First Year In Practice Research Articles

A partnership for success: Tips for retaining associates and tips on getting the most out of your first year in practice

Large animal practices have historically had a difficult time recruiting new veterinarians into the profession. Recently, the data on retention has shown that veterinarians are leav­ing large animal practice for other sectors of clinical practice. Onboarding new associates is different in ambulatory prac­tice when compared with companion animal practice. Setting up the new associate for success will benefit both the existing practitioners as well as the new veterinarian. Spelling out ex­pectations, communicating these expectations, and flexibility will help retain the new associate. This paper gives some tips on ways to increase the retention of associates as well as tips for the new graduate veterinarian on how to make the first year in practice a success.

Improving Staffing in the ICU with New Graduate Nurses: A Novel Critical Care Fellowship Program

Background: There is a growing shortage of critical care nurses. New graduate nurses (NGN) are increasingly hired into critical care settings, though NGN job turnover is estimated between 18-60% in the first year of practice. The COVID-19 pandemic exacerbated nurse turnover and the need to rapidly train new ICU nurses while also employing effective retention management strategies.
 Aim: To highlight the success of a NGN Critical Care Fellowship Program (CCFP) within the existing health system’s NGN Residency Program prior to and during the COVID-19 pandemic.
 Methods: The CCFP was launched in 2016 with 7 participating ICUs. The NGNs participate in the medical center’s existing 1-year NGN Residency Program and spend a total of 24 weeks orienting in 3 different ICUs. Orientation concludes based on a performance evaluation and readiness to work independently. NGNs are mentored and supported throughout their first year in practice through monthly debriefing of clinical and preceptor experiences.
 Results/Findings: Between 2016-2022, a total of 65 NGNs have participated in the CCFP. Sixty fellows completed orientation and were hired into an adult ICU during their orientation period. Retention of CCFP NGNs after 1 year was 96% (n=48/50), 2 years was 97% (n=33/34) and 3 years was 96% (n=23/24).
 Conclusions: Results demonstrate the development of an educationally robust, emotionally compassionate program, concentrated on the development, training and focused support of the NGN can be successfully implemented and sustained over time.

A Longitudinal View of Perceptions of Entering Nursing Practice During the COVID-19 Pandemic.

Background The COVID-19 pandemic significantly changed the landscape of health care and transition to practice for new graduates. The purpose of this pilot study was to explore the effects of the pandemic on the first-year experience of new nurses. Method A longitudinal, observational, descriptive study design was used. One hundred eighteen survey links were sent to new bachelor of science in nursing graduates from June 2020 to May 2021, with 56 responses to the first survey. Results Participants indicated the COVID-19 pandemic negatively affected the new graduate experience, resulted in concern for personal health and safety, and negatively altered preparation for the first year in practice. However, desire to be a nurse and view of nursing remained positive. Conclusion The first year in practice is stressful and challenging. The pandemic posed additional challenges to employers and new graduates. Future research should explore the long-term impact of the pandemic on an already strained nursing workforce. [J Contin Educ Nurs. 2022;53(6):256-263.].

Robotic-assisted surgery enhances the learning curve while maintaining quality outcomes in sleeve gastrectomy: a preliminary, multicenter study.

The frequency of robotic-assisted bariatric surgery has been on the rise. An increasing number of fellowship programs have adopted robotic surgery as part of the curriculum. Our aim was to compare technical efficiency of a surgeon during the first year of practice after completing an advanced minimally invasive fellowship with a mentor surgeon. A systematic review of a prospectively maintained database was performed of consecutive patients undergoing robotic-assisted sleeve gastrectomy between 2015 and 2019 at a tertiary-care bariatric center (mentor group) and between 2018 and 2019 at a semi-academic community-based bariatric program (mentee 1 group) and 2019-2020 at a tertiary-care academic center (mentee 2 group). 257 patients in the mentor group, 45 patients in the mentee 1 group, and 11 patients in the mentee 2 group were included. The mentee operative times during the first year in practice were significantly faster than the mentor's times in the first three (mentee 1 group) and two (mentee 2 group) years (P < 0.05) but remained significantly longer than the mentor's times in the last two (mentee 1 group) and one (mentee 2 group) years (P < 0.05). There was no significant difference in venothromboembolic events (P = 0.89) or readmission rates (P = 0.93). The mean length of stay was 1.8 ± 0.5days, 1.3 ± 0.5days, and 1.5 ± 0.5days in the mentor, mentee 1, and mentee 2 groups, respectively (P < 0.0001). There were no reoperations, conversion to laparoscopy or open, no staple line leaks, strictures, or deaths in any group. This is one of the first series to show that the robotic platform can safely be taught and may translate into outcomes consistent with surgeons with more experience while mitigating the learning curve as early as the first year in practice. Long-term follow-up of mentees will be necessary to assess the evolution of fellowship training and outcomes.

