From right, Drs. Andrew Neck and Andre Mushahwar get fitted for respirators during the first day of house staff orientation. Orientation continues through today for the first-year resident staff. (photo by Dana Johnson)
Vanderbilt greets new house staff
If you notice any added liveliness on campus this week, it may have its source in the annual arrival of a new group of residents, this year numbering more than 220.
About 70 percent of this year’s incoming residents are fresh from medical school. Of the remaining 30 percent, some are second-year residents whose specialties required them to undertake an initial year of training in a related field. Others in the new group are fourth-year residents — also known as clinical fellows — embarking on subspecialty training at Vanderbilt.
Each new resident has been accepted into one of the 60 specialty training programs offered by Vanderbilt. (The accrediting body for graduate medical education today recognizes 116 distinct areas of specialty training.) While some subspecialties require up to eight years of graduate training, doctors can be licensed after a year of training and can sit for specialty boards after three years of training.
Most of the new residents arrive in time to participate in a weeklong house staff orientation, which concludes today in preparation for the July 1 start of work in the hospital and clinic.
“Residency is a time of transition from student to competent independent practitioner,” said Dr. Fred K. Kirchner Jr., associate dean for Graduate Medical Education. “House staff orientation is concerned with fostering awareness and imparting lessons to help smooth this transition.”
During orientation the participants learn about Vanderbilt’s expectations regarding professional behavior, as well as how to recognize and seek help for stress-related problems that may befall them in the course of their training. Orientation sessions include an introduction to medical center policies, institutional support for stress-related problems, compliance issues, risk management and medical malpractice issues, obtaining family approval for autopsy, introduction to clinical information systems, welcoming remarks from Dean Steven G. Gabbe and Vice Chancellor Harry R. Jacobson, and a picnic that provides an opportunity to meet members of the existing house staff. Orientation is also in part a strategy to streamline various administrative activities, from setting up payroll and computer access to issuing parking stickers. The final day is devoted to orientation within individual departments.
“You are at the beginning of what will shape you not only as a practitioner of our great profession, but as server of people and lifelong learner,” Jacobson told the group. “Contrary to popular myth, tonight will not be the last full night of sleep you get for the next four years … and your husbands, wives and families will not need to be admitted on your service just to see you. Residency is hard and it is demanding but it need not be demeaning. It should, at its best, be a noble pursuit, and a partnership between you, the seeker, and we, the guide. I’ve watched with disbelief and sadness as institutions and their residents have become adversaries. I can think of no poorer fate than to be the head of such an institution, or a resident there or maybe worst of all a patient there.”
George C. Hill, Ph.D., associate dean for Diversity in Medical Education, spoke on the need to end unequal treatment for racial and ethnic minorities within the nation’s health care system.
“You can help us meet this challenge,” Hill said, ”by playing your part in making the environment here at Vanderbilt an even more welcoming, sensitive, caring one for our diverse population of patients. After all, that is one of the reasons that we are here.”
To supplement specialty training, an interdisciplinary core curriculum for Vanderbilt house staff provides quarterly sessions on topics ranging from communication skills to financial management to managing stress. Social events offered throughout the year, including free tickets to sporting events and concerts, help build collegiality among Vanderbilt residents.
Risk management: serving patients, avoiding pitfalls
This year’s new residents will start their training amidst the third malpractice insurance crisis to rock health care in the past 30 years. Some institutions around the nation saw their malpractice insurance costs double this year, and Middle Tennessee is catching up in the frequency of suits and the size of malpractice awards. Vanderbilt self-insures its first $2 million of liability per occurrence and buys extra coverage for large malpractice awards; Vanderbilt’s cost for extra coverage rose 38 percent this year and is budgeted to rise a similar amount next year (this cost hits department balance sheets according to each department’s degree of risk).
House staff orientation includes a half-day on risk management topics to introduce residents to malpractice risk and to examine pitfalls that can cause adverse patient incidents resulting in lawsuits.
“Part of our message to new residents is that they will be involved in the legal system at some point in their career, whether as a witness, or as the initiator of a child negligence case, or as a defendant in a malpractice suit,” said John C. McCauley, executive director of the Risk and Insurance Management office, which sponsors the sessions.
Residents are involved in approximately one-third of malpractice claims involving payments by Vanderbilt. If recent trends continue, about one-fourth of this year’s new group of residents will be involved in risk management investigations and 10 to 12 will be named in law suits. “Given these statistics, the materials presented in this introductory program are most essential,” said Dr. Robert H. Ossoff, Guy M. Maness Professor and Chair of Otolaryngology and chair of VUMC’s Self Insurance Trust Committee.
At orientation a former resident recounted for the group her involvement in a malpractice suit during training at Vanderbilt. Dr. Gerald B. Hickson, professor and vice chair of Pediatrics, imparted conclusions from his research into why patients sue doctors. A central conclusion of Hickson’s research is that inability to establish rapport with the patient is a root cause of increased risk of malpractice suits.
“To me, our risk management presentation is as much about teaching effective communication skills as it is about avoiding malpractice suits,” Kirchner said. In particular, residents learn the importance of appropriate communication when an error may have occurred, and the importance of contacting the risk management office before there’s a claim, to allow early investigation and quicker resolution of any liability. Discussion of case studies and a review of Vanderbilt malpractice statistics according to specialty area help drive home the message.