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For many around the country, this week is the start of a new year of residency education in the United States. For new residents, this is a nerve-wracking time where they are making the transition from student (with no responsibilities) to resident (with a much greater level of responsibility). Don't worry residents. You don't know real responsibility until you become the attending!
 In dedication to all the new residents, their attendings, and residency directors, let's focus this week's discussion on the use of technology in resident education. Residency directors around the country work tirelessly to provide quality educational content to their residents, but with new technologies available we should be utilizing them to make our lives easier.
As a new residency director (my tenure started just shy of one year ago) I've been on the lookout for any tools that can help me be more efficient and effective for my residents. My disclaimer here is that since I'm new at this I am by no means an expert. Additionally, I'm only midrange in technology skills, so there may be better ways to do things than I recommend. I should also mention that I am not advocating for particular programs or companies, but am using some as examples of what is possible. With that out of the way let's discuss useful technology for resident training.
For Residents
First, and most obviously, it seems almost impossible today to survive and succeed without the use of a smart phone. The residents at my local hospital communicate almost exclusively via text messaging. It's fast and very efficient. However, there are important caveats to consider. First, avoid violating your institution's HIPPA police by never including patient identifying information. There are programs that will erase texts automatically after a certain number of days. Second, be very careful with images. In many cases it is difficult to appreciate all of the important details of a radiograph or clinical image on the small screen of a smartphone. Attendings, always verify your residents' work with your own eyes (good advice in all situations).
Additionally, smart phones allow rapid access to emails, calendars, and various applications. One of my residents uses Evernote to create and share templates for various activities such as surgical dictations. The beauty of this technology is the capability to share information. Instead of having my residents spend time reinventing the wheel individually, they collaborate, adding important information for each other to use. They can then spend the spare time reading and studying (or they'd better be)!
Programs such as Epocrates are a must for the active clinician. If you don't already have this free application then you're way behind. Along a similar vein, one of my residents recommends the Medscape application, which lists high yield, rapidly acquired information at the point of care.
The application podiatric residents are missing is one for Residency Resource. Don't know what Residency Resource is yet? You will. Imagine an app that would allow residents to input their logs during clinic or immediately thereafter. This may make a laborious process that much easier.
For Directors and Staff
Recently I adopted the Google Drive suite of applications. This starts with Google Calendar, which allows me to track all events pertinent to the residency while giving the residents a centralized location to look for information. The on-call attending and resident are listed as well as academic activities, requested days off and other events. Everyone involved can view all the same information simultaneously in a relatively clean and easy-to-use format. I'm also able to create separate calendars for personal life, work, and other situations as needed. The calendar allows me to attach readings and objectives for our academic activities to the particular calendar event, which further centralizes things for the residents.
Google Hangouts is another component of this service, which allows us to text message or use a video call, similar to Skype (another option, by the way). We haven't actually started using this yet, but I fully plan to do so. Hangouts will allow my residents that are on a distance rotation to call in during one of our didactic activities. The traffic in the Los Angeles metro area can be so bad that it can make returning to a central location difficult. In this manner, my residents can handle their clinical/surgical responsibilities at various areas and video call when it's too difficult to make it in person. This also gives us the option to potentially participate with other residency programs.
Another useful component of the Google Drive suite is Google Docs. Using a relatively simple format, Google Docs provides the ability to create shared documents. For example, I recently set up a shared document for my residents to sign up for lectures. Instead of doing it myself I gave them the option to pick and choose topics on their own. Hopefully, giving them the option will increase buy-in from the residents. We'll see!
This program also allows me to create surveys that go out via email. I've recently started using this as a paperless method to track resident attendance at various academic events. The only difficulty I've had with this is that Gmail does not allow users to schedule when to send emails. The best I can do is save the attendance email as a draft and then mail it out near the time of the activity.
As with everything, there are disadvantages and problems with its use. Nothing is perfect. For example, privacy is an issue. We've heard many stories about this in the news media, and it's always a concern. We don't include any patient health information and don't use this to list upcoming surgical cases. Also, there is a time investment, especially at the beginning, if one hasn't used this platform previously. An additional benefit for the residency director that is uncomfortable using this system is the ability to give editing permissions to others. Directors can utilize their chief resident or other trusted individual to run this system.
I'm interested to see what future technologies will make residency easier to manage. I wonder about automated email document-driven monthly resident assessment forms, for example. It's difficult enough for directors to get assessment documents returned from other attendings, so perhaps an easy online assessment form will make it more convenient. File sharing and interactive applications may make it possible for residencies to pool their resources and work to each other's strengths. Imagine what we could do if we used technology to work together?
Best wishes,
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
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Technology in Residency Education
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