SUO/AADO/OPDO Combined Program November 10th, 2018 › suo-aado.org › resource › resmgr ›...
Transcript of SUO/AADO/OPDO Combined Program November 10th, 2018 › suo-aado.org › resource › resmgr ›...
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SUO/AADO/OPDO Combined Program
November 10th, 2018
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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
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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.
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Mentorship Eric Thorpe, MD
Loyola University Medical Center
Program Director
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“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
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*Vertical Mentorship
*Horizontal Mentorship
*Cultural Mentorship
*Systems Mentorship
Mentorship
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*Traditional style of Mentorship *Usually faculty to resident
Vertical Mentorship
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*Strengths *Tradition
*Respect
*Experience
*Noncompetitive
Vertical Mentorship
*Weaknesses *Can feel too formal
*May lack complete honesty
*Generational gap
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*Peer to peer style of mentorship *Resident to resident
*Typically senior-junior relationship
Horizontal Mentorship
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*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
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*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
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*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
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*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
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*Institutional programs to help residents succeed *GME
*Academy
*Resident resiliency team
Systems Mentorship
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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
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Have their been any changes to your institutions model of mentorship throughout your tenure?
Do you offer faculty development on the art of mentorship?
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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
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*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?
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Resident Onboarding: Encouraging Teaching & Leadership Skills
Ronda E Alexander, MD, FACS Director Otolaryngology Residency Program McGovern Medical School part of UT Health (Houston)
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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
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How do we learn to teach?
• Observation of direct models • Fantasy-based (TV, movie teachers) • Figure it out aka “Flailing”
• Direct Training
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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?
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Level-up!
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Option A(CGME)
$1015 + travel + lodging + partial food Philly, Chicago, Hollywood (FL) only
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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!!!
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Consensus Model for Teaching “Teaching” • Train
• Didactics • Simulation
• Observe • Dedicated session • Simulation +/- distractors
• Provide feedback • Medical Students • Peers inside program • Outside services
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Our GME Team’s solution
• Developed by Faculty • Resident consultants • Local University resource • Focus on educational
philosophy development
• Obvious weakness…
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Take a step back
• Do your Faculty know how to teach effectively? • Do your evaluations of Faculty (by Residents) assess
teaching skills?
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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)
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Resident Leadership??
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Closer to home
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Why bother?
• Analagous to “real” life • 1:1 correlation
• requirements during training: realities of life thereafter
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Ideal Result
Medical Knowledge
Surgical Procedural Knowledge
Business of Medicine Awareness
Self-awareness/Wellness
Teaching Skill
Leadership/Participation
The primary priority
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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?
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RESIDENCY WELLNESS:
MAINTAINING PHYSICAL & MENTAL HEALTH DURING RESIDENCY
VANDRA HARRIS, MD PGY-5
JOHNS HOPKINS DEPT. OF OTOLARYNGOLOGY – HEAD & NECK SURGERY
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• 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!
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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
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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
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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
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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
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Are you using innovative models for wellness in your program?
Is our current tremendous focus on wellness uniformly a positive thing?
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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
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Adapting to Millennialism
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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
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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
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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
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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.
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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
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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
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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.
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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
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Surgical Training - Recommendations 3) Use technology, consider gamification
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Surgical Training - Recommendations
3) Tech/ Crowd Sourcing
• Pulse QD
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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
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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
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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.
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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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