Making a Name for Herself: Anna Wagner Keichline, [Woman] Architect

ABSTRACT Women have long engaged in the field of architecture through various avenues beyond design, including teaching and research. This article considers how the first registered female architect in Pennsylvania negotiated the development and dissemination of architectural knowledge. Anna Wagner Keichline of Bellefonte, a trained architect, shaped space through her building and product designs while participating in architectural discourse through instruction, publicity, and writing. This article explores some of her structures as well as her teaching activities, which have yet to be addressed in scholarship. Keichline leveraged an expertise in home design to establish her career and support her first year in practice through teaching. She then balanced her interests in materials research with design projects in both residential and commercial spheres.

Experiences of and support for the transition to practice of newly graduated occupational therapists undertaking a hospital graduate Program.

Newly graduated occupational therapists face well-documented difficulties as they embark on professional practice. Occupational therapy departments need to ensure that new graduates conduct their roles appropriately while developing experience and building clinical and professional skills. This study aimed to explore the experiences of new graduates at a major Australian metropolitan hospital occupational therapy department, the support provided to them and their perceptions of this support. The research design was Interpretive Description. Semi-structured interviews of approximately 60min were undertaken with seven occupational therapists, their team leader and the Departmental Head. The two research questions were as follows: What were the graduates' experiences of their first year in practice? What support was provided to graduates and what were their perceptions of this? New graduates perceived the transition to practice as overwhelming, particularly regarding their caseload responsibility. During the first few months, work tasks took them longer and they felt stressed and anxious. They received a range of support and education, both inter-professional and discipline specific. Their occupational therapy team leader and clinical senior provided tailored support, guidance and reassurance. Guided questioning facilitated development of new graduates' clinical reasoning and professional skills. Reflection helped them to identify and address learning goals relating to occupational therapy professional competencies. New graduates valued having a consistent caseload and a supportive workplace was highly valued. New graduates initially feel overwhelmed by being responsible for their decisions. However, they can benefit from tailored supervision and guided questioning to help develop clinical reasoning and professional skills, formal and informal support from experienced occupational therapists and their inter-professional teams and time to increase skill with their caseload. Engagement in a professional community of practice is important.

Considering your wellbeing needs in practice

As part of the ‘Wellbeing &amp; Diversity’ sessions at The British Cattle Veterinary Association's Congress 2019, David Charles discussed some important things to consider to protect your wellbeing in practice. He also touched on the importance of working to protect the wellbeing of new graduates and new team members in your practice. This article summarises some of the BCVA talk and lessons learned throughout the author's first year in practice.

How Can Nurses Stay Resilient and Engaged During a Long and Ever-Changing Career Path?

Forty years ago, on a New Hampshire hilltop, I received my nursing pin as a new graduate from nursing school. A white dress, bright white stockings, and nursing shoes were the order of the day, along with a red rose. Despite the trend away from caps, I secretly loved my nursing cap with its blue velvet stripe. But, the nursing world moved on and, by the end of my first year in practice, nursing caps had become a relic of the past. Looking at a picture from that day, with my favorite professor on the chapel steps, I notice the cap is just a little crooked, but my smile is big. How did that young nurse survive the next 40 years?

Discussion

Discussion

New Graduate Nurse Experiences in Clinical Judgment: What Academic and Practice Educators Need to Know.

The aim of the study was to determine if use of a structured reflection exercise using a clinical judgment framework would result in more practice-ready new graduate nurses (NGNs). Clinical judgment is a critical skill for all nurses, yet it is identified as a deficit in NGNs. Seventy-four NGNs in two groups participated in this mixed-methods study in their first year in practice. Scores from two quantitative measures were collected for all participants. The Lasater Clinical Judgment Rubric framed the structured intervention. Although the quantitative data showed no significant differences between the groups, use of the reflection exercise indicated a positive impact on NGNs. Qualitative data revealed four themes that present challenges for preparation of NGNs: enhancing communication, finding interprofessional support, responding to complexity of care, and appreciating the role of the nurse. Implications provide guidance for academic and practice educators to smooth the transition into practice.

