A quality improvement intervention to enhance performance and perceived confidence of new internal medicine residents

Abstract

Background: Orientation for new medical residents is challenging due to the diversity of prior experiences and cultural backgrounds and is compounded by a lack of orientation curricula that adequately addresses the needs of the medical residents to allow them to perform their duties in an efficient manner from the start. The beginning of residency training is associated with reduced quality of healthcare widely referred to as the ‘July effect’.Objective: To assess the impact of a peer-led orientation for new interns on (a) self-reported confidence level, (b) improvement in performance of first-year residents in appropriate clinical documentation and efficient discharge procedures and protocols.Design/methods: In June 2016, a hybrid of interactive teaching and simulation exercises was used to teach documentation of critical information, such as discharge medication reconciliation and discharge summary. A handout of an intern guide/manual was also provided. The previous year’s data served as comparison/control data. Comparison data were obtained for both groups from hospital’s utilisation review department.Results: Twenty-one of 23 expected new interns (91%) participated in the intervention. There was a significant decrease in non-compliance for clinical documentation in the intervention group compared to the control group. The self-reported confidence level in the intervention group increased 34%.Conclusions: Such peer-to-peer orientation has the potential to effectively improve appropriate documentation and discharge process by new residents and may help to reduce the ‘July effect’.

“It’s helpful to get the time and opportunity to discuss drug treatment; that’s what I think is the most important thing.”—A qualitative study on prescribing education in junior physicians

“…Indeed, the complexity of prescribing takes time to master, including determining priorities in a time-pressured medical environment. However, positive experiences from peer-led orientation for new interns have been described elsewhere [20], suggesting that time for interaction with colleagues may add value, irrespective of seniority.…”

“…Indeed, active learning has been shown favorable among students [19], a finding which may also apply to post-graduate training. The small group format may facilitate discussions, and interaction between knowledgeable tutors and participants has been shown to increase the comfort of the group and their performance regarding the topics focused on [13,18,20]. Interestingly, a recent educational effort using small-group educational workshops with peers increased evidence-based practice among the participating health professionals [21].…”

“…However, the easy-to-do efforts must not be ignored; the interns also appreciated being introduced to practical tools and provided with supporting materials. Likewise, the usefulness of intern manuals has previously been acknowledged [20,28].…”

Improving the quality of discharge summaries through a direct feedback system

“…17,18 Techniques employed have ranged from the provision of one-off and regular teaching sessions to clinicians through to programmes providing both teaching and feedback. [19][20][21][22][23] Importantly, it has been shown that the results of these QIPs can be long-lasting. 24 Additionally, the Royal College of Physicians has provided guidance on how to improve discharge summaries, which can be utilised when designing teaching on this subject.…”

Assessing the quality of electronic medical records as a platform for resident education

“…Lee et al [ 5 ] investigated the use of medical record templates in an EMR system, and the result showed that residents appreciate templates, but the overall documentation quality remained unknown. Other studies have developed curricula for better understanding of medical documentation [ 6 , 7 , 9 , 10 ]. However, these curricula and study results are insufficient for use with medical record writing assessment.…”