A Faculty Development Newsletter

March, 2001

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Newsletter Overview

The theme for our newsletter this month is, "providing an effective trainee orientation. "  Our preceptor highlight is on Dr. Lorenzo Pence of Saint Vincent Mercy Medical Center in Toledo.

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Preceptor Highlight

For some clinical clerkships, providing an effective orientation for the trainee at the beginning of the clerkship is common practice. However, orientation for the trainee is not at all common practice among the majority of clinical services. Addressing this void, our featured preceptor for this month is Dr. Lorenzo Pence, D.O. Dr. Pence is a family practice physician and currently serves as Assistant Dean, Northwest CORE, Ohio University College of Osteopathic Medicine and Associate Director of Medical Education, St. Vincent Mercy Medical Center, Toledo, Ohio. Dr. Pence’s comments and suggestions have been grouped into seven (7) categories that clinical teachers should consider in their design of an effective trainee orientation:

Overview of the Clinical Experience, Training, and Potential Education

• Meet with the trainee and discuss learning and performance expectations.
• Encourage the trainee to share their expectations regarding the clinical rotation and interests.
• Review the rotation curriculum and assignments.
• Discuss education and training opportunities to be provided by more senior trainees such as residents.
• Provide an overview of possible cases and clinical procedures that may be experienced through the rotation.

Physical/Environmental/Office Operation

• Provide a tour or visual lay-out of the clinic and office setting.

Relationship Building

• Introduce the trainee to clinic staff (residents, interns, nurses, and ancillary staff).
• In large clinical settings the trainee should also be introduced to key staff in other departments, expecially those with whom the trainee may communicate or interact with on a frequent basis.

Policies

• Discuss procedures, policies, note taking, universal precautions, and generally how the clinic operates.

Patient Care

• Discuss how the trainee is expected to be involved in patient care.
• Review what the trainee can and cannot do.

Professional Standards

• Discuss the training "work" schedule (time the trainee is expected to arrive and leave).
• Attendance and participation at department meetings and lectures/case discussions.
• Patient confidentiality.

Evaluation of Performance

• Discuss how feedback will be provided.
• Encourage the open exchange of questions and ideas

In addition to the valuable information noted above, Dr. Pence recognizes the diversity that is present in each clinical clerkship.  As a result, Dr. Pence suggests that trainee orientation should be specific to the nature of the clinical specialty.  He also encourages the use of senior trainees to serve as clinical teachers and mentors for less senior trainee.  Although the clinical rotation requires advanced scheduling and confirmation, Dr. Pence suggests, it is important that the trainee contact the preceptor at least one week in advance of the beginning of the clerkship, as a reminder and courtesy.  In conclusion, Dr. Pence notes that failure to provide an effective trainee orientation could deprive the trainee of valuable learning opportunities and place pateint management  as well as the clinical operation at risk.

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Related Research

In spite of many efforts that are made to help medical students in their transition from the classroom to the clinical setting, engaging in clinical rotations is still found to be a stress producing learning experience. As Moss and McManus (1992) note, “the rigid pre-clinical structure of lectures and laboratory is replaced by the less organized routine of ward rounds and bedside” care and teaching. From their study of 74 medical students in London who rated “40 possible sources of anxiety” thought to be associated with clinical rotations, “interactions with senior medical staff”, “presenting cases” during rounds, and “admitting ignorance” to clinical teachers were found to be among the most anxiety producing sources. A careful examination of “possible sources of anxiety” regarding clinical rotations may suggest that many anxiety producing conditions could be eliminated or reduced through an effective trainee orientation at the beginning of the rotation. Deutsch, Wallenstein, and Ognibene (1997) while addressing teaching in private office-based settings, advocates the need for a trainee orientation associated with the “practice” or clinical service “to which they are assigned”. They also suggest that such an orientation “is best done on the first day of the rotation” and “should address the overall philosophy of the practice”. Deutsch, Wallenstein, and Ognibene contend that “the orientation session helps to engender a sense of welcome and comfort” regardless of whether the trainee is a medical student or resident. Westberg and Jason (1993) mention that “learners need, but do not always get, an orientation when they begin a new clerkship, preceptorship, or other CLE (clinical learning experience)”. As advocates of a more collaborative learning climate, Westberg and Jason encourages trainee involvement in the orientation experience and believes that orientation “should focus more on acquainting students with the resources they can use”. In addition, Westberg and Jason suggest that the development of “first impressions”, capturing the “learners’ attention”, and avoiding errors in patient care and office procedures are among the many significant reasons for providing an effective clinical orientation.

