The document summarizes a Preparing for Safe Practice as an Intern (PSPI) program designed to reduce adverse events for new interns. It discusses the program's aim to address challenges interns face in their early employment through experiential learning. The 5-day program uses case-based and simulation learning across six clinical themes. An evaluation found participants highly rated the clinically focused sessions and all final year medical students could benefit. The program is being expanded through a curriculum guide and facilitator training to be made available nationally, with ongoing research of long-term impacts.

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