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INTERNAL MEDICINEINTERNAL MEDICINE

BEGINNING YOUR RESIDENCY BEGINNING YOUR RESIDENCY

July 16, 2014July 16, 2014G. Fitzgerald-CoddG. Fitzgerald-Codd

Academic Skills CoordinatorAcademic Skills CoordinatorUCI, School of MedicineUCI, School of Medicine

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““Change Points” ?Change Points” ?Points during their medical education experience Points during their medical education experience

when Medical Students and Residents must when Medical Students and Residents must adapt:adapt:

New study/learning strategiesNew study/learning strategies

New perspectives re: their Time Management and New perspectives re: their Time Management and Organizational Skills Organizational Skills

New test-taking approaches and strategiesNew test-taking approaches and strategies

What Do New Residents What Do New Residents Encounter?Encounter?

New environmentNew environment

New cultureNew culture

New scheduleNew schedule

New routine and rulesNew routine and rules

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Research on Transitioning from Research on Transitioning from Medical Student to New ResidentMedical Student to New Resident

Literature is replete with information on Literature is replete with information on various transition points, difficulties, tips various transition points, difficulties, tips to survive the transition year to survive the transition year

Following information taken from Yao & Following information taken from Yao & Wright (Journal of General Internal Wright (Journal of General Internal Medicine 2001: 16:486-492)Medicine 2001: 16:486-492)

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Why Resident’ Problems Arise Why Resident’ Problems Arise Literature confirms 3 distinct causative Literature confirms 3 distinct causative

areas :areas :

Insufficient use of time (44%)Insufficient use of time (44%)

Insufficient knowledge (48%)Insufficient knowledge (48%)

Poor clinical judgment (44%)Poor clinical judgment (44%)

Demands of a Resident’s Demands of a Resident’s ScheduleSchedule

Results in:Results in:

New stressors and challengesNew stressors and challenges

Need to do moreNeed to do more

Need to read and study moreNeed to read and study more

Less time to accomplish it allLess time to accomplish it all66

Lack of TimeLack of TimeResults in:Results in: Less time for things that make you uniqueLess time for things that make you unique

Personal neglectPersonal neglect

Inability to keep pace with studiesInability to keep pace with studies

Sleep deprivationSleep deprivation

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Coping With Stress Physical and mental stressors in residency

training can contribute to a resident’s poor performance (Firth-Cozen, Morrison, 1989)

These stressors can be further delineated under 3 areas: situational, personal, and professional (Resident Services Committee, Association of Program Directors in Internal Medicine, 1988)

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STRESSORSSTRESSORS Situational:Situational: starting a new job, moving to a new starting a new job, moving to a new

environment, sleep deprivation. environment, sleep deprivation.

Personal:Personal: family situations (e.g., marriage, family situations (e.g., marriage, parenting) or financial issues (e.g., educational debts) parenting) or financial issues (e.g., educational debts)

Professional:Professional: more complex situations, difficult more complex situations, difficult patients, and career planning issues. Residents have patients, and career planning issues. Residents have noted that factors such as excessive workloads, noted that factors such as excessive workloads, chronic fatigue, and frequent on-call responsibilities chronic fatigue, and frequent on-call responsibilities contribute to their lack of psychological well-being contribute to their lack of psychological well-being (Butterfield, 1998).(Butterfield, 1998).

Cognitive Impairment

Kahn & Addison (1992) define cognitive impairment as “a state in which the resident’s ability to care for self or others, particularly patients,, is hampered because of stress, emotional illness, or substance abuse.”

Small ( 1981) described 7 features of house-officer stress syndrome; four occurring in most residents and the remaining three being more suggestive of serious impairment.

