. This workshop is easily replicated across programs or sponsoring institutions.
Acceptability: This format leads to greater engagement with the content by residents. Self-evaluation by residents indicates improved understanding of the materials. Further study should measure residents' retention and ability to reference and apply over time.
