Transcript End of Rotation Feedback – Summary June 2008

End of Rotation Feedback –
Summaries
May 2010
Dr Shari Kirsh
Dr Susan Abbey
Dr Claire De Souza
Dr Kenneth Fung
Dr John Langley
Dr Cliff Posel
Dr Pamela Stewart
Dr Wayne Baici
Dr Jason Joannou
Dr Mark Lachmann
Dr Chloe Leon
Dr Judy Lin
Dr Ajmal Razmy
Dr Oshrit Wanono
Dr Justin Weissglas
Baycrest Center
Number of residents 2
Total number of residents:
Areas of strength
1.
2.
3.
4.
5.
6.
7.
Very strong educational
experience (under-utilized)
Very professional
Excellent Teaching Site
A lot of seminars
Work balance is excellent
Assigned 2 supervisors: all
resident-oriented;
Flexible, approachable
Areas of Concern
1.
2.
3.
4.
5.
6.
Previous complaints of
dictation not commented
on as typed own notes
Option to dictate but not
used
Good work balance
created:
Community with
inpatient;
C/L with day hospital
worked well
Addressed all previous
concerns
Suggestions for Change
1.
Increase utilizations: more
residents should go there
CAMH
Number of residents 7
Areas of strength
Areas of Concern
Suggestions for Change
1.
1.
2.
Multiple areas of
subspecialization
Responsive &
supportive to
resident issues
with excellent chief
residents, postgrad
site coordinator &
admin assistant.
1.
2.
3.
4.
5.
6.
7.
8.
Teaching is not consolidated and
requires much travel and time with
disturbance/fragmentation in clinical
care and other activities
Call has been very busy in recent
months related at least in part to
“Transforming Lives” media campaign &
and worsened by ED form.
On call rooms are noisy and unpleasant.
Safety concerns about exiting CS from
Spadina at night (front door locked b/c of
construction)
Grand Rounds technology is poor,
detracts from the experience and
compromises resident’s ability to deliver
optimal presentations
Geriatric rotation - 3 month rotation is
fraught with challenges in terms of
meeting requirements and attending
educational events. Limited scope in
outpatient geriatric rotation (e.g. not Rxing Cog. En.).
Family Tx seminar problematic – poor
quality, poorly organized, little value
Facilities at QS are lacklustre.
2.
3.
4.
5.
6.
7.
Review teaching schedule in terms of: a)
potential consolidation of teaching on
same day as grand roundsb) review of
teaching activities in light of core
curriculum and prune current schedule to
offer only high yield activities
c) consider consolidating teaching into
one or two whole days per month
Review emergency on call with respect to:
a) resident coverage for on-call
b) options for triage
c) ED Alliance Form to be reviewed –
residents uniformly describe it as
cumbersome and not clinically useful
Suggestion of moving a call room to the
12th floor.
Suggestion to put a #1 key lock on the
front door so that residents could come
and go through front door at night.
Review technology options for grand
rounds to allow Power Point presentations
to be delivered in acceptable manner
Geriatric outpatient rotation – supplement
with extra-rotation experiences
Suggestion to stop family tx seminar
Mount Sinai Hospital
Number of residents: 11
Total number of residents ?
Areas of Strength
1.
2.
3.
4.
5.
6.
7.
Site-positive atmosphere,
supportive, responsive to
feedback (change happens),
clean
Chief resident- great
Site coordinator
approachable
Interviewing seminarexcellent,
Supervisors-overall good,
supportive and flexible
PGY2 workload improved on
the inpatient rotation. Limited
number of medication clinic
patients.
Great psychotherapy
opportunities
Areas of Concern
1.
2.
3.
4.
Key concerns related to CAMH
call. Please see Narrative
report.
PGY2s- Outpatient rotationpatient load not adjusted when
there are fewer incoming
residents than out going
residents.