Four Dimensions of StressFour Dimensions of Stress

4 features of stress syndrome found occurring in most Residents (Small, 1981):

Episodic cognitive impairment (due primarily to sleep deprivation)Chronic angerPervasive cynicismFamily discord

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Sleep DeprivationSleep Deprivation

Manifests in several ways:Manifests in several ways:

Poor judgmentsPoor judgments

Poor organizational skillsPoor organizational skills

Poor time management skillsPoor time management skills

Poor planningPoor planning

My RoleMy Role Academic Skills CoordinatorAcademic Skills Coordinator

Conduct assessments Conduct assessments

Consultation/conferenceConsultation/conference

Assist with organizational skills, test-taking strategies and time managementAssist with organizational skills, test-taking strategies and time management

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Main Reasons Residents are Main Reasons Residents are ReferredReferred In-Service Training Exam (ITE) performanceIn-Service Training Exam (ITE) performance

Step 3 Board score failureStep 3 Board score failure

Test-taking strategiesTest-taking strategies

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Process When ReferredProcess When Referred

Resident sets up appointment/s for:Resident sets up appointment/s for:

Assessment batteryAssessment battery

Consultation/conferenceConsultation/conference

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Possible Problematic Areas Possible Problematic Areas Test-taking strategies, organizational Test-taking strategies, organizational

and time-management concernsand time-management concerns

Sleep deprivationSleep deprivation

Knowledge gaps Knowledge gaps

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Time ManagementTime Management

Need to manage your time differently, effectively, Need to manage your time differently, effectively, and efficiently.and efficiently.

Ask yourself 4 questions: Ask yourself 4 questions:

How do you use your time?How do you use your time?

Have you devised a new study plan?Have you devised a new study plan?

Do you have a daily schedule?Do you have a daily schedule?

Do you keep a daily schedule? Do you keep a daily schedule?

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5 Categories of Problems Residents May 5 Categories of Problems Residents May EncounterEncounter

Category 1: Medical Professionalism:Category 1: Medical Professionalism:

Reynolds (1994) defines medical professionalism as: Reynolds (1994) defines medical professionalism as: “serving the interests of the patient above one’s own “serving the interests of the patient above one’s own interest. Professionalism aspires to altruism, accountability, interest. Professionalism aspires to altruism, accountability, excellence, duty, service, honor, integrity, and respect for excellence, duty, service, honor, integrity, and respect for others” (Reynolds, 1994).others” (Reynolds, 1994).

Yao & Wright (2001), further add: “While there is little Yao & Wright (2001), further add: “While there is little evidence about the best way to teach professionalism to evidence about the best way to teach professionalism to residents with a deficiency in this area, role modeling by residents with a deficiency in this area, role modeling by faculty and resident colleagues is believed to be faculty and resident colleagues is believed to be important.”important.”

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Category 2: Emotional ImpairmentCategory 2: Emotional Impairment

““Emotional impairment, including Emotional impairment, including depression and post-traumatic stress depression and post-traumatic stress disorder symptoms, is not uncommon disorder symptoms, is not uncommon during residency” (Samkoff & McDrmott, during residency” (Samkoff & McDrmott, 1987; Klamen, Grossman, & Kopacz, 1987; Klamen, Grossman, & Kopacz, 1995).1995).

Situational, personal, and professional Situational, personal, and professional domains of stressors may also overlap.domains of stressors may also overlap.

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Preventive ManagementPreventive Management

Some things you can do to maintain Some things you can do to maintain homeostasis as you begin your residency: homeostasis as you begin your residency:

Set up a new schedule template Set up a new schedule template

Stick to your new schedule; tweak as neededStick to your new schedule; tweak as needed

Importance and necessity of sleep should not be Importance and necessity of sleep should not be underestimated underestimated

ExerciseExercise

Set aside some downtime Set aside some downtime

Maintain Personal WellnessMaintain Personal Wellness

Wellness is a state of psychological & physical well Wellness is a state of psychological & physical well being:being:

It helps you to maintain balance between your residency It helps you to maintain balance between your residency and lifeand life

It makes you a better person, doctor, partner, and friend to It makes you a better person, doctor, partner, and friend to others and selfothers and self

It enhances your general happiness, work, relationships, It enhances your general happiness, work, relationships, hobbies, & other interestshobbies, & other interests

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Q & AQ & A

ANY QUESTIONS?ANY QUESTIONS?

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Contact Information

gcodd@uci.eduPhone: (949) 824-3415Medical Education Bldg.UCI, School of MedicineIrvine, CA