Clinical teachers and trainees are encouraged to review these and other studies in more detail. Please continue to add to your teaching/learning “tool kit”.

References

Deutsch, S., Wallenstein, L., and Ognibene, A. Planning a Teaching Program. 1997. in Community Based Teaching, Susan Deutsch, 1997. pp.135-166.

Moss,F. and McManus,C. The Anxieties of New Clinical Students. 1992. in Journal of Medical Education. 1992. pp.17-20.

Westberg,J. and Jason,H. 1993. Collaborative Clinical Education. pp. 73-85.

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Teaching Tips

Tips to Enhance the Trainee Orientation

1. Commit to providing an orientation each time a trainee (student, intern, resident) begins their training at your office or clinic.
2. If more than one trainee is scheduled to begin their rotation on the same day or even within the same week, try to conduct one orientation that could be designed to accommodate both trainees. But please remember, information that may be essential for a medical student may not be essential for an intern or resident.
3. Organize the orientation in an outline format. On your copy, include notes that will help you in the orientation discussion and help to avoid forgetting or failing to mention important details that need elaboration.
4. The amount of time required for orientation will most likely vary according to the level of the trainee. That is, orientation for a resident beginning a rotation may require less time and contain less content to discuss than an orientation that is structured for a medical student.
5. Try to involve other attendings, residents, and interns in the development and delivery of the orientation.
6. Make sure that the orientation includes an opportunity for the trainee to talk and ask questions.

Remember to spend time discussing when and how feedback regarding the trainee’s performance will occur during the rotation.

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Teaching Resources on the Web

The following URL will take you to the orientation information students read prior to going on the ortho clerkship at the University of Wisconsin.    http://www.surgery.wisc.edu/medstudent/handbook/handbook_ortho_handout.html 

Integrating Learners into the Busy Office Practice is an monograph on this faculty development web page.  This monograph has some excellent tips on planning and conducting an orientation.  The section on conducting an orientation is near the beginning of the monograph.  You may want to read the entire monograph and take the quiz for faculty development credit.

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Curriculum Update

The new Clinical Presentation Continuum (CPC) curriculum is going smoothly.  Second year students just completed the Renal and Electrolytes Block and are now in the Urology Block.  

Year one CPC students have just started the GI Block after having completed the Cardiovascular Block.  

Our year 2 CPC students will be coming to the CORE sites in September which is not far away. To help familiarize preceptors with the new CPC curriculum we are publishing a hard copy and an on-line version of a CPC Bulletin each month.  This bulletin is designed to familiarize everyone at the sites with the new curriculum so they will be more prepared to interface with the students.   the bulletin is only one page so it is a "quick read."  Three issues (Jan., Feb., and March) have been mailed and the April issue will go out in two weeks.  If you are not on the mailing list to receive the bulletins and would like the hard copies sent to you monthly, please call Christina McGuire in the Office of Faculty Development at 740-593-2215 and she will add you to the mailing list.  To see the January, February, and March  issues online, just go to our faculty development web page at http://www.oucom.ohiou.edu/fd/ and click on Monthly CPC Bulletin.

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Academic Leadership Fellowship News

The Acacemic Leadership Fellowship (ALF) continues to meet monthly.  Participants are: Jenny Zamor, D.O., Geri Urse, D.O., Doug Stahura, D.O. Jose Torres, D.O., Joynita Robinson, D.O., Nicole Wadsworth, D.O., and Ed Robles, D.O.  Participants are currently engaged in three courses.  These are: Clinical Teaching I, Clinical Teaching II, and Curriculum Project II.  Our last meeting was on February 17 and 18.  One of the learning activities for the fellows was to lead a case discussion on a cardiovascular topic.  Three students from our CPC I class volunteered to be "students" for this activity.  Leading the case discussion  was a positive experience for the fellows and the students.  Additionally, Michael Adelman, D.O., Associate Dean for Academic Affairs was a special guest at the evening dinner.  Dr. Adelman shared some his clinical teaching experiences with the group. 

The next live meeting of the ALF group will be on Saturday and Sunday, April 21 and 22.

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