Mentoring Conversations Reflective Writing Exercises for Interns MAJ

Mentoring Conversations: Reflective Writing Exercises for Interns MAJ Jason Sapp, MD, FACP Associate Transitional Year Intern Program Director Madigan Army Medical Center Tacoma, WA 7 January 2015

Disclosure • No conflicts of interest to report. • The views expressed are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense or the U. S. Government.

Agenda • • • “My Mistake” overview Milestone analogy Mapping “My Mistake” to milestones Quality improvement opportunities “My Reflection” overview Mapping “My Reflection” to milestones

Poll Question 1

Poll Question 2

“My Mistake” Project

“My Mistake” Project • Second half of the academic year • Residents summarize a mistake they or their team made • Written reflection • Oral presentation and discussion

“My Mistake” Project • Give a brief description of the circumstances surrounding the mistake: • What was your specific role in the mistake? • What factors contributed to the mistake (i. e. fatigue, miscommunication…)? • What did you do when you realized the mistake was made?

My Mistake Project • Did you tell your team and how did they react? • Did you or someone from your team tell the patient (if a patient was involved)? • How did the patient or patient’s family react (if a patient was involved)? • What could be done to prevent others from making this same mistake?

Common Mistakes • Sign out or transfer errors • Order entry errors • Nursing interactions

Factors Leading to Errors • Fatigue • Miscommunication • Knowledge deficits

Milestone Analogy

Milestone Practicing physician Ambulate without assistance Half way through TY year After medical school Expert (12 months) Proficient (3 -6 months) Competent Advanced Beginner Novice TY graduate Residency graduate The 5 Dreyfus Levels Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in directed skill acquisitions. February 1980

Milestone Example SBP 2: Works in interdisciplinary teams to enhance patient safety and improve patient care quality Dreyfus Level 1 Novice Recognizes failures in teamwork and communication in health care as a leading cause of preventable patient harm After medical school Dreyfus Level 2 Advanced Beginner Dreyfus Level 3 Competent Dreyfus Level 4 Proficient Dreyfus Level 5 Expert Works with other Works in Analyzes team Leads members of the interdisciplinary experience and interdisciplinary health care teams to identify works with the teams to improve to identify system solutions (action team to enhance health care errors and areas plans) to identified patient safety and delivery systems of potential system errors care quality in the quality specialty area improvement Half way through TY year TY graduate Resident graduate Practicing physician

Milestones Milestone committees define levels Practicing Physician End of PGY-3 Medical school graduate Novice End of PGY-1 Year Advanced Beginner End of PGY-2 Year Expert Graduation Proficient Competent The 5 Dreyfus Levels Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in directed skill acquisitions. February 1980

Mapping “My Mistake” to Milestones

Competencies Addressed • Systems Based Practice • Practice Based Learning and Improvement • Professionalism • Interpersonal and Communication Skills

TY Milestones

Milestone Evaluation 0 – No opportunity to assess these skills 1 – Not demonstrated 2 – Developing 3 – Consistently demonstrated

Milestone Evaluation

TY Milestones

Family Medicine Milestones

Quality Improvement Opportunities

My Mistake Project • Information/recommendations relayed to the appropriate hospital committee or department • One topic group quality improvement project

“My Reflection” Project

Poll Question 3

Question 4

“My Reflection” Project • Quarterly learning activity • Reflection of a specific event, situation, or learning point during one of their rotations • Written summary: – Resident’s thoughts – Self-reflection – Identification of strengths and weaknesses – Plan for improvement

Topics 1) Cost-conscious patient care 2) Patient diversity and vulnerable populations 3) Ethical dilemma and personal belief system 4) Managing personal wellbeing in the setting of clinical duties.

“My Reflection” Questions • Summarize the case or experience you will reflect upon: • Briefly describe why you chose this case or situation to reflect upon:

“My Reflection” Questions • Self reflective statement: – Identify individual deficiencies or strengths, system deficiencies or strengths, and/or areas of varied practitioner approach as they pertain to your case. – Devise a plan for improvement of self or the system if needed. – Assess what you learned from this case / experience and how it will change the way you practice medicine in the future. – If applicable, devise a plan for improvement / future learning.

Mapping “My Reflection” to Milestones

Competencies Addressed • Systems Based Practice • Professionalism • Interpersonal and Communication Skills

TY Milestones

Family Medicine Milestones

Summary • • • “My Mistake” overview Milestone analogy Mapping “My Mistake” to milestones Quality Improvement Opportunities “My Reflection” overview Mapping “My Reflection” to milestones

Questions? jason. e. sapp 2. mil@mail. mil