Enhancing Confidence in Graduating General Surgery Residents: Establishing a Chief Surgery Resident Service at an Independent Academic Medical Center

Providing opportunities for autonomy to enhance the development of independence and confidence during surgery residency remains among the greatest challenges of the current training paradigm. The objective of this study was to evaluate the implementation and outcomes of a chief resident service (CRS). A CRS was designed with operative, call and office responsibilities. Supervision and evaluation were consistent with institutional guidelines. CRS operative logs from 2011 to 2014 were compared with logs from the participants' first year in practice. Select procedures were compared and evaluations were reviewed. Residency graduates' satisfaction with the CRS was evaluated. Independent academic medical center. Nine general surgery residency graduates with one complete year in practice. Nine residents completed CRS rotations and submitted case logs. Median total case volume was 1101 (994-1311) during the 5-year residency, 92 (20-149) during CRS and 299 (99-784) during the first year in practice. Median case volumes for selected procedures for the entire 5-year residency, CRS, and first year of practice were: 93 (66-97), 7 (3-16), and 9 (1-26) laparoscopic appendectomies; 146 (120-157), 24 (3-32), and 34 (15-112) laparoscopic cholecystectomies; 81 (51-94), 1 (1-4), and 3 (0-8) ileocolectomies; 57 (35-86), 4 (0-9), and 8 (2-34) ventral/incisional hernia repairs; 102 (87-137), 12 (3-16), and 13 (3-86) inguinal hernia repairs. Graduates reported that the CRS experience was very beneficial to their current practice. Annual program reviews emphasized the CRS as a major strength of our residency. Creation of a CRS to increase resident autonomy and provide continuity of patient care with appropriate faculty supervision was successful. Case mix and volumes provided an opportunity for independent operative and clinical experience during residency which realistically paralleled graduates' first year of practice.

Practice transition in graduate medical education.

Debt repayment, professional negotiation and practice management skills are vital to a successful medical practice, yet are undervalued and seldom taught in graduate medical education. Medical residents need additional training to confidently transition to independent practice, requiring the development of novel curricula. Medical residents needadditional training to confidently transition to independent practice METHODS: We developed a trial practice management curriculum to educate senior residents and fellows through voluntary workshops. Topics discussed in the workshops included debt repayment, billing compliance, medical malpractice, contract negotiations, and lifestyle and financial management. Resident self-confidence was assessed, and feedback was obtained through voluntary survey responses before and after attendance at a workshop, scored using a Likert scale. Twenty-five residents from 20 specialties attended a 1-day session incorporating all lectures; 53 residents from 17 specialties attended a re-designed quarterly session with one or two topics per session. Survey evaluations completed before and after the workshop demonstrated an improvement in residents' self-assessment of confidence in contract negotiations (p<0.001) and their first year in practice (p<0.001): after the curriculum, 94percent (n=42) of respondents felt confident participating in contract negotiations, and 93percent (n=38) of respondents felt confident about their first year in practice. One hundred percent of respondents agreed that the presentation objectives were relevant to their needs as residents. Participant responses indicated a need for structured education in practice management for senior trainees. Senior residents and fellows will benefit most from curricula, but have high familial and professional demands on their schedules.

Newly qualified health visitor: Aiming high

Lisa Forbes looks back on her first year in practice and reflects on some of her hopes for the future of the health visiting profession in the current climate.

A year of progress and promise

Kristie Hill qualified as a health visitor in 2013 and joined the JHV editorial board for a year. As her tenure on the board comes to a close, she reflects on the achievements of her first year in practice and looks forward to her future as a health visitor.

A Critical Appraisal of the First-year Experience of 5 Pediatric Orthopaedic Surgeons