GERIATRICS: Some
improvement, staff more
receptive/understanding but
concerns continue. These
include: -Expectation to follow
outpatients and complete
psychodynamic assessments
on all patients; -Staff
supervision lacking expertise in
specific modalities (ie CBT)
CL – limited variety of patients
(but this is offset with less
workload and more time to
spend with each patient)
Suggestions for Change
1.
2.
PGY2s- Site should try to
assign the same number of
residents to each rotation; or
adjust patient load according to
changes.
GERIATRICS: Staff should
review resident’s goals/needs
and case assignment should be
informed by learning needs.
North York General Hospital
Areas of strength
1.
2.
3.
Busy and useful inpatient
experience
Good medication experience
Good family therapy
supervision
Areas of Concern
1.
2.
3.
Branson outpatient not very well
organized
Only new out-outpatient assessments
are on Tuesdays, unclear what
opportunities there are for residents on
outpatients
No office for resident
Suggestions for Change
1.
2.
On in-patient unit book
protected time for staffresident supervision
For out-patients having a
clear schedule and
clearly communicating
what opportunities are
available for residents
St. Michael’s Hospital
Number of residents: 10
Total number of residents 14
Areas of strength
Areas of Concern
1.
2.
3.
4.
Staff is very supportive
and responsive to
feedback. They seem to
enjoy teaching and
respect that residents
have other obligations.
The work environment is
very positive.
Every rotation is
consistently strong - there
is no sub-department that
detracts from the whole.
The senior interviewing
course is excellent, a
tremendous opportunity to
improve your skills for
STACERS
1.
2.
3.
4.
5.
Residents on in-patient felt that
they focus more on service than on
their learning needs.
PGY-2’s feel they don’t get
teaching around interviewing and
formulation.
On call, there is a lack of clarity
about the role of the nurses in
assessment, and in general,
residents feel overworked
overnight.
Residents on outpatients take on
patients for short term therapy but
end up carrying them for much
longer due to no GP.
Junior female residents feel
intimidated to turn down a male
patient if they do not feel safe
seeing him, although when they do
approach supervisors about his,
supervisors are generally
supportive
Suggestions for Change
1.
2.
3.
4.
5.
6.
Site co-ordinator to organize
mock-orals, perhaps even
assign a mock oral supervisor,
to ensure these get done every
two months.
Staff to attend and present at
Thursday general psychiatry
rounds
PGY-2 interviewing/ formulation
seminar as protected
educational time.
Integrate ‘how to discuss feeling
unsafe with supervisors’ into the
initial orientation.
O/P supervisors to take REP
patient’s back after six sessions
if need ongoing care.
Neutral resident present at
resident eval committee to
ensure fairness and
transparency.
On Call
Areas of Concern
1.
Good on call supervision;
supervisors always available by
phone
Suggestions for Change
1.
2.
Very quiet on most nights; not
felt to be a valuable learning
experience
Morning handover rounds with
crisis team: Concerns about one
supervisor who can be
judgmental about referral
sources and some patients; noncollegial atmosphere; residents
sometimes feel they are being
attacked for their clinical
decisions such as admitting a
patient, even after discussion
the previous night with on call
staff
Midterm update
1.
2.
May be worthwhile to consider an
on call model wherein residents
are on call only until 11 pm
Resident concerns should be
raised with the particular
supervisor in a forum where
feedback can be accepted and
real change is possible
Sunnybrook Health Sciences Ctr
Number of Residents: 11
PGY1 – 4 ; PGY2 – 4; PGY3 – 1; PGY4 – 1; PGY5 -1
Areas of Strength
1.
2.
3.
4.
5.
6.
Staff – friendly, good teaching,
approachable, accessible; no internal
politics affecting residents
On-call – collegial, available, supportive;
good crisis nurses; Dr. Gerber – great
teaching & helped out hands-on when busy
Great teaching seminars: interviewing skills
(Senior – Dr. Schaffer; junior – Dr. Gerber),
formulation (1st block), couples therapy,
psychopharm (extra, open to all years) &
IPT (1st block, Dr. Barakat)
Psychotherapy – great supervision dynamic (Dr. Gerber), IPT, and CBT (Drs.
