Category: Medical Education

Starting a new job in Medicine can be exciting, but it can also be very stressful. How often have you started a new rotation or a new job and felt a bit lost on the first day? Have you ever had an experience where you can honestly say that you “hit the ground running?” Assigning a workplace buddy can help ease the transition for new employees into their new roles can be very beneficial for all involved, especially during the onboarding process.

What is a Buddy System?

Buddy systems have been used in other industries and schools for many years and proven to be effective ways of ensuring that employees get off to a good start. This has all sorts of benefits to both employee and the organisation.

Simply put a buddy system involves assigning a new employee a workplace buddy. The buddy is an existing doctor who guides the new doctor through the first few weeks or months on the job. In Australia we have started to see the rise (or in some cases rebirth) of buddy programs, sometimes also referred to as mentor programs. In particular it is now common in the State of NSW, for the second of the 2 weeks of Intern induction to consist of a “buddy week”, where the new intern gets the chance to understudy a finishing intern in their first new rotation. Whilst these buddy weeks are quite popular they do have their limitations. The key one being that because the relationship is very brief it only really permits a small transfer of knowledge and in particular doesn’t afford the new intern doctor a chance to reflect and ask questions of their buddy about the hidden curriculum of the workplace.

Evidence has emerged that longer relationships between new employees and existing employees in Medicine can help reduce stress, and improve morale, sense of support and job satisfaction.

Buddy systems should include a formal documented process that outlines the buddies’ responsibilities as well as what items they should cover over the first few weeks or months of employment. The buddy system should also encourage the new employee to share tips, tools, knowledge, and techniques they have learned about the workplace. A buddy also potentially gives the new doctor a psychologically safe opportunity to offer confidential feedback about how their onboarding process is going. For these reasons the closer the buddy is to the new doctor in terms of peer relations the better.

Why Implement a Buddy System?

The last thing we should hear from a doctor on their first day is “Nobody knew I was starting today.” At the end of their first few weeks in the job we want new interns to feel that they made the right decision to study medicine and for other doctors starting new jobs we want them to feel that they accepted the right position.

First impressions are key. The initial enthusiasm that interns experience to have “finally made it” can be either lifted or ruined, depending on their start. What happens during the first few days can determine the long-term perception of the job and the organization. Studies have shown that a large number of employees quite within 6 months of taking up a job. Often citing a poor onboarding process or lack of clarification about their role as the key reason for doing so.

Regardless of whether there is a formal process in place or not, onboarding is going to happen; the real issue is the quality of the experience. When onboarding is done well it sets up new doctors for long-term success. If an orientation consists of handing the new intern a pile of forms to fill out on their first day, then there are going to be future problems, which is where a buddy system may come in handy.

Implementing a buddy system can be part of an effective onboarding program that provides new doctors with a way of resolving questions regarding work processes. Some of which may be difficult to predict and / or hard to deal with in a formal orientation seminar. This socialization and support can make a big difference.

In particular, a buddy can help with the last 3 of the 4 C’s of onboarding: Compliance, Clarification, Culture and Connection.

The buddy system is not only valuable to the new doctor. Its obviously also an opportunity for existing doctors to develop skills as a mentor and may foster the early development of a range of people management and leadership skills.

From a bottom line point of view a well executed buddy system will likely reduce the number of doctors leaving a hospital or organisation, particularly early. And this will save the hospital a lot of money in re-recruitment costs.

But at a deeper level buddy systems can improve employee engagement with the organisation which can be a vital component of instilling a positive workplace culture. Which in itself is likely to lead to better outcomes in terms of both patient care and cost.

Benefits To Buddy	Benefits To New Doctor
Recognition	One-on-one assistance and single point of comfortable contact
Expand Network	Jump start on networking
Opportunity To Lead	Smoother acclimation
Fresh Perspective	Knowledge of “how things really get done”

What Is a Buddy?

A buddy is someone who partners with a new doctor during their first few months of employment. He or she is a colleague assigned to assist the new doctor to get through this period. They can provide insight into the daily activities of the hospital and help the new doctor fit in more quickly.

An effective buddy is a good communicator, has an interest in the development of others and is the type of doctor the organisation hopes to emulate (fits with the value system). They will generally take the new doctor around their hospital and orientate them and introduce them to key people who can help them out.

A Good Buddy

• Is known as a good performer and well regarded;
• Is willing and able to mentor others;
• Has the time to be available;
• Knows the new doctors job;
• Is a peer of the new doctor;
• Has good communications and interpersonal skills.

A good buddy should be a good representative for the culture and values of the hospital and organisation and be familiar enough with the formal and informal organizational structures to be a reliable source of information.