The transition into practice following a fellowship in pediatric orthopaedics is challenging. This study seeks to describe the first-year experiences of 5 pediatric orthopaedists. An Institutional Review Board-approved retrospective review was conducted of 5 pediatric orthopaedic surgeons' first year in practice. All were fellowship trained and practiced at private or academic subspecialty groups. Clinical volume, payor mix, surgical cases, as well as complications were evaluated. A total of 1172 surgical procedures were available for review. Surgeons performed an average of 234 cases with a mean case load of 19.5 procedures per month. Fracture care and surgical management of infection represented the largest number of procedures. 42.3% of patients were covered by government insurance or were uninsured. Surgeons saw an average of 30.5 new patients per week in clinic. Of these, 10.7% of patients were scheduled for an elective surgical case. A sample of clinical practice revealed that 41.3% of patients were covered by government or no insurance. 17.8% of surgical patients sustained a complication with the majority being minor or expected. 18.8% of complications were major and required repeat operation. Complications peaked in the fourth month of practice. Although clinical and surgical volumes can vary during the first year of practice, fracture care and surgical management of infection represent the majority of operative cases. A large portion of surgical volume results from emergent care, whereas elective cases are more elusive with only 1 in 10 elective patients resulting in surgical treatment. Despite a significant number of untoward events related to surgery, major surgical complications are uncommon in the first year of practice. The majority of surgical cases in the first year of practice are due to trauma and infection. A high volume of patients must be seen to establish a practice, particularly given the high rate of Medicaid patients. These figures provide benchmarks to guide training programs and to establish realistic expectations for new pediatric orthopaedic surgeons and their partners.

A journey that gives back to humanity

Every year, Journal of Health Visiting (JHV) will welcome a newly qualified health visitor, fresh from their training, onto the editorial board for one year. Throughout the year, they will provide JHV with an insight into their training and a roundup of their first year in practice. For 2013, JHV is delighted to introduce Victoria Halls, a health visitor from White City, London who completed her training in September 2012. Victoria talks to JHV about her training experiences, her first few months in practice, and what she hopes to achieve in 2013.

Feet first into farm animal practice

The first year in practice is arguably the most challenging, stressful and emotional, says Emily Gascoigne, who qualified in 2012. She has begun her career on a one‐year intern programme with the Royal Veterinary College (RVC) and Synergy Farm Health

New graduate's diary

It is almost a year to the day since Jen Hall graduated from Nottingham – one of the first group of vets to do so. Here, she looks back on her first year in practice and offers some thoughts on PDP.

Advocacy for Tenant and Community Empowerment: Reflections on My First Year in Practice

In May 2009, the landlord of a rent-stabilized building in Williamsburg, Brooklyn openly declared his intention to force out the current tenants if they did not leave on their own. Located on North 8th Street right off trendy Bedford Avenue, the property was prime real estate in Williamsburg. The only obstacles that stood between the landlord and the potential for him to reap large profits were the rent-stabilized status of the building and all the tenants who paid the regulated rent, a fraction of the market rate. Once he forced those tenants to leave, he could “gut rehab” the apartments, move them out of the rent-stabilization system, and easily generate five to six times the amount of revenue from the building. The tenants, however, refused to walk away from their homes. So the landlord decided to take matters into his own hands: in June 2009, he illegally excavated a portion of the building’s foundation, removing a chunk of the cellar wall. His unauthorized work, done without requisite permits or prior City approval, compromised the structural stability of the entire building. That immediately prompted the City to vacate the building for safety reasons. To ensure that the tenants could not return to their apartments, even if the City later lifted its vacate order, the landlord then shut off all sewage, gas, water, and electrical services in the building, and padlocked the front door. In a matter of days, all six tenants in one building on North 8th Street had lost their homes. One of the tenants had lived in her apartment for over thirty years and raised her family there. Another lived with her husband and two young children. With no more than a couple days’ notice, all of them had to leave their apartments and belongings behind, indefinitely.

The Transition from Veterinary Student to Practitioner: A “Make or Break” Period

This paper examines the transition from veterinary student to practitioner, in the context of assessing the outcomes of the veterinary degree program in which the students were trained. Questionnaires were sent to all registered veterinarians who graduated from Massey University between 2001 and 2003 and the heads of human resources of all veterinary practices in New Zealand. These groups, together with veterinarians who had graduated from Massey University between 1993 and 2000, were also invited to participate in focus groups or interviews. Replies were received from 64 graduates and 114 employers. In addition, 115 veterinarians were interviewed or joined focus groups. Most participants thought that the veterinary degree program at Massey University provided a strong basis in scientific theory and clinical reasoning, but was lacking in communication skills training. Clinical exposure was regarded as less than optimal, but adequate for starting practice and as much as could be achieved within the duration of the program. Graduates and employers both recognized the pivotal importance of the first year in practice in the careers of veterinarians. Most graduates had positive experiences of their first year, but for those whose experiences were negative, they were often strongly so. Situations in which confidence and clinical competence could be developed in a supportive environment were associated with positive outcomes. The first year after graduation was regarded by graduates and employers as a "make or break" period. Many of the changes that the veterinary profession is currently experiencing, particularly in terms of the demographics of its entrants, impact upon this first post-graduation year.