Background: Effective onboarding is essential for physician confidence, safety, efficiency, and early integration into a hospital medicine division. Onboarding into a large academic institution adds additional complexities including medical trainee oversight, elaborate shift structure and responsibilities, and multiple practice sites. Despite existing orientation materials, new hires at our Academic Institution reported variable preparedness for their first shifts, uncertainty around workflows, and inconsistent understanding of local policies and Electronic Medical Record (EMR) operation. To identify gaps and guide improvements, we conducted a structured assessment of the onboarding experience.
Purpose: To evaluate the current hospital medicine onboarding process, identify strengths and areas for improvement, and develop a standardized onboarding program guided by new hire feedback.
Description: A ten-question electronic survey with additional open-response fields was distributed to thirteen recently hired hospitalists oriented via Existing Onboarding Process (EOP). Quantitative responses assessed prior experience, EMR proficiency, and perceived preparedness. Qualitative comments were analyzed using thematic content analysis. Themes were mapped to develop targeted interventions for an enhanced onboarding program. Once these interventions were completed, the same ten-question survey with additional open-response fields was distributed to six newly hired hospitalists oriented via Improved Onboarding Process (IOP) for comparison.Based on the EOP survey findings, we designed a multimodal onboarding program that includes: (1) standardized “shadowing” across both sites; (2) a hands-on hospitalist-focused EMR setup session; (3) an updated HM 101 and workflow quick-guides; (4) structured first-week and first-month schedules; and (5) a formalized buddy program with defined roles.Thirteen hospitalists completed the EOP survey. Respondents had varied prior experience, though most had not previously worked in academic settings. Key gaps included: (1) unclear expectations and workflow nuances prior to Day 1; (2) need for structured EMR optimization specific to hospitalists; (3) desire for more formalized sessions on division expectations, pager access, and shift structure. New hires expressed that “you don’t know what you don’t know,” highlighting the need for proactive, structured guidance. After the interventions were put in practice, six new hospitalists oriented via IOP were asked to complete the same survey. The HM 101 quick-reference guide and being paired with a buddy for the first month were universally valued. The majority found focused shadowing shifts and being scheduled on a non-teach team as a first rotation were also helpful with adjustment into a new position.
Conclusions: New hire feedback revealed consistent gaps in workflow clarity, EMR optimization, and understanding of local policies that significantly affect early success. A structured, multimodal onboarding program directly addressing these needs was implemented at a large academic medical center. Implementation has improved new-hire preparedness, reduced early errors and inefficiencies, and enhanced integration into the division. Future steps will include standardized training of the onboarding support faculty, pre-recorded short videos reviewing institution specific policies, and periodic check-in with new hires during the first year of employment to provide additional support.