Resident Orientation Program created for learner physicians

Resident Orientation Program created for learner physicians

Since January 2016, there have been 811 improvements from active units.

Here are 5 things to know about Rhonda McNicoll-Whiteman and the improvement opportunity she implemented at Hamilton General Hospital.


Rhonda is a Clinical Nurse Specialist with the Regional Stroke Program at the Hamilton General Hospital. She’s worked in health care and in the Neurosciences Program at Hamilton Health Sciences for 28 years.


Due to the severity of some strokes and someone’s co-morbidity conditions, the patient often may not communicate their advanced case planning path.

The Physician Ordered Scope of Treatment helps the health care team in charge of a patient identify their wishes for treatment. However, the POST was not always completed upon patient admission.

This potentially ties up more resources than necessary.

We discovered a learning opportunity for residents. Some were not aware of the policy related to the POST when they arrived on the unit.


A neurology resident identified the issue as a PICK (Possible, Implement, Challenge, Kibosh) chart item on the huddle board. A working group formed to work through the A3 methodology.

Nurse specialist points to a white huddle board in front of a group of hospital staff

The group identified the current state of the problem, asked the “5 Why’s” and developed an action plan. The objective was to educate the residents and fellows in a standardized way.

Working through the current state, the group reviewed the orientation of new residents. The education provided was high level and there were gaps in the resident and fellow orientation to key hospital policies applicable to stroke and neurology patients.

We used process observation to observe the sustainability of this work.


The group worked with the key physician leads from Neurology and Stroke to develop a presentation to address key policies. It touched on Physician’s Orders, Discharge Planning, POST, HEWS, Medication Reconciliation and key Stroke Unit practices and policies.

A resident physicians listens to a nurse specialist give a presentation in a hospital unit

The Stroke, Navigator or Clinical Manager gives a presentation at the start of each new Neurology Block Orientation. Participants also get it by email and via archives for later use.

Now, we see the POST is completed consistently and the residents and fellows are more aware of the hospital and unit policies and practices.

In the future, we hope to develop a program orientation booklet to sustain the learning and provide in different formats.

The project has also supported several key metrics on the unit, including our Stroke QBP Length of stay targets.


Find the root cause of the issue by exploring the current state and using A3 methodology. This will help develop the right solution.

Had we just educated our residents in isolation about completion of the POST, we would not have resolved the issue.