" What Do I Do? " Discussing Difficult, Realistic Scenarios and the General Competencies during New Housestaff Orientation

Publication ID Published Volume
797 April 22, 2008 4


A focused, 2.5 hour interactive session was explicitly designed to orient new Housestaff to the six General Competencies and address key topics related to Risk Management and DNR (Do-Not-Resuscitate) orders. In small, facilitated groups, Housestaff review and discuss a set of scenarios, focused on difficult situations for new interns/fellows, answering questions on how to respond to the situation, what resources are available, and how the General Competencies relate to the situation. Trained facilitators (Residency Program Directors, Associate Program Directors or Faculty) guided discussions in small, six-person groups within their own classroom of Housestaff. Each facilitator monitors one classroom of up to 24 Housestaff. In the small groups, Housestaff read a scenario about an intern who must respond in a difficult situation. Housestaff then answered questions about the scenario including what they should do if they were the intern, what resources are available, and how/where the General Competencies appear in this situation. After small groups discussed a scenario, facilitators led a discussion with the large group (whole classroom) about the answers to the scenario questions. Materials for this session include a detailed instructor's guide, discussion scenarios and questions (two versions - one for learners and one for facilitators with discussion points for each question), evaluation form and pre-post multiple choice examinations.

Three data sets highlight the success of this program. Results of a pre-test/post-multiple choice test requiring residents to identify the ACGME competency associated with 20 statements revealed that Housestaff arrived with a general understanding of the competencies and that this session enhances that comprehension. Mean percentages for the Housestaff changed from 76% to 81% (p< .001) following the session. Results from the Housestaff evaluation of the session revealed that they enjoyed the case-based discussions, citing the opportunities to interact in small groups, discuss relevant and interesting scenarios, and learning the ACGME General Competencies. Faculty facilitators evaluated the sessions highly and have already volunteered to serve as facilitators for next year. Submission Image: http://creativecommons.org/licenses/by-nc/2.0/deed.en

Facilitators need to be trained preferably two weeks prior to the session. They should be prepared to introduce the General Competencies and facilitate discussions of the various scenarios. Each facilitator is assigned to a group of 15-24 residents/fellows. The facilitator then sub-divides the group into leaderless sub-groups to allow all trainees to actively participate, guided by the scenario specific questions. Small groups are randomly assigned (alphabetically) and therefore include Housestaff from a variety of programs. Fellows are mixed with residents to provide "senior" insight to the discussions. Sub-group reports to the large group allow the facilitator to assure consistency, accuracy, and application to the competencies across sub-groups to the large group as the mechanism. Facilitator must have skills to lead discussions and answer questions related to the scenarios. The areas that need improvement, as suggested by the participants, include shortening the discussion time and minimizing redundant questions. The strength of this approach is that the length of the session may be reduced (or lengthened) dependent on the degree to which objectives have been achieved. Facilitators can change the content or characters in the scenarios to enable the discussion to continue in a related direction. Also, Housestaff may want to contribute their own experiences to the discussions, especially new fellows. It was decided not to separate the groups by level of experience, as the fellows would likely add more to the discussions when discussing the scenarios with new residents. In some cases, fellows were able to say, "This actually happened to me and here's what I did ..." providing valuable insight for the new residents in their group.


Gleason Heffron M, Larson D, Derse A, et al. " What do I do? " discussing difficult, realistic scenarios and the general competencies during new housestaff orientation. MedEdPORTAL Publications. 2008;4:797. http://doi.org/10.15766/mep_2374-8265.797

Educational Objectives

  1. To be able to apply the six General Competencies in the scenarios discussed and in their own practice.
  2. To be able to reason through/solve problems similar to the difficult situations or dilemmas presented in the scenarios.
  3. To be able to collaborate with others to solve clinically relevant problems.
  4. To be able to confront fears regarding call assignments, handling other people's patients, and making tough decisions during the first few days on the job.
  5. To be able to apply ethical principles and requirements (e.g., MCWAH policies, WI law) to clinical situations.
  6. To be able to utilize system resources when needed (SBP).


  • Group Discussions, Orientation of Housestaff, Scenario-based Discussions, Decision Making, Risk Management, Resuscitation Orders

Prior Scholarly Dissemination

ACGME RSVP URL: http://www.acgme.org/outcome/implement/rsvpTemplate.asp?rsvpID=39


Poster Presentation 2004 ACGME/ABIM conference in Chicago Poster Presentation 2006 ACGME conference in FL ACGME RSVP publication -- 1 page description.

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ISSN 2374-8265