Fefergrad, Shin and Chandler); CBT
centralized pre-assessed patient list
Geriatrics – Dr. Rapoport - flexible,
observed interviews, good teaching with
EBM
Safety - “Spider” system safety buttons (on
ER, F1 and F2); newly rearranged family
room
Areas of Concern
1.
2.
3.
4.
ER – systems issues - pressure
from ER to move people quickly;
only 1+ “½” dedicated psych
beds; often assessing patients in
the family room
Inpatient nursing - improved but
problems & errors still occurring
(e.g. medication administration,
CIWA, charting). People are
responsive (incl inpatient
director). Improvement in
progress.
Difficulty getting medical consults
on inpatient psychiatry (esp
orthopedics)
Behavioural Neurology rotation –
Good rotation, but late days (8 –
9 PM); lot of time wasted while
waiting around to review cases
Suggestions for Change
1.
2.
3.
4.
5.
Increase PGY1 call
stipend. ($50 –
discrepant from other
sites.)
Improve clinical
training of nurses.
Code white training
earlier in the year.
Have a replacement
program for Stage
Program; improve flow
and referral to
outpatient programs on
discharge
Consider in-pt groups
Sunnybrook Health Sciences Ctr – pg 2
Areas of Strength
7.
8.
9.
WCH Shuttle convenient for residents living downtown
ECT exposure – booked in, 3 sessions, good teaching
Nancy Gribbon, post-grad admin - phenomenal,
organizes mock orals
10. Site coordinator– approachable, meets with residents
11. Social events – staff come, pub night, movie night at Dr.
Levitt’s
Areas of Concern
5.
6.
7.
8.
9.
Transitioning inpatient to outpatient will get
even worse, because Stage Program (dayhospital) is closing down.
Commute (not downtown); parking limited (due
to construction) and expensive (but cheaper
than downtown).
Temperature control in the offices (either too
hot or cold) and thin walls (concerns of pt
confidentiality).
Outpatient – sees less psychotic disorders;
mostly mood & anxiety
Addictions resources lacking
UHN
Number of residents 12
Areas of strength
1.
2.
3.
4.
5.
6.
Excellent site coordinator: very
responsive to resident concerns
Very organized academic program
with easy access to psychotherapy
supervisors and mock orals;
Maluah Dewhurst (admin ass’t) is
seen as key to this excellence in
organization
Inpatient ward is excellent:
general experience, good diversity
of pts, goo support
C/L: excellent supervisors at both
sites, and great learning
environment
Call: excellent overall. Very
supportive morning rounds
(especially Dr. Brar), nurses are
helpful, PESU is a safe and
functional environment, good # of
cases
Resident book amount was
increased to $250/6 months
Areas of Concern
1.
2.
3.
4.
Feedback to residents needs to be
more timely
Chief residents to be involved as often
as possible in critical resident issues
Travel between TWH/TGH is time
consuming
Geriatric inpatient rotation could be
improved in terms of diversity of
patients seen, & flexibility of
supervisor’s schedule
Suggestions for Change
1.
Geriatric inpatient
rotation: supervisor’s
schedule should be
more flexible; more
opportunity for seeing
patients on other
services (C/L, memory
clinic at TWH) since
diversity not always
present on the inpatient
ward (note: this may be
unique to this cohort of
residents doing only 3
months of geriatrics)
St. Joseph’s Hospital
Areas of strength
1.
2.
3.
4.
5.
6.
7.
Excellent orientation with
1GNorth staff at retreat
Well organized in-patient unit
Great diversity of cases
Good psycho-pharmacology
experience
Great office (large, however
far from outpatient psychiatry
department)
Set up mock orals easily
Supervision – easily
accessible (ie available),
approachable, and supports
other academic activities
Areas of Concern
1.
2.
3.