Buddies Should Not Be

A buddy is definitely not a supervisor and probably should not be a mentor (at least in the first few months). This helps to make the task of the buddy more limited and definable. Learning how to be an effective buddy can be useful as a foundation step to learning how to be a mentor or supervisor. The buddy is are available to answer straightforward questions about how the hospital operates. It is important to make clear to both the new doctor and the buddy that the buddy is not being asked to develop the new doctor and is not accountable for performance. This makes the buddies role easier in terms of being able to support the new doctor without fear of reprisal.

If a doctor does not want this extra responsibility, then they should not be assigned the buddy role. Some doctors simply don’t want the responsibility or are not ready. Worse, some doctors are not well suited temperamentally for the role. A doctor who is known to be someone who gossips at work is probably not a good fit for a buddy role. The last thing a new doctor wants to hear about is gossip and speculation in their first few weeks.

What Do Buddies Do? What Training and Support Do They Need?

Buddies should be given the skills and knowledge to be able to:

• Teach or tutor, for e.g. explain an unfamiliar task;
• Explain tactical matters, such as how to submit a time-sheet and where the pathology forms go;
• Talk about and explain the hospital’s structure, written as well as unwritten rules;
• Share insights on how things are done in the hospital;
• Involving the new doctor in social activities, such as coffee and lunch with new team.

Buddies can benefit from some training and support in their role. But probably the best thing that can be provided is a suggested list of task and a timeline for completing them.

Generally speaking the buddy is encouraged to meet more frequently with the new doctor e.g. daily for the first week, weekly for the first month, monthly for the next few months and gracefully exit from the relationship. Its helpful to set a solid time frame for when the relationship finishes (6-months is generally good).

During the first few meetings the buddy works to help with urgent and practical questions. As the relationship matures and the new doctor finds their feet the explaining turns into more of the “why things are done this way around here.”

Tips for Being a Buddy

If you are asked to be a buddy, here are some tips that can help you:

• Keep a list and timetable of what things the new doctor needs to know or be shown;
• Be patient. Relationships take time to develop. Your new colleague is unlikely to open up to you until they have spent a bit of time getting to know you and you have earnt their trust;
• You are not the expert on everything, instead think about who else can answer questions you don’t know the answer to and introduce them to the new doctor;
• Don’t try to cover everything at once. Remember the new doctor is going to feel overwhelmed in the first few weeks. So try to avoid cognitive overload. Leave the deeper discussion till later;
• Stay positive. New doctors will grow into their roles in time with appropriate support and confidence is infectious. Maintain a positive, teaching attitude;
• If possible try to identify the new doctor’s personality and communication style and adapt;
• Be open and don’t judge. Your new doctor is relying on you to be a safe place to get answers to their many questions.

Remember. Despite the best efforts of the manager who asked you to be buddy. Sometimes buddy relationships don’t work out. Don’t be afraid to approach your manager to express concern and/or suggest an alternative buddy.

Troubleshooting Problems With Buddy Programs

There are some practical problems with assigning buddies in hospitals. Firstly, there are often not enough experienced buddies to go around. Especially with 100+ new interns starting all at the same time. Secondly, often those who are identified to act as buddies are taking leave or moving on at the same time as when the new doctors are arriving.

One way to get smart about this issue is to gather information and consider the level of readiness of the new doctors. There are likely to be some in this group that require more support than others. Typically some may have already studied as student or worked in the hospital already and have a level of familiarity. These new doctors can probably more safely be assigned less experienced buddies and you can save your best buddies for the completely new doctor.

Setting up regular training and check ins with your buddy group can identify gaps and issues. This can be triangulated with sessions with the new doctors themselves.

Facts

Cognisco in 2008, estimated that UK & US businesses lose $37 billion annually because employees do not fully understand their jobs. According to their white paper, “$37 billion: Counting the Cost of Employee Misunderstanding.”

Summary

Creating a buddy system for new doctors requires some time investment and buddy choice should be carefully considered. However, this is not a difficult or expensive option to implement.

Make sure you’ve chosen a willing and effective buddy; create some documents to support them and the new doctor. Set an end date for the formal buddy relationship. Watch for the things that do not work so you can guide both the experienced and new doctors.

A buddy system can dramatically reduce the time a new doctor requires to be productive and aid retention. An additional benefit of a buddy program is that it allows for corporate knowledge sharing and positive recognition for the buddy.

References:

Cooper, J. & Wight, J. (2014). Implementing a buddy system in the workplace. Paper presented at PMI® Global Congress 2014—North America, Phoenix, AZ. Newtown Square, PA: Project Management Institute.

