New roles and new sites can be disorienting for learners, whether they are interns new to the ED or experienced residents taking on additional responsibilities. Providing an effective orientation for learners at the beginning of the shift decreases learner anxiety and allows them to work towards realistic goals in a more effective way—which makes your job easier.

We recommend utilizing a huddle to get your team on the same page at the beginning of the shift. Worried about how long this takes? A few minutes spent setting expectations early will pay back dividends over the course of the shift. 

 

Step 1: Provider Team Introductions (be sure to include medical students and off-service rotators)

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• What’s the learner’s educational background? What rotations have they done?

• Do they have additional experiences that change their needs/expectations? 

• What are they hoping to accomplish today? This week? This month? Year? 

• This is a great opportunity for residents to initiate daily goals and evaluations using MyTIPReport if they have not already done so. Discuss the suggested goals and a plan for meeting and evaluating them.

 

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Step 2: Business of the Day

Educational Nuts and Bolts

• With whom should each learner staff their patients?

• When should they pick up new patients?

• How long should a typical H&P take? A presentation?

• What should they do if they suspect patients are critically ill?

• If the learner will be presenting to you, what information should be included?

• Will you be directly observing the learner during patient encounters?

• What are the expectations for documentation?

• When and in what format should the learner expect feedback?

Getting around the ED (May be omitted on basis of trainee experience)

• Which rooms should the learner see patients in?

• How will they know when a new patient has arrived?

• Where can they find important equipment?

• Where are other important locations (bathrooms, break rooms, lockers, etc) and codes to open them?

• What types of patients should they expect to see?

• How are consults and admissions operationalized at your site?

• How do they negotiate special resources (behavioral health, social work, case management, language interpreters, etc.)?

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Step 3: The Rest of the Team

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• Who else is on the team? What are their roles and how can they be contacted?

• This is a good opportunity to introduce the learner to the nursing team and set expectations about who should be the point person for order requests and clarifications. 

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Step 4: The Debrief

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• At the end of the shift, provide learners with feedback and complete MyTIPReport evaluation. 

• When debriefing the shift, consider using the "plus-delta" technique (i.e. What went well? What could have made the shift better?).

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