Keys To Initiating New Residents Into Residency Programs

These residency directors offer guidance on how to incorporate new residents into a residency program, focusing on orientation, training and what new residents are permitted to do.

Q: 

How and when do you start the process of incorporating new residents into your hospital system with human resources, medical records, electronic health records (EHR), compliance training and medical examination?

A:

Alan Catanzariti, DPM, FACFAS, notes his program’s coordinator contacts new residents in April following the match. As he says, the early incorporation of new residents is necessary as state-specific guidelines for podiatric residents require full physician and Drug Enforcement Administration (DEA) licensure, which involves the completion of multiple continuing medical education (CME) prerequisites including part III of the American Podiatric Medical Licensing Examination (APMLE) among others.

David Bernstein, DPM, FACFAS, says his program’s contact with new residents starts on June 1 with a request for health, license, contract and tax information. He says incoming residents sign their one-year contract on June 15 with an introduction to human resources and EHR/medical records training starts June 20 with three all day sessions with Epic medical software company trainers. Dr. Bernstein says new residents then have additional training with senior residents with additional podiatric protocols and EHR training for two days.

As Thanh Dinh, DPM, FACFAS, notes, her Podiatric Surgical Residency Program is part of a large teaching hospital so her program’s residents attend an all-inclusive orientation program through the Department of Surgery’s Graduate Medical Education office. She says the week-long orientation happens one week prior to the July 1 residency start date and includes review of hospital policies, compliance, introduction to EHR as well as resources for the well-being of physicians. 

“This orientation allows our residents to meet the trainees in other programs and offers them an opportunity to build relationships both professionally and personally, particularly if they are new to the area,” says Dr. Dinh. “This orientation is concluded with a reception during which the new house staff are introduced to the attending staff in a formal, yet fun environment.”

In his large network of teaching hospitals, Dr. Catanzariti says the compliance training and EHR training occurs in late June when new residents from all specialties have several days of joint orientation training organized by the office of Graduate Medical Education. In addition, his new residents have program-specific EHR training during several peer-to-peer learning sessions with senior residents in the week prior to their start.

Q:

Do you provide new residents with a written handbook of protocols and procedures, or a resident survival manual? In your experience, what is the best approach to getting new residents acclimated and up to speed in a timely, efficient manner?

A:

Dr. Dinh’s program provides residents with an electronic version of the program resident manual, which formally outlines the program’s policies and procedures. Dr. Bernstein’s incoming residents receive a written and electronic version of his program’s residency manual with protocols and procedures that is readily available on the American College of Foot and Ankle Surgeons (ACFAS) website and soon on the ePresent website.

Dr. Dinh adds that previous residents have also created a more informal written “survival” manual that details more practical information such as surgeon preferences and information that allows the incoming residents a step up while acclimating. Dr. Catanzariti’s program also provides new residents with a resident survival manual, a bound, pocket-sized document. The program assigns revisions to each advancing class at the end of their first year, as Dr. Catanzariti says advancing residents are most accustomed with day-to-day function on the hospital floors.

“This is a quick reference guide of information vital to the new resident’s successful navigation through their first year, containing a variety of high yield information including staff contact information, guides for basic OR setup and tips for successful interaction with adjunctive faculty,” says Dr. Catanzariti.

Much more extensive, notes Dr. Catanzariti, is his program’s comprehensive binder of protocols and procedures that each incoming resident receives prior to formal orientation.

In order to efficiently acclimate new residents to their environment and duties, Dr. Catanzariti’s program has found the best approach is to pair new residents with advancing second year residents for the first several months of call, clinic and operative cases. He says that method provides the new hire with an abundant and reliable source of information, and also forges bonds and camaraderie between residents, which he says often extends beyond the three years of formal training. Dr. Dinh’s and Dr. Bernstein’s programs also pair a new resident with a senior resident for mentoring opportunities. Dr. Bernstein’s program assigns first-year residents to second- and third-year residents for the months of July and August for emergency department and call schedule at night and on weekends. 

Q:

What procedures are new residents allowed to do? Do you have a list of procedures that they must perform under guidance before they can do it on their own?

A:

During the two weeks leading up to their first official day of training, Dr. Catanzariti’s new residents have extensive orientation training in addition to peer-to-peer learning to ease them into their first day on the job. He cites this as “an integral part of our educational process.” During multiple sessions of one-on-one training with their senior residents, new residents receive instruction in basic skills, says Dr. Catanzariti, including dressing application, cast application, the drawing up and administration of injections, proper tourniquet application, and sterile prep of the operative patient. He says residents also receive suturing instruction on cadaver specimens in the program’s fully equipped wet lab.

All Dr. Bernstein’s residents are trained in individual procedures with three levels of competence: performing procedures with observation, independently performing procedures and independently performing and teaching procedures. He and other attendings evaluate new residents every six months to determine if they should update the criteria.

In Dr. Dinh’s program, new residents perform all procedures under guidance until they have demonstrated proficiency. She notes the rate at which they attain proficiency varies by individual and her program will supplement OR training with workshops to improve skills and confidence.

Dr. Catanzariti adds that his residency program has successfully employed a post-graduate year based system of case assignments for the past several decades. His program permits first-year residents to function as first assist primarily with debridement and amputation cases.

“By restricting case types in this manner, new residents achieve a sound basis in surgical principles, soft tissue handling and operative instrumentation prior to advancing to elective forefoot and medial column procedures in their second year,” says Dr. Catanzariti.

Dr. Catanzariti adds that his program’s first- and second-year residents have ample opportunity to serve as second assist to their senior residents, which he says makes for a “seamless transition” to higher level cases when it is time for new residents to advance.

Dr. Bernstein is the Director of the Podiatric Residency Program at Bryn Mawr Hospital in Wayne, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Catanzariti is the Director of Residency Training at the Western Pennsylvania Hospital in Pittsburgh. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Dinh is an Assistant Professor of Surgery at Harvard Medical School. She is the Program Director of the Podiatric Surgical Residency Program at the Beth Israel Deaconess Medical Center in Boston. Dr. Dinh is a Fellow and a member of the Board of Directors for the American College of Foot and Ankle Surgeons.