Sonia Chanchlani, Daniel Chang, Jeremy SL Ong and Aresh Anwar. The value of peer mentoring for the psychosocial wellbeing of junior doctors: a randomised controlled study. Med J Aust 2018; 209 (9): 401-405. || doi: 10.5694/mja17.01106 

This post was originally written as a flipped resources session for a teaching session I took  with some Psychiatry Trainees.

The aim of this post and the teaching session is to touch on some practical issues in relation to becoming a better medical educator.

Presentations

There are many more bad presentations than good

Giving a presentation is a core skill for most doctors.  It is something you are often requested to do, whether this be for some medical students, a Grand Rounds or a scientific meeting.

It is often said that there is a real “art” to giving a good presentation.  But I’d like to call BS on that and suggest to you that actually its a science and we know a lot about what makes an effective presentation and most of the time we largely choose to ignore this.

Some resources you might find helpful include this wonderful TEDx Talk by David J Phillips on “How to Avoid Death By Powerpoint”.  For me watching this video about 4 years ago was a game changer.  It made a massive difference to my slide presentations, partly by paradoxically lengthening the number of slides (whilst reducingthe overall content).  Before watching this video I had converted from powerpoint over to Prezi.  But it turns out I was trying to solve the wrong problem.  I thought that powerpoint made bad presentations.  Actually its people that use powerpoint to make bad presentations.  And to a lesser extent the default settings of powerpoint are also to blame.

Another great resource just released by Queensland Medical Educator Kate Jurd is this eLearning Resource.

If I was to give my 4 top tips for more effective presentations they would be this:

1. Think firstly whether the presentation you are going to deliver will be enhanced by slides or whether it may be better (and more novel for the audience) if you don’t use slides.  There are several other options, including just an oral presentation.  I often find that if I have a good case prepared and perhaps a white board for demonstration purposes I can provide a more interactive and passionate and lively session.
2. If you must use slides try not make your last slide “Any Questions”.  This just creates doubt and ruins any impact you have just made.  Leave the audience with the key point and a Call To Action. 
3. There are many great places to find creative commons licensed images to enhance a presentation.  Pixabay is my general go to.

4. Light Text, Dark Background.

Some resources for improving your presentations:

The Informal Teaching Session

Many experiments have demonstrated that passion for one’s subject is the best means for engaging learners.  Whilst, the results of these experiments have been overinterpreted to infer that students learn more effectively from engaged and passionate teachers. It remains likely that being a passionate teacher is one of the ingredients to effective learning.

There are 4 principles that form a good starting basis to an effective teaching or learning session which I always give to new medical educators.  They are FAIR and are from Ronald Harden.  You can source them from the following text (available in many medical libraries and from me if you ever work as an Education Registrar or the like with me).

Essential Skills for a Medical Teacher

Lets go through them in a bit more detail.

• F – Feedback 
• A – Activity
• I – Individualisation
• R- Relevance

Feedback is fundamental as it can help to correct problems for learners, clarify learning goals and reinforce good performance (motivate learning).  More on this later.

Active Learning has been shown to accelerate learning.  By actively involving the learner in the process.  By getting them doing things (rather than listening or observing) more cognitive processes are engaged.  There are many options for “activating learners”.  Here are a few ideas:

• Find out what the learner already knows about the topic
• Give the learner a problem to solve related to their new knowledge
• Give the learner a test
• Get the learner to carry out a procedure
• Ask the learner to reflect on their learning
• Ask the learner to share their knowledge with other students

Individualisation

• Where possible make sure that the learning your are involved with is attached to a clearly accessible and understandable syllabus.  A syllabus is a document that communicates course information and defines learning expectations. Done well it can translate the curriculum into something actually understandable by students (as well as most teachers!).  And usually includes a list of resources for the students to use to help them in their learning
• Provide a range of different resources in different modalities to assist learners.  I often try to provide a mix of book recommendations along with blog posts and link to videos and where possible also examples of any assessments (if the course includes an assessment). 
• Provide opportunities for the learner to come back and repeat the learning exercise.

Relevance is particularly important in view of the ever-expanding mass of medical knowledge.  There is a temptation for everyone to view their own component of Medicine as vital for everyone else to know about.  Some strategies that clinical educators may want to apply to ensure that their teaching is relevant, include:

• Asking the Learner.  Medical Students and Trainee Doctors will be aware of the next gaps in their knowledge and have a reasonable view on what they are attempting to learn or master.  Bear in mind that the learners view of what is important may not be the total picture and may often reflect what the learner perceives as the next steps in learning  (see Zone of Proximal Development below) as well as what they think will be on the test.
• Obtain Feedback from the Learner.  Find out from the learner if what you are teaching and in the way you are teaching is helpful.
• Find out what the learner needs to know.  It is not uncommon to be confronted by a situation where there are learners who would like some impromptu teaching.  In such circumstances, with no clear understanding of the curriculum, we tend to either ask the students or use our best judgement.   This may lead to teaching and learning which is perhaps useful but not what the learner “needs” to know.  If you regularly teach medical students or trainee doctors make enquiries about their curriculum, syllabus or learning outcomes. When you get your hand on a document like this find some things in it that you feel comfortable or passionate in teaching.

