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PGY-1 RETREAT

PGY-1 RETREAT. AGENDA. Introduction Supervising Resident Job Description Admitting Strategies Work Round Strategies Conflict resolution/professionalism Wrap-up. INTRODUCTION. Goals of Retreat Recognize the significance of the transition Highlight practical strategies

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PGY-1 RETREAT

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  1. PGY-1 RETREAT

  2. AGENDA • Introduction • Supervising Resident Job Description • Admitting Strategies • Work Round Strategies • Conflict resolution/professionalism • Wrap-up

  3. INTRODUCTION Goals of Retreat • Recognize the significance of the transition • Highlight practical strategies • Address concerns/uncertainties • Acknowledge the end if internship • Bring group together in a relaxed environment

  4. SUPERVISING RESIDENT Job Description

  5. ACGME Competencies • Patient Care • Medical Knowledge • Practice-based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems-based Practice

  6. Overview Organizational Strategies Triage Strategies Personal Strategies ED Strategies ICU Strategies Teaching On-Call ADMITTING STRATEGIES

  7. Admitting Strategies Organization

  8. Admitting Strategies Triage

  9. Triage Factors to Consider?

  10. Triage Factors • Stability of patient • Critical nature of disease (bad potential) • Need for acute decision-making a. disposition b. diagnostic testing c. intervention • Route of entry • Duration since last evaluated

  11. Triage Examples • CCU Transfer: 57 yo male 48 hrs s/p AMI • GI Clinic: 38 yo female with Crohn’s exacerbation • Direct Admit: Unknown pt (RN calling for orders) • ED: a. 71 yo s/p THR presents with dyspnea b. 52 yo male with chest pain

  12. Personal Strategies • Delegation of tasks • Reconvene and share information • Maintain your pace • Take 5 minute breaks to reorganize • Don’t waste energy • Ask for help • Other?

  13. ED Strategies

  14. ICU Strategies

  15. Teaching Strategies What is your role? Where do you fit this in? What are the greatest challenges to this?

  16. Running Effective Work Rounds • Goals • Before rounds begin • Outside the patient’s room • At the bedside • After the bedside visit • Finishing rounds

  17. Resident as Role Model Professionalism Conflict Resolution

  18. Conflict Resolution • Avoiding: Most appropriate when one’s stake is low. • Competing: Forceful, overpowering approach-most suitable for short-run gains. • Accomodating: Smooth over differences to maintain harmony.

  19. Conflict Resolution • Collaborating: Most effective when issue is critical and continuing relationship is important. Time is generally not a pressing issue. • Compromising: Most appropriate with complex issues of moderate importance.

  20. Keys to Negotiation • Establish common goals • Separate people from the problem. • Focus on interests rather than problems. • Use objective criteria (remove emotional content). • Practice diplomacy skills: a. remain humble (you could be wrong) b. remain respectful c. don’t embarrass your colleague (leave an option for retreat with dignity)

  21. Conflict resolution The ED calls you with an admission.The patient is A 79 y.o. woman with acute dyspnea. Her CXR is read as R basilar atelectasis vs infiltrate. The ED is admitting her with community-acquired pneumonia. You review the CXR and are unimpressed with the infiltrate. In addition, after seeing the patient you note that she has no fever or leukocytosis, but does have a recent history of prolonged travel. You are concerned she may have a pulmonary embolism.

  22. Conflict resolution • Is this issue important (should you act)? • What is your goal? • What is the ED resident’s goal? • What are your common goals? • How would you discuss this with the ED resident?

  23. Conflict Resolution You are a ward resident at the University campus. Early in the rotation you detect some tension between yourself and one of your interns. You have some concerns about his ability to follow-through on assigned tasks, but he becomes defensive when you first attempt to give him feedback. You decide to just let it go. During the last week of the rotation, on a particularly busy day, the case manager informs you that a patient

  24. Conflict Resolution you were planning to discharge to STR, will be delayed because her AM labs were not ordered. You turn to the intern and ask “so what happened?”. The intern becomes agitated and states “if you thought they were so important, why didn’t you just order them yourself?” • What went wrong here? • How would you handle this?

  25. Support Systems • Attending of Record • Consider “Team Meeting” • Chief Resident • Program Director/Associate Director • Teaching Attending/Faculty Mentor • Treatment Issues Committee • Mary Philbin

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