“What Do I Do?”—Discussing Difficult, Realistic Scenarios and the General Competencies During New Housestaff Orientation

Abstract

Abstract Introduction This resource contains a focused, 2.5 hour interactive session explicitly designed to orient new housestaff to the six ACGME General Competencies, and address key topics related to risk management and do-not-resuscitate (DNR) orders. Methods Trained facilitators (residency program directors, associate program directors, or faculty) guide discussions in small, six-person groups within their own classroom of housestaff. In the small groups, housestaff read a scenario about an intern who must respond in a difficult situation. They then answer questions about the scenario including what they should do if they were the intern, what resources are available, and how and where the ACGME General Competencies appear in this situation. After small groups discuss a scenario, facilitators led a discussion with the large group (whole classroom) about the answers to the scenario questions. Results Three data sets highlight the success of this program. Results of a multiple-choice pre- and posttest requiring residents to identify the ACGME competencies associated with 20 statements revealed that housestaff arrived with a general understanding of the competencies and that this session enhances that comprehension. Mean percentages for the housestaff scores changed from 76% to 81% (p < .001) following the session. Results from the housestaff evaluation of the session revealed that they enjoyed the case-based discussions, citing the opportunities to interact in small groups, discuss relevant and interesting scenarios, and learning the ACGME General Competencies. Faculty facilitators evaluated the sessions highly and volunteered to serve as facilitators the following year. Discussion The strength of this overall approach is that the length of the session may be reduced or lengthened dependent on the degree to which objectives have been achieved, and facilitators can change the content or characters in the scenarios to enable the discussion to continue in a related direction. Also, housestaff may want to contribute their own experiences to the discussions, especially new fellows. It was decided not to separate the groups by level of experience, as the fellows would likely add more to the discussions when discussing the scenarios with new residents. In some cases, fellows were able to say, “This actually happened to me and here's what I did …” providing valuable insight for the new residents in their group.

Keywords

• Resuscitation Orders
• Decision Making
• Group Discussions
• Orientation of Housestaff
• Scenario-based Discussions
• Risk Management