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MGH Orientation Information

Orientation for EM residents (MGH Site)

  1. SCHEDULING: Reminder to review the documents “SCHEDULING YOUR EMERGENCY MEDICINE ROTATION AT THE MGH” and “Number of shifts at adult sites”.
  2. ORIENTATION: On first day of rotation at 8h00 in ED conference room B1.112.  Required for all R1’s and those who have not done a rotation at the MGH ED in the past 12 months.  MedUrge training will also take place at orientation and must be attended, before working first shift, by anyone who has not yet been trained for a rotation in the ED.  If for some reason a resident is unable to attend, the resident must contact Dr Monica Cermignani ASAP to organize a separate session with a trainer.
  3. TEACHING:  All residents must attend 15h00 teaching on days they are scheduled to work either a day or evening shift.  They are not expected to attend if doing a night shift.  All residents must give one 15h00 presentation.  Topic must be approved by the site director and written on the schedule posted on the residents' room door.  Do NOT choose a topic that will already be covered by one of the staff or by another resident (i.e. check the posted schedule for already assigned/declared topics).  Style of presentation must be informal and interactive; avoid using slides unless you need to project images.  Duration should not exceed 40 minutes, in order to allow 10 minutes for questions.  Remind everyone who attends your presentation to evaluate your teaching skills by filling out an evaluation form (available in the conference room), and don’t forget to do this yourself every time you attend a session. 
  4. GOAL(S) FOR SHIFT: Think about what you want to accomplish during your shift and tell your attending!  Your goal(s) should be specific, realistic, and measurable:
    1. “I want to improve my communication skills” is a non-specific goal.  “I am going to give clear verbal and written discharge instructions to all my patients, and verify their understanding before discharge, making sure their questions get answered” is specific.  (If you want to find out whether you are meeting this goal, it will help if the staff knows to pay specific attention to this aspect of the encounter, and you can also ask the patient for feedback).
    2. “I want to see more trauma” is not a realistic goal.  “I will assess trauma patients using an organized, systematic approach to the primary and secondary survey" is a realistic goal.
    3. “I want to see patients faster” is not a measureable goal.  “I will try to  take no more than ten minutes for my initial patient assessments” is measureable.
    4. PATIENTS SEEN AND PROCEDURES DONE:  There is currently no formal log used at the MGH site although you are encouraged to keep track of each patient you see/procedure you do and the teaching point that you got from each case.  Sometimes the teaching point might be a question you will have to look up or discuss later – by writing it down, you won’t forget to do so, and you will not have lost that teachable moment.  Use the list to guide the feedback discussion you have with your attending at the end of the shift. 
    5. EVALUATIONS:  Must be sent via One45 to the attending before the end of  your shift.  If you work with an attending who is not yet in the one45 system, give them a paper copy of the form (located in the folder for staff evaluations on the far wall of the AC near the pharmacist's desk).  Ask your attending for verbal feedback at the end of every shift, or a little bit before the end of the shift if either one of you will be in a hurry to leave.  The staff will return the completed paper form to the site director by placing it in the appropriate completed evaluation folder.
  1. RESPONSIBILITIES:  Remember that your shift is not over until you have signed over your patients, completed your notes (don’t forget those reassessment notes and procedure notes), made sure all your charts have been signed by the attending, sent off and completed all your evaluations and gotten feedback.
    1. BE ON TIME:  Being punctual for your shift is extremely important.  This means you need to arrive early enough to change into your scrubs, arrange your things, and be ready for signover at the designated time.
    2. SIGNOVER: All residents, starting July 1st of the PGY-1 year, should be giving the signover on their own patients.  This is an important skill to learn.  You can practice by giving a “mock signover” of each case after you have finished discussing it with your attending or review your global case load as a "mock sign over" just prior to the actual one (NB. for day shifts this should be done before you go to teaching).
    3. MANAGING YOUR OWN CASES: As a PGY1-2 you will only be responsible for the new patients that you see (plus some assigned patients to reassess if there are not enough new cases to keep you busy).  You must ensure good documentation of your initial encounter and any reassessments, as well as discharge instructions.  Make sure that all your patients have their usual medications prescribed while they are in the ED.  If your attending agrees to consult another service, make sure your question is clear and include a request for a disposition plan if applicable.  All patients seen by any resident at any level must be reviewed with the attending before the patient is discharged.
    4. FLOW: Start to take over management of flow in your PGY-3 year.  To start, you can take on only the new patients seen in the ambulance room, and eventually add on increasing numbers of reassessments as you gain skill and confidence.  Similarly, on SWING shifts you can take on increasing numbers of reassessments over time in addition to any new patients seen.  In the AC you are only responsible for new patients.   Make sure the nurses know which patients you are “in charge” of by writing your initials on the magnetic strip (until MedUrge in effect).   Discuss with each attending how you can increase your autonomy while still having enough supervision to feel safe.  Ask the attending and nurse in charge to review the “board” with you once or twice during the shift.  Solicit their feedback, in particular, the nurses will have a different perspective from your attending’s and may provide valuable insight – and this will help you gain their trust and collaboration.
    5. TEACHING: You should start occasionally reviewing cases with and teaching procedures to junior learners in your PGY-3 year.  After you have completed the CTU month, you should begin to integrate teaching and supervision into your routine more regularly.  At first you may not be able to comfortably handle both flow and teaching.   By the end of the PGY-4 year you should be able to integrate the two duties more smoothly.  Practice this as much as you can.

Dr. Monica Cermignani

MGH Postgraduate Site Coordinator

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