Emergency Medicine Resident Orientation: How Training Programs Get their Residents Started

Abstract

IntroductionThe first formal orientation program for incoming emergency medicine (EM) residents was started in 1976. The last attempt to describe the nature of orientation programs was by Brillman in 1995. Now almost all residencies offer orientation to incoming residents, but little is known about the curricular content or structure of these programs. The purpose of this project was to describe the current composition and purpose of EM resident orientation programs in the United States.MethodsIn autumn of 2014, we surveyed all U.S. EM residency program directors (n=167). We adapted our survey instrument from one used by Brillman (1995). The survey was designed to assess the orientation program’s purpose, structure, content, and teaching methods.ResultsThe survey return rate was 63% (105 of 167). Most respondents (77%) directed three-year residencies, and all but one program offered intern orientation. Orientations lasted an average of nine clinical (Std. Dev.=7.3) and 13 non-clinical days (Std. Dev.=9.3). The prototypical breakdown of program activities was 27% lectures, 23% clinical work, 16% skills training, 10% administrative activities, 9% socialization and 15% other activities. Most orientations included activities to promote socialization among interns (98%) and with other members of the department (91%). Many programs (87%) included special certification courses (ACLS, ATLS, PALS, NRP). Course content included the following: use of electronic medical records (90%), physician wellness (75%), and chief complaint-based lectures (72%). Procedural skill sessions covered ultrasound (94%), airway management (91%), vascular access (90%), wound management (77%), splinting (67%), and trauma skills (62%).ConclusionCompared to Brillman (1995), we found that more programs (99%) are offering formal orientation and allocating more time to them. Lectures remain the most common educational activity. We found increases in the use of skills labs and specialty certifications. We also observed increases in time dedicated to clinical work during orientation. Only a few programs reported engaging in baseline or milestone assessments, an activity that could offer significant benefits to the residency program.

Bringing the Flipped Classroom to Day 1: A Novel Didactic Curriculum for Emergency Medicine Intern Orientation

“…Almost all emergency medicine (EM) residencies provide orientation programs for their incoming interns. 1 Orientation programs are commonly a mix of clinical time, didactic teaching, administrative onboarding, and social activities. 1 While medical educators have sought to replace lectures with alternative methods that promote active learning and longer term retention, 2 – 3 lectures continue to be the predominant educational activity during EM orientations.…”

“… 1 Orientation programs are commonly a mix of clinical time, didactic teaching, administrative onboarding, and social activities. 1 While medical educators have sought to replace lectures with alternative methods that promote active learning and longer term retention, 2 – 3 lectures continue to be the predominant educational activity during EM orientations. 1 , 4 – 5 Few programs have yet to engage in baseline, or programmatic, assessment of Level 1 Milestones for incoming interns.…”

“… 1 , 4 – 5 Few programs have yet to engage in baseline, or programmatic, assessment of Level 1 Milestones for incoming interns. 1 , 6 …”

Intern Passport: Orienting New Travelers to the Emergency Department

“…The majority of emergency medicine (EM) residency programs offer formal intern orientation. Didactic sessions and social activities are the most common components of intern orientation, but skills training sessions are increasing in frequency 1. Emergency department (ED) access, exposure, and introduction are key components and areas of focus for intern orientation 1.…”

“…Didactic sessions and social activities are the most common components of intern orientation, but skills training sessions are increasing in frequency 1. Emergency department (ED) access, exposure, and introduction are key components and areas of focus for intern orientation 1. During semiannual evaluations, our residency program identified intern self-reported challenges with achieving timely orientation to our ED personnel and resources.…”