Blog #4 – March 13, 2017

During this selective, the chief resident led an informal teaching session covering common issues junior residents may encounter while on-call. I found this talk to be very relevant for my learning as the resident not only covered her approach to scenarios she personally experienced, but also shared useful advice. In addition to covering content, I learned when and how to document patients I may assess on-call, the value of assessing all patients as a junior resident (to understand what patients look like when nurses are concerned), and how to prioritize and juggle between different ward and ER responsibilities. These were all important points that I will hopefully utilize to survive the first year of residency!

Much like my experience with the ward emergency simulation, I think covering common on-call issues and approaches on how to manage them should be a mandatory component in our transition to residency curriculum. Preparing trainees on what to expect may not only ease their anxiety about being a resident on-call, but can also enhance trust between new learners and the medical team they join. I have often heard junior off-service residents voice anxiety and fear with completing call while on a service they are unfamiliar with. Orienting these learners to the common potential issues they may face at the beginning of their rotation, or perhaps having debrief sessions with learners after their first few call experiences, may better prepare them for future experiences. Perhaps having these discussions may help mitigate such anxiety, but more importantly, may result in better patient care.

I hope that when I am a resident, I will follow the CMR’s example, summarizing how to approach common on-call issues in a presentation and sharing this information with junior trainees. I think creating such teaching material would not only help enhance my own learning as a resident, but also help me to reflect and learn from errors in my own practice. Additionally, given the recent findings of a systematic review by Mata et al. (2015) that found that 28.8% of residents (range = 20.9% to 43.2%) suffer from depression or depressive symptoms, I think having these discussions during residency is important because it normalizes the fact that residents are not alone in their training process, that errors are made, and may hopefully help reduce the incidence of burnout/depression among trainees.

While reflecting on what I have been taught, I also thought about how the information was delivered as there were many case scenarios that we covered in a short time frame. If this content were to become a mandatory component of TTR, what should the nature of the experience be for trainees, and what would be the most effective method of delivery (e.g. informal lectures, video modules, readings, etc.)? How will we determine what issues to cover? How many teaching sessions should there be before trainees feel prepared? Who will lead these sessions? What will be the learning objectives for students? How will students be evaluated? Having been previously involved with some aspects of curriculum design, I acknowledge that while having such teaching sessions would be ideal, there are challenges associated with delivering this content in a formal curriculum (e.g. time, achieving buy-in from various stakeholders, etc.). In the end, would having these teaching sessions actually meet students’ needs, or can nothing truly prepare them for the issues they will encounter in residency? I suppose I will only know after July 1.

- CY