Background: There is often little communication across inpatient medicine teams at a busy academic medical center. Although teams comprise trainees across many levels, individual teams often work in parallel without relating shared challenges and experiences. This can be isolating, and practicing in such silos can propagate systems issues and contribute to burn out.
Purpose: Create a structured forum that brings together senior residents and attending physicians from all teams on service each week to discuss shared challenges and to celebrate successes. Objectives include: 1. Create dialogue and build camaraderie 2. Promote peer-to-peer knowledge sharing across levels of training and practice 3. Formulate pathways for addressing systems issues that are raised
Description: At our institution, we have 6 inpatient general medicine teams, each with 1 senior resident and 1 attending physician. Attendings rotate on service for 1-week intervals, while residents rotate on service for 4-week intervals. Our forum occurred weekly on Fridays for 15-20 minutes. We created and adopted a “3F structure”: fizzles (challenges), fuzzies(successes), and fascinomas (interesting cases), with each resident-attending dyad sharing an example their team encountered from the past week from each of the aforementioned categories. Follow-up tasks to fizzles were delegated to faculty or resident participants, and a summary email was distributed to the group at the end of each session. We implemented our feedback forum for 10 weeks across 4 rotation cycles: 24 residents and 18 attending physicians participated. Over the pilot period, the teams brought up 18 fizzles. We identified 4 main categories for fizzles: coordination of care (33%), transitions of care (22%), patient safety (17%), and interprofessional dynamics (27%). Examples included: miscommunication with other physicians, team leadership training needs, case management accessibility, and lack of a clear emergent dialysis-line placement pathway. Of the 18 fizzles brought up in the pilot period, 78% have been or are being addressed with new initiatives.
Conclusions: We implemented a structured, weekly forum for inpatient wards teams to communicate to each other on shared challenges and successes. This low-cost intervention identified several areas of opportunity. Participation from front-line providers such as housestaff allows trainees to be active stakeholders in systems improvement. Our forum allowed for peer-to-peer knowledge exchange for challenges as well as celebration of each other’s weekly successes, which can have significant downstream benefits on teamwork and burnout.