What should be included in new hire orientation in the emergency department?

[piteog]

Our group has hired a few new hires but the established members disagree about how best to approach training the new people.  In one camp, there's the "expose them to everything" group.  The other camp is "make sure they learn how to do simple stuff."

 

Either way, it's hard to design an orientation "program" for new hires.  What would you include?  How long do you orient your new PAs (specifically in emergency medicine)?  How do you train them?  Do you just scheduled them to work double coverage where they are not actually needed and can work at their own pace and then help them as they go?  Do you do suture/abscess/other procedure labs?  Do you have them read anything?

 

Thoughts welcome.

[EMEDPA]

we try to only hire folks with 2-3 yrs experience min, but when desparate will take the right new grad or a former student.

we have several different shifts in several different places. they work 1 shift in each location as double coverage then they are on their own. they also get a few hrs of emr training. trial by fire.

[sunny2spot]

When I was hired my shop hired new grads almost exclusively. I was fortunate to start where I did because they had a strong orientation process: new hires were started as extra/double coverage in the Fast Track area which is typically staffed by one PA and one physician. They had about 10 orientation shifts in FT and then started in FT where they would work for a month or two before starting shifts in the Main ED on overnights.

 

This is still how we do things now, but we've put more preference in hiring ppl with experience in which case their orientation and progression to Main ED shifts were accelerated.

 

If hiring new grads, speaking from experience, it would be VERY challenging to start in an ED with an "expose them to everything"  approach. Eventually, yes of course they should be exposed to everything.. but starting out they need to get comfortable with the way their dept flows, how their attendings work, how to document efficiently, etc. before having to worry about the deep clinical questions on top of all that

[True Anomaly]

Outside of the actual medical training, I think it's very helpful to have some sort of written guide as to what specialties are available at the particular hospital you're working at, who the hospitalist groups are (if there is more than one), what imaging modalities are available and at what times they are available.  If there is an observation unit, what are they capable of handling, etc.

 

The structure of nursing leadership in the ER can be helpful too- it took me a while to learn that because we have so many psych patients in our ER that there's actually a "psych charge nurse" on at all times.

[piteog]

Thanks for your input so far.  Keep it coming!  I guess my thought would be this:

 

I want someone to come out of "orientation" able to be useful in some capacity.  The easiest path to usefulness is ensuring that the new hire can handle straightforward, uncomplicated complaints.  This is what I had in mind, what am I missing?

 

Lacerations (suture selection, cleaning, basic wound repair, not the details of every special case)

Upper and lower respiratory infections (nasal congestion/"sinusitis", ear pain, sore throat, neck pain, cough, PNA vs bronchitis)

Nausea, vomiting diarrhea without abdominal pain and "dehydration"

Basic fractures -- distal radius, hand, ankle fractures

Nursemaid's elbow and shoulder dislocations

Common GU complaints - Nonpregnant pelvic pain and vaginal discharge or bleeding plus first trimester pregnant vaginal bleeding, pelvic pain, or discharge

UTI diagnosis and management

Rash basics

 

If you can handle that list, I think you can probably handle 85% or more of a typical fast track.  Agree/disagree?  What am I missing?

[EMEDPA]

eye stuff: corneal abrasions, metal in the eye from grinder, etc

FBs in ears/nose

[RetNavyPAC]

All of our new grads/new hires get 8 weeks of orientation (double covering a shift with an EP or PA). The senior PA at each of our main EDs keeps a close eye on them and re-evaulates at 4 weeks and at 8 for feedback and in case they still need a little more time.

 

They also get the following books (and a STRONG recommendation that they need to consider these 'homework' for the first 6 months of their new job):

EMRA's The Basics of Emergency Medicine, A Chief Complaint Guide, The Basics of Emergency Medicine: Pediatrics, Emergency Medicine’s Top Clinical Problems & Emergency Medicine’s Top Pediatric Clinical Problems

Emergency Medicine: Avoiding the Pitfalls and Improving the Outcomes

Avoiding Common Errors in the Emergency Department;

Case Files: Emergency Medicine (3^rd Ed)

ECG 2014 Pocket Brain

 

And lastly a 32Gb thumb drive with what I consider the Canon of Basic EM Knowledge.  A collection of articles & monographs sorted by system & specialty, the complete EM Basic podcasts collection and show notes, choice chapters from EM:RAP and some important video lectures from EMedHome.

[EMEDPA]

wow, I got a tarascon pharmacopeia, orientation  x2 shifts( 1 at each place) and an instruction to see at least 3 pts/hr...

[Nonlegit]

All of our new grads/new hires get 8 weeks of orientation (double covering a shift with an EP or PA). The senior PA at each of our main EDs keeps a close eye on them and re-evaulates at 4 weeks and at 8 for feedback and in case they still need a little more time.

 

They also get the following books (and a STRONG recommendation that they need to consider these 'homework' for the first 6 months of their new job):

EMRA's The Basics of Emergency Medicine, A Chief Complaint Guide, The Basics of Emergency Medicine: Pediatrics, Emergency Medicine’s Top Clinical Problems & Emergency Medicine’s Top Pediatric Clinical Problems

Emergency Medicine: Avoiding the Pitfalls and Improving the Outcomes

Avoiding Common Errors in the Emergency Department;

Case Files: Emergency Medicine (3^rd Ed)

ECG 2014 Pocket Brain

 

And lastly a 32Gb thumb drive with what I consider the Canon of Basic EM Knowledge.  A collection of articles & monographs sorted by system & specialty, the complete EM Basic podcasts collection and show notes, choice chapters from EM:RAP and some important video lectures from EMedHome.

 

That thumb drive idea sounds cool. It reminds me of the "all wiki" thumb drive, where you get all of wikipedia accessible on a flash drive, offline.

[JMann]

All of our new grads/new hires get 8 weeks of orientation (double covering a shift with an EP or PA). The senior PA at each of our main EDs keeps a close eye on them and re-evaulates at 4 weeks and at 8 for feedback and in case they still need a little more time.

 

They also get the following books (and a STRONG recommendation that they need to consider these 'homework' for the first 6 months of their new job):

EMRA's The Basics of Emergency Medicine, A Chief Complaint Guide, The Basics of Emergency Medicine: Pediatrics, Emergency Medicine’s Top Clinical Problems & Emergency Medicine’s Top Pediatric Clinical Problems

Emergency Medicine: Avoiding the Pitfalls and Improving the Outcomes

Avoiding Common Errors in the Emergency Department;

Case Files: Emergency Medicine (3^rd Ed)

ECG 2014 Pocket Brain

 

And lastly a 32Gb thumb drive with what I consider the Canon of Basic EM Knowledge.  A collection of articles & monographs sorted by system & specialty, the complete EM Basic podcasts collection and show notes, choice chapters from EM:RAP and some important video lectures from EMedHome.

This sounds like great training and ideal instruction for a new grad. 

[GreatChecko]

One of the things done at a sister facility is to start the new PAs in main ED with the MDs and PAs. This is to help them figure out sick/ not sick, which is vitally important in the fast track realm in a busy facility. We don't do it, but it is something they are considering for the future once we fully integrate the PAs into the main ED.