So much going on that difficult to
get an out-patient experience
Limited number of psychotherapy
(psychodynamic and CBT)
supervisors
Difficult to set door lock code
(system issue)
Suggestions for Change
1.
2.
Block time off (maybe half a day
of week) for protected out-patient
assessment and follow-up times
Increase number of different
psychotherapy supervisors and
organize prior to beginning
rotation
Toronto East General Hospital
Number of residents: 2 of 2 present
Areas of strength
1.
2.
3.
4.
5.
Good site co-ordinator
Residents enjoy autonomy
Mock orals organized
Responsive staff
Broad exposure to general
psychopathology
Areas of Concern
1.
2.
3.
4.
5.
Not able to do call on site
Formal
teaching/seminars/grand
rounds still improving (WCH
and local seminars helpful,
grand rounds often not very
academic, Wednesday
lunches cannot be attended)
Informal, everyday teaching,
around clinical cases could be
stronger with more emphasis
on formulating and
psychopharm
Quality of CBT education may
require some standardization.
This is being looked into by
the CBT people at U of T.
Inpatient house staff (allied
and RNs) still becoming
familiar with role of resident
MD on team
Suggestions for Change
1.
2.
3.
4.
On site call
Continue to improve opportunities
for more formal/informal teaching
Provide inpatient team with
information re:
expectations/objectives of
resident education/training
Provide out-patient orientation
package to residents containing
contact information
Women’s College Hospital
Number of residents: 1
Areas of strength
1.
2.
3.
4.
5.
6.
In general good experience
Responsive to concerns: quick
Excellent Life-Stage Program
Little exposure to psychotic
illness
Excellent mindfulness and
trauma program
Excellent Supervision
Areas of Concern
1.
2.
3.
Would like to observe
interviews of staff
No Email Reminders of
coming events (done at
other sites)
Only one resident doing
outpatient therefore isolated
Suggestions for Change
1.
2.
3.
4.
Possible linking with other hospitals
to create more seminars
More residents assigned to site to
reduce isolation
More Email reminders
Observed interviews of staff
CAMH - Child
Areas of strength
1.
2.
3.
4.
Good psychopharmacology
experience
Lots of opportunities for observed
interviews
Good variety of patients
Strong psychotherapy supervision
Areas of Concern
1.
2.
3.
Scheduling ADHD clinic with Dr.
Jain remains difficult. Younger
children are assessed only on
certain days.
Primary and secondary
supervisor roles sometimes not
clear. For, example one
secondary supervisor insisted that
the resident do too many PDD
assessments.
Some residents feel overwhelmed
when starting family therapy.
Didactic teaching and assigned
readings still disconnected from
clinical experience.
Suggestions for Change
1.
2.
3.
Residents should be assigned
specific days for ADHD clinic at
start of rotation, ensuring that
they assess younger children
and that the supervisor is
aware that they are attending
the clinic
More careful matching of
primary and secondary
supervisors to better round out
the resident experience.
Scheduled check-in with site
coordinator after one month to
address any supervisory issues
Better coordination between
teaching, readings, and clinical
experience. Assign two
residents as co-therapists for
each family
Hincks-Dellcrest
Areas of strength
1.
2.
3.
4.
5.
6.
Psychotherapy supervision:
opportunities for reviewing
tapes of play therapy
sessions
Opportunities for feedback
during multidisciplinary team
assessment
Collegial work environment
Opportunity for ½ day/week
at primary school/day care
In Person Intake
Assessments (“IPI’s”) for
residents
Exposure to multidisciplinary
clinicians and students
Areas of Concern
1.
2.
3.
4.
disproportionate amount of
time observing other
clinicians and students
versus active interviewing
little experience initiating
and following up trials of
pharmacotherapy
families on wait lists for
psychopharmacology and
therapy too often outdated
and/or inappropriate
residents spend a lot of
time completing paperwork
and trying to contact waitlist
patients
Suggestions for Change
1.
2.
3.
