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Description of How the Problem was Identified and Explored: A common complaint among our intern and upper level house staff is the lack of training interns receive regarding efficiency of the pre-rounding process and training with the EMR. Additionally, the ward teams are often burdened with work and find it difficlut to provide extra support to struggling team members. Description of the Innovation: A collaborative effort between the chief residents and senior residents identified as having scored high marks in efficiency and familiarity with the EMR resulted in a series of documents highlighting efficient pre-rounding techniques. Also, senior residents on electives were paired with interns starting an inpatient ward or critical care service for the first time and pre-rounded with those interns for two days at the start of their rotation, allowing a supportive environment in which to implement the efficient techniques. Results to date: Collection data is via a questionnaire, and results are still being acquired. We currently have two additional months in which we plan to observe this project. Initial data returned shows a signifant improvement in 1) Efficiency of the pre-rounding process, 2) Comfort with the pre-rounding process, 3) Quality of the pre-rounding process and 4) Familiarity with the EMR. Respondents have recommended that the project continue next year beginning at the start of intern year, and current interns who were included in the project have identified themselves as hoping to serve as future mentors in the PAL program. Discussion/Reflection/Lessons Learned: Though efficiency and the use of EMR are topics addressed in our intern orientation, it is difficult to retain this information without being able to immediately utilize or implement information. The busy nature of the inpatient ward teams can make it difficult for a particular ward team to provide additional support to struggling team members regarding ways to improve efficiency. By utilizing our house staff currently on elective rotations, the PAL project is able to provide this support prophylactically to all interns starting an unfamiliar rotation, resulting in improved performance for the intern and a more active educator experience for the senior resident.


Presented at Association of Program Directors in Internal Medicine. Nashville, TN. 4/2014