• Orientation priorities: Doctor In Training wellbeing and understanding cognitive load.
• Understanding a 120-page book on how the hospital works doesn’t translate into knowing how to order a CT scan for a patient. This type of disconnect can lead into issues with patient safety.

• It’s not just Junior Medical Officers and it’s not only medicine. We have recently run pilots using MedApp to help with orientation and engagement amongst allied health and nursing staff.
• The issues in those areas are exactly the same if not larger because you are dealing with a much larger workforce.
• Thinking of handover as a hospital wide issue not just for doctors is very important.

• An Australian study a few years ago found that orientation and handover is more important these days as junior doctors are faced with more complex patients with multiple comorbidities. There’s a rising demand in services because of the workplace shortages all across Australia. There is a growing need and responsibility to teach students as they move through the system.
• The handover ritual is estimated to occur at least 7 million times a year in Australian hospitals.
• It is important to be set up for success, if orientation and handover are done poorly at the start of a rotation or shift then the psychological impact and the impact on patient care can be higher.
• Handovers are an acute point of communication and error whereby any breakdown can have serious consequences for patients. The knock-on effects to clinicians, known as the second victim complex, can have secondary trauma as a result.

• It is normal to feel slow and like you don’t know anything. You have a lot of theoretical knowledge but now it is about learning practical knowledge. The intern year is really an orientation to being a doctor.
• It can take at least 9 months to hit the plateau phase when you have learnt all the basics. Then you can start to layer on top the clinical knowledge.
• Prior to hitting that plateau phase, you can feel like an imposter.

• Medicine and technology have always operated closely together.
• There are some advantages to technology such as better diagnoses and better therapies. Medical research can exemplify this especially in the last 12 months with the COVID Vaccine.
• In terms of the hospital environment, the digitisation of hospitals is increasingly leading, particularly junior clinicians, to be glorified data entry clerks or secretaries.
• The amount of time people are now typing and entering information in notes has increased hugely, compared to a rural hospital (or a place that doesn’t have full eMR) where there is a two page sheet to do a full assessment of an emergency patient. There are also copy and paste functions being used between notes that have not been processed cognitively.
• There is also evidence that the time spent on computers is destroying our interactions with patients. It’s reducing empathy, it’s reducing compassion and it’s reducing patient satisfaction. It’s a big issue.

• MedApp is a way to reduce the administrative overheads ensuring a smooth transition. This ranges from ensuring that rover can be easily kept up to date (e.g. making it easier to change meeting times and communicate this change) and ensuring that the hospital handbook information is easily accessible (e.g. everything is only two clicks away and easily searchable).
• Looking at the anonymous aggregate analytics, we can see those hospitals using MedApp from the start of internship have shown, that by the time their interns become residents, they have a much higher baseline level of engagement and a different way of accessing information compared to the residents who have not used MedApp from beginning of internship and have gone on to become registrars.
• MedApp is changing the paradigm, generally, for how doctors access information.
• MedApp is developed by doctors for doctors. As a result it can function better in the medical system when there are constant interruptions to work. MedApp reduces the time it takes to get from one area of information to another helping to minimise mistakes.
• User interface and user experience is an important area that is now becoming a research hub to smooth clinical flows.

• People have found it positive and useful
• Implementation resources and hospital capacity are limiting factors
• There are sites where it is evident that MedApp has changed the nature of the interaction between medical workforce or the hospital administration and clinicians and significantly improved their access to information. From things as small as how many times someone needs to call switch every day to how clinicians are accessing rosters.
• MedApp now has a robust framework around how we’re saving not just clinical time but also medical administration time and including how to use the platform to run quality improvement and clinical change projects through the platform.
• For us, at MedApp, we have to have frank conversations with hospital executives around whether the value is going to be there for them and how it’s going to lead to saving the healthcare dollar. Because, when you get down to it, the benefits to clinician wellbeing and clinician efficiency are often not necessarily important to the people making these decisions. We have found that with this generation of the ‘medical student tsunami’ the healthcare system has just soaked them up because the reality is that we’re spending so much time on the cumbersome electronic medical record systems.

• Every screen on MedApp has a feedback button at the bottom of it. Screens are purposely built to promote real-time physician feedback and streamline all the workflows in hospitals.
• MedApp has an in-app feedback function where you can easily get through to MedApp administration (particularly when information may be outdated).
• This then increases the response time to make changes to any outdated information that in other scenarios may take months.

• Sonia: It is definitely possible. Studies have shown that increased screen time has been linked to poor mental health. People accessing their work emails and medical records at home means that it is possible to always be in ‘work mode’ and not really be able to shut off.  We are seeing that with American studies around the eMR’s causing burnout and then now the screen time causing burnout. The pervasive invasion does not stop.
• Rob: There are some good systems coming out regarding patient results and being able to do eMR functionality on mobile or tablet. I don’t think they are very widely deployed around Australian hospitals just yet. I think there’s this option, because so many processes and navigational systems deployed, in my view, are currently inefficient, if doing work on your mobile streamlines other processes then that’s great because it is saving time elsewhere, however if this is not the case then obviously this is a bad thing. There’s this caveat that people need to work out a time where they are not constantly on duty.
• Sonia: It is self-regulation essentially, but I think when you are feeling burnt out as a result of everything going on in life then having easy access to the right resources through your mobile to seek help and maintain healthy lifestyles is where technology can help as opposed to hinder.

• Sonia: Be proactive about your health and wellbeing as early as medical school. It is important to set up the right supports for yourselves when you start your junior doctor rotations including finding a regular GP AND GOING TO THEM. Making sure that you have the right set-ups for eating well and exercising and especially accessing professional and personal supports. If you notice that something in the organisation that requires improvement, or you have a new idea I would encourage those to take the initiative and get involved.

• Rob: I would advise people to get involved in the solution. There have been a lot of MedApp implementations that have come from junior doctors reaching out to us saying they would like to set it up. Often that’s the best way to build a case internally in the hospital. Review and reflect on the orientation and handover gaps in your organisation, speak to your consultants and Director of Education and Training around new ideas and keep on pushing to try and improve things. I think that’s how so much change occurs is through JMO advocacy and support and that junior doctor leadership is really powerful.
• Let MedApp know of any ideas that you have

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Keesara, Sirina, Andrea Jonas, and Kevin Schulman. “Covid-19 and health care’s digital revolution.” New England Journal of Medicine 382.23 (2020): e82.

Davis, Matthew J. “Using Technology to Combat Clinician Burnout.” Journal of Healthcare Management 65.4 (2020): 265-272.