Increase opportunities for residents
to do IPI assessments
Ongoing review of therapy and
psychopharmacology wait lists to
ensure potential cases are
appropriate for residents
Shift administrative duties to
appropriate staff
Youthdale
Areas of strength
1.
2.
3.
4.
Well organized structured schedule
Excellent supervision, including CBT
and psychotherapy(individual and
family)
Good experiences with medications
Great learning environment
Areas of Concern
1.
Minimal exposure to initial
assessment of common mood and
anxiety problems
Suggestions for
Change
1.
Think of ways to
improve resident
exposure to mood
and anxiety concerns
– possibly increasing
use of telepsychiatry
either at Youthdale or
at HSC
The Hospital for Sick Children
Areas of strength
1.
2.
3.
4.
5.
good balance between
supervision and clinical
autonomy
variety of both outpatient and
inpatient rotations
opportunity for residents to
complete plenty of new
assessments
good family therapy and CBT
supervision
regular supervision with
psychology staff on
neuropsychiatry outpatient
rotation
Areas of Concern
1.
2.
some trouble integrating ongoing
outpatient responsibilities with
schedule of inpatient rotations
residents “feel like visitors” on
short, one month inpatient
rotations
Suggestions for Change
1.
2.
more communication between
inpatient and outpatient
supervisors in advance of
transition between rotations
longer inpatient rotations (ex.
2 months plus 1 of crisis),
perhaps at the expense of
experience on all inpatient
teams
NYGH-Child
Number of residents 4
Total number of residents
Areas of strength
1.
2.
Overall good experience
ON CALL: Residents
enjoyed Variety, business of
call, exposure to different
populations
3. Call only until 11:00pm.
4. Child Supervision excellent
(inpatient)
5. Variety of exposure in child
6. Child experience good for
self-directed resident
7. General Outpatient
8. Site has been responsive to
concerns
9. Psychotherapy supervision
excellent
10. CBT groups with
opportunities for observing
and conducting
Areas of Concern
1.
2.
3.
4.
5.
6.
7.
8.
9.
Not much teaching or individual
supervision on child rotation
Diminished opportunity for observed
interview on outpatient
No children seen under age 10 in child
rotation
No office for resident at Branson Site,
and less opportunities on Outpatient
experiences (resident has to recruit
opportunities)
Need more communication on
requirements and rotation expectations
between Postgraduate and community
sites (ST. Joseph’s, TEGH and NYH)
No switch of outpatient supervisors for
six months
Too heavy outpatient service: ie. 6
outpatient consultations per week plus
2 elective consultations at the expense
of education
Pressured to see more patients quickly
than level of training
Seminars at site are minimal
Suggestions for Change
1.
2.
3.
4.
5.
Primary Supervisor, with
exposure to other
assessments from
another supervisor to
create variety within six
months
Introduce more teaching
and protected time for
supervision
Need maximum on
number of consultations
per week with clear
guidelines from
Postgraduate (suggest
3/week)
All potential supervisors
have goals and
objectives of rotation RE:
level of training
Better standardized
supervision
George Hull
Areas of strength
1.
2.
3.
4.
5.
6.
7.
very supportive
multidisciplinary team
* great supervision & flexible
staff psychiatrists
* encourage attendance at
supplementary conferences,
workshops, etc.
* good exposure to
community clinic practice
* opportunity to participate in
parent/ child groups of
varying modalities
* opportunity to be involved in
teaching medical students
* opportunity to be exposed
to a wide variety of agegroups
Areas of Concern
1.
2.
3.
away from downtown core &
not as accessible by TTC
(access to a car would be
preferable)
predominance of initial
assessments, with less
opportunity for follow-up in
contrast to other sites (ie.
med management)...
although opportunities still
available
no dictation system - all
reports hand typed
Suggestions for Change
1.
2.
Nil - I believe that my
negatives were unique to my
particular experience and
timing of the rotation. The
site is very receptive to
feedback (so much that we
(myself & staff) had weekly
feedback sessions, which
were great!).
consider using a dictation
system