Residency orientation: Friend or foe?

Residency Program Insider, April 22, 2008

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Imagine the first day of orientation; you know the scene. It’s early. The coffee is hot, the pastries are cold. An auditorium full of interns, wide eyed and nervous. The department chairman enters stage right and begins to speak, “Welcome to the department. As residents of our prestigious program, you join the ranks of a select cadre of venerable physicians who can boast long hours spent toiling in our hallowed institution…”

As the lecture goes on like this for the next hour, and then the next, and the next, your residents squirm and fidget, surreptitiously checking PDAs and cell phones.

Intern orientation can be a truly terrifying and painfully boring experience for the interns. And yet, you count on this time to deliver critical information such as human resources policies, hand-off procedures, explanations of meal money, and electronic record training to your interns.

How then, do you make this necessary training meaningful for interns?

When queried, freshly oriented interns offered the following perspective: “We have no context, no framework of understanding about the day-to-day operation of the program. Combine that with our anxiety, and we can neither focus on nor retain any of the information presented by the talking heads at the podium. We just want to start working!”

And yet they cannot start working because they haven’t been oriented. This is a big dilemma for residency program administrators.

However, I have three strategies that can help you conquer this problem. First, create context for your residents. Allow them the opportunity to shadow on your services right away. Integrate interns into the team by creating a shadow schedule in inpatient and ambulatory settings during the week prior to orientation. Offer this opportunity to them as “optional,” and this should eliminate the need to put them on payroll. Not surprisingly, many of them will jump at the chance. As with any observer, make sure the interns complete any required release forms.

Once your new residents see the “action” first hand, the information that you present in your didactic sessions suddenly has the context it needs. They’ve shadowed that code and they now realize how truly important it is to listen to the code leader. They’ve observed in your continuity clinic, and they now understand the important role your social workers play.

Another possible solution is to keep your orientation interactive. Most individuals have varied learning styles. They learn visually, but also kinesthetically—by doing. Get as much of the policy talks and other trainings out of the way either by e-mail or via on-line learning modules before interns even walk in the door. Pre-orienting interns frees up time during your formal orientation, and you can role play or reiterate the learning content in a more dynamic context.

A third possible solution is to create bonding experiences ahead of orientation.  Shadowing on the wards will certainly accomplish this, but a social event will too. I recommend making this event very casual, like a barbeque in your program director’s backyard. Invite residents’ spouses and children. This activity provides interns an opportunity to get to know each other, and they’ll be more relaxed, and better able to listen and retain information the following day during orientation.

Orientation need not be a necessary evil. With a little creativity and advanced planning, it can be a truly meaningful bonding experience that can set the tone for residents’ entire training at your institution.

Diane Farineau
Residency Program Coordinator
Department of Medicine
University of Virginia Health System
Charlottesville, VA

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