Presentation by Dr James Edwards

1. 1
Right Start Forum
Preparing for Safe Practice as an Intern
(PSPI Program)
Presenter:
Dr James Edwards
Project Partners:
Sydney Medical School
Northern Sydney Local Health District
Sydney Local Health District
Team Health Right Start Program Showcase
27 February 2012

2. 2
Faculty
 Merrilyn Walton: Professor of Medical  Jennifer-Smith Merry: Research Fellow, School of
Education (Patient Safety) School of Public Public Health
Health, Sydney Medical School
 Susan McKenzie, Clinical Lecturer, Sydney Medical
 Stewart Dunn: Professor of Psychological School
Medicine, Northern Clinical School
 Clare Richmond: Emergency Physician, Simulation
 James Edwards: Emergency Physician, Royal Fellow, RNSH, RPAH
Prince Alfred Hospital
 Gillian Nisbet, PhD candidate & project manager
 Kar-Soon Lim: Senior Lecturer
 Barbara Cassidy, Educational design instructor
Anaesthesia, Concord Clinical School
 Beth Vogelzang (Acting) Nursing Unit
 Vasi Naganathan: Ass. Professor
Manager, Concord Repatriation General Hospital
Medicine, Concord Clinical School, Centre for
Education and Research on Ageing (CRGH)  Evelyn Dalton Manager Clinical Simulation
Laboratory/Academic Sydney Nursing School
 Leonnie Watterson: Clinical Associate
Professor, Anaesthesia, Northern Clinical  Registrars and resident medical
School, Director officers, actors, volunteer nurses.
Team Health Right Start Program Showcase
27 February 2012

3. 3
Introduction & Background
 July phenomenon
 Increased errors occur with new house staff at the beginning of the
academic year
 Inaba K, et al., Complications and death at the start of the new academic year:
Is there a July phenomenon. The Journal of Trauma: Injury Infection and
Critical care, 2010. 68(1): p. 19-22.
 Haller G, et al., Rate of undesirable events at the beginning of academic year
:retrospective cohort study. BMJ, 2009: p. 339:b3974.
 January phenomenon
 Hilmer S, et al., Do medical courses adequately prepare interns for safe and
effective prescribing in New South Wales public hospitals? Internal Medicine
Journal, 2009. 39: p. 428-34.
Team Health Right Start Program Showcase
27 February 2012

4. 4
Aim & Methods
 Program Aim:
 Reduce adverse events or the potential for adverse events for
patients being treated by interns during their first months of
employment.
 Learning Outcomes:
 Demonstrate knowledge of and be confident in situations that
have the potential to harm a patient
 Identify the ‘red flag’ situations
 Know when to seek assistance
 Act appropriately to avoid an adverse event.
Team Health Right Start Program Showcase
27 February 2012

5. 5
Aim & Methods
 Program designed around 6 theme areas:
 Clinical challenges – case management problems
 Procedures – skills for discrete procedures
 Organisational skills – clinical clerking – working safely and
effectively within the system
 The deteriorating patient – clinical emergencies
 Interactive – patient doctor, colleague communication
 Self-management – behaviours directed as self-regulation and
professionalism
 5 Day experiential program for pre-intern medical students:
 Case-based learning; simulations; workshops; role plays
Team Health Right Start Program Showcase
27 February 2012

6. 6
Results
 Process evaluation
 37 Pre-internship medical students
 70% of participants rated Program 8 out of 10 or above
 Clinically focused sessions well received:
 Active participation - time for practice and questions
 Based on real cases/ real mistakes – met immediate needs of
participants
 Participants ‘put in situation’ – i.e. it could have been them that had
made the mistake
 All but 4 participants indicated that all final year medical students
would benefit from such a course
 Impact evaluation - ongoing
Team Health Right Start Program Showcase
27 February 2012

7. 7
Conclusions & Lessons Learned
 PSPI program fills the gap in transition from student to
practitioner
 Maintain clinical focus on avoiding adverse events:
 Retain the most effective and efficient learning methods
 Integrate communication skills development into clinical case
scenarios rather than a separate session
 Provide opportunities for individual feedback on performance
 Clinician teachers are prepared and include
 Clinician educators with recent graduate experience
 Experienced clinicians with teaching and supervisory responsibilities
Team Health Right Start Program Showcase
27 February 2012

8. 8
Where to from here?
 Finalise the PSPI Curriculum Guide incorporating:
 Principles and background for content covered and teaching
strategies adopted (i.e. how to teach)
 Comprehensive description of topics, resources and facilitator
actions
 Develop the PSPI Facilitator Training Program (How to
teach)
 Make available the PSPI program to all medical schools
 Continue research plan to evaluate the longer term impact
of PSPI Program
 Opportunities for IPL??
Team Health Right Start Program Showcase
27 February 2012