Transcript Slide 1
2009 Chief Resident Development Conference: Caring for Your Residents
Roseanne C. Berger, MD Senior Associate Dean for Graduate Medical Education & ACGME Designated Institutional Official (DIO) for UB
Goal: Support residents experiencing problems that impede learning.
Fatigue
Academic Difficulty
Harassment
Impairment
Relative Risk by Specialty Anesthesiology Emergency Medicine Neurological Surgery Pl astic surgery Family/ General Practice Otolaryngology OB/Gyn Thoraci c Surgery Radiology Psychiatry Neurology Internal Medicine Orthopedics Ophthalmology Pediatrics General Surgery Pathology 0 0.5
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www.cphny.org 800-338-1833 www.cphny.org 800-338-1833
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Warning Signs
Warning Signs
Selected Warning Signs
Deteriorating personal hygiene
Unfocused, confused, distracted
Mood swings
Unprofessional demeanor or conduct
Anger/Abusive Language
Frequent lateness, absence or illness
Isolation: avoidance of associates
Inappropriate response to patient needs or staff requests
Ignoring requests to catch up on paperwork
Uncooperative and defiant approach to problems and/or performance feedback
Impairment/Substance Abuse
Signs & symptoms of impairment Report to PD or GME – do not handle yourself Encourage individual to self-report to GME or Committee on Physician’s Health (CPH) Treatment options Coincident with training Leave of Absence – up to 3 months
CPH Contact Info
1 (800) 338-1833 or (518) 436-4723 The Committee for Physician Health 99 Washington Avenue, Suite 410 Albany, NY 12210 Fax: (518) 436-7943 Email: [email protected]
All calls are confidential
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Harrassment/Discrimination
Sexual or other forms If possible, tell harasser to stop Discuss with PD, Chair, DIO, Office of Equity, Diversity, and Affirmative Action 645-2266 https://secure.newmedialearning.com/psh/ ubuffalo/
UB/GME Resources
Susan Orrange, M.Ed
Roseanne Berger, M.D. [email protected]
Chief Resident Listserv Policies on Impairment, Harassment, and Academic Status www.ACGME.org
Common Program Requirements RRC Requirements for your program The Joint Commission http://www.jointcommission.org/
LIFE Curriculum
(Learning to Address Impairment and Fatigue to Enhance Patient Safety) Self-directed learning modules in the areas of: Fatigue Disruptive Physicians Stress & Depression Substance Abuse Burnout Impairment Negative Feedback
UB Human Resources http://hr.buffalo.edu
Work/life balance UB Employee discounts • Fitness centers, theme parks & attractions, software, wireless phones, moving services, and more
Learning & Development
Registration & Course Catalog • Short courses in Career and Personal Development, Software and Computer Productivity, Wellness & Worklife Balance • Over 1,000 online, self-directed learning modules (Skillsoft)
Assignment
Read and Discuss the case scenarios and answer the following questions. 1.
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What is your differential diagnosis?
What questions would you ask to confirm your hypothesis? What is your plan to assist this resident? How will you assess if it is effective?
How would you address the situation with the residency program director?
Case 1:
Dr. X recently transferred into your program. You learn she was treated for substance abuse during a stressful divorce. She is soft spoken, hard working, and well liked but appears anxious when presenting cases and is not organized or focused. The faculty question her ability to “cut it” and critique her judgment in front of others.
Case 1 continued
Evaluations do not include comments. Most raters circled “3” on a 5-point scale for medical knowledge and patient care and 4-5 for professionalism and communication skills. The resident says faculty have not spoken to her about her performance.
Case 2:
Dr. Y is never able to finish their work. He comes in early and stays late to keep up. BFH (Buffalo’s Finest Hospital) is cracking down on this behavior and even asked the residents to sign an attestation saying they would be subject to dismissal if they violated work hours.
Case 2 cont.
The resident has been nodding off during morning report. You’re concerned because the resident is about to start ‘night float’ and it will be important to finish work in time for the day shift.
Case 3:
Dr. Z is performing well clinically but has very low inservice exam scores. Faculty have warned that he will not be promoted to the next level of training if he does not achieve a minimum standard on a repeat exam. He did particularly poorly in the sections on GI and Renal disease, two areas that you have noticed are not well taught.
Case 3 continued
Dr. Z had nearly perfect SAT’s and scored 33 on the MCAT. His USMLE part I score was strong but USMLE II scores were marginal. Formerly a slave to fashion, he is no longer attentive to his appearance. He often wears scrubs at work and has taken to wearing a ‘play-off’ beard when its still early in the season.
Remember…for struggling residents
Make diagnosis and treatment plan Include objective assessments Provide frequent honest feedback Consult policies appropriate people, resources, and Involve program director and faculty