Feedback

Lets look at feedback in a bit more depth.  Feedback is a core skill for anyone working in mental health.  We use it constantly with our patients but its also an important skill for working with colleagues.

There are many models and approaches to feedback.  There are none that really stand out in terms of being better than others.  What is more important is how quickly or immediately you provide feedback.  The closer to the activity the better as the student or learner will be able to better relate your feedback.  As well as being specific.  Although specific does not necessarily mean detailed.  Sometimes you observe more than one thing that you would like to give feedback.  Its often best to decide on the key piece of feedback.  Be specific about that and leave the rest for another time.  This helps to avoid “cognitive overload”.  More about this below.

If you are starting out its probably a good idea to find a model that makes sense to you and use it.  But bear in mind the need to be flexible in your approach.

One model I recently came across which I like is from Michael Gisondi at the ICE Net Blog and is called the “Feedback Formula”

1. Ask permission
2. State your intention
3. Name the behavior
4. Describe the impact
5. Inquire about the learner experience
6. Identify the desired change

To quote Michael a good summary of the research on feedback is:

(1) feedback is important, and (2) the quality of feedback varies widely. 

Michael Gisondi

Psychological Safety

One important principle of feedback is Psychological Safety. It is a term that you may hear a lot if you are ever involved in Simulation Training.  Psychological safety is a shared belief amongst members of a team that the team is safe for interpersonal risk-taking. It can be defined as “being able to show and employ one’s self without fear of negative consequences of self-image, status or career”. In psychologically safe teams, team members feel accepted and respected. It is also the most studied enabling condition in group dynamics and team learning research.

If you are wanting to establish a psychologically safe space with a new learner (someone you are not familiar with).  Be aware that it takes time to do so.  A good rule of thumb is you need to ask a novice learner 3 times if there is something they wish to learn or are worried about before they will take you seriously.  So persist.

The Basic Assumption

The Basic Assumption© was developed by the Center for Medical Simulation at Harvard. It is a useful concept to carry with you as you engage with feedback.  It encourages you to have a curious mind when delving into the reasons for learners actions.

“I believe that trainees are intelligent, capable, care about doing their best and want to improve.”

Center for Medical Simulation, Harvard

Practice Your Feedback

Review some of the vignettes from the Teaching to Teach Series below and think about the process of feedback in each vignette.

First, think about the learner and what sort of feedback you would like to give them.

Then think about the teacher in the situation.  How would you appraise their feedback skills?  What feedback would you give them about their feedback?

The Intern – 3 Part Video Series

Teaching Medical Students

Learning Theory

In order to be a better clinical educator its worth knowing a little bit about educational theory.  If you have read this post all the way through then you have already learnt some theory in relation to feedback, as well as Cognitive Load and Action Learning.

A great source to get started with Learning Theory is the ICE (International Clinical Educators) Net Blog which is supported by the Royal College of Physicians and Surgeons of Canada.

A good starting post is

https://icenetblog.royalcollege.ca/2015/06/26/education-theory-for-the-meded-clinician/

In this post you will learn that knowledge is constructed (often socially) rather than transferred and learning involves a process of building new knowledge on top of existing knowledge.  So new learning is influenced by past learning experiences.  Authenticity and emotion can be useful tools to improve learning and retention of knowledge.  Along with regular challenges (assessments) to ensure embedding of knowledge.

You will also read in this post that contrary to popular belief matching your teaching approach to learning styles is definitely not practical and probably not based in sound evidence.  And also that Adult Learning Theory is probably not a great theory.

The ICENet also did a series of 9 posts looking at other relevant Learning Theories which are worth making your way through:

• Bloom’s Taxonomy
• Zone of Proximal Development
• Deliberate Practice
• Digital Natives
• Spaced Repitition
• Action Learning
• Transformative Learning
• Constructive Development
• Skill Acquisition
• Organisational Learning
• Self Determination
• Type 1 and Type 2 Thinking
• Gamification
• Self Directed Learning
• Reflective Practice
• Social Constructivism
• EQ & IQ
• Community of Practice
• Naturalistic Decision Making
• Modal Model of Memory