It’s that time of the year again in Australia for the medical system. The time where around 90% of the trainee doctors in the health care system step up a level in responsibility. And it’s all done in a matter of a few weeks from mid-January to early February. This includes all the new graduated medical student doctors who are commencing their first paid role in the system as interns.
Add into this equation the current additional pressure being experienced on our health care system due to increasing COVID-19 cases it is even more important to have good systems in place to ensure that doctors taking on new levels of responsibility are appropriately supported. If your formal orientation and onboarding system does not include a well thought out buddy program then it should.
So here are my 7 top tips for a successful buddy program in medicine:
- Have a checklist
- Get the buddies to write the checklist
- Sell the buddies on the personal and organizational benefits
- Have a clear exit date for the buddy relationship
- Support your buddies through the program
- Give guidance about how often buddies should meet with their new doctor
- Troubleshoot problems with the program if/as they emerge
Read on further to find out more about what exactly is a buddy program in medicine, how it can complement and benefit a hospital’s formal orientation and onboarding system and a more detailed explanation of my key tips for a successful program.
What is a Buddy Program?
Buddy programs have been used in a range of industries and educational settings for many years and are proven to be effective ways of ensuring that employees/students get off to a good start. This has all sorts of benefits to both employee/student and the organisation.
Simply put a buddy program involves assigning a new employee a workplace buddy. For a buddy program in medicine, the buddy is an existing doctor who guides the new doctor through the first few weeks or months on the job.
In Australia we have started to see the rise (or in some cases rebirth) of buddy programs, sometimes also referred to as mentor programs. In particular, it is now common in the State of NSW, for the second of the 2 weeks of Intern induction to consist of a “buddy week”, where the new intern gets the chance to understudy a finishing intern in their first new rotation.
Whilst these buddy weeks are quite popular they do have their limitations. The key one is that because the relationship is very brief it only really permits a small transfer of knowledge and in particular doesn’t afford the new intern doctor a chance to reflect and ask questions of their buddy about the “hidden curriculum” of the workplace.
Evidence has emerged that longer relationships between new employees and existing employees in Medicine can help reduce stress and improve morale, sense of support and job satisfaction.
Tip Number 1 For a Succesful Buddy Program in Medicine – Implement a CheckList
Buddy programs in medicine should include a formal documented process that outlines the buddies’ responsibilities as well as what items they should cover over the first few weeks or months of employment. The buddy program should also encourage the buddy to share with the new employee to share tips, tools, knowledge, and techniques they have learned about the workplace.
The documentation does not need to be lengthy or complex. It can be as simple as a one-page checklist.
In fact, here’s an example of a buddy checklist I once implemented in my own hospital setting for new interns in mental health that was very successful.
|Has downloaded Med App and is able to login and access|
|Knows where to find things in the Med App|
|Tour of Ward|
|Tour of Hospital|
|Introduced to Team|
|Introduced to Consultant|
|Introduced to Registrar|
|Introduced to NUM|
|Has Term Description|
|Access to Resources on Shared Drive|
|Duress Trained and Aware. Knows not to actively participate in a Code Black (PMVA) restraint – need to be trained (It’s OK to go fetch the patient’s notes and med chart and be available)|
|Knows when education is and where and where to find the topic list in RG|
|Knows how to get a patient list|
|Can access email and Clinical Applications|
|Has read weekend After Hours Roster and understands weekend After Hours responsibilities|
|Can complete a Discharge Summary|
|Can complete a Tribunal Report|
|Knows how to contact the community team|
|Knows how to request pathology and imaging|
|Knows how to obtain drug levels and withhold morning medications if necessary|
|Knows not to prescribe Clozapine till registered|
|Run through any MedChart, EDRS, IIMS, CAP etc… #hacks that you have found useful|
|Can write a schedule and Form 1|
|Knows role in the ward round|
|Can describe the roles of other team members (e.g. Consultant, Registrar, NUM, ward clerk, nursing staff, psychology, social work, occupational therapy etc…)|
|Has visited the library and can access CIAP|
|Knows where to lookup drug information (e.g. eTGA, UptoDate)|
|Understands process for dealing with a Medical Emergency (MET) call|
|Understands process for dealing with a deteriorating patient|
|Understands process for requesting a medical or surgical consult|
|Understands how to request/arrange a rostered day off|
Why Implement a Buddy Program?
The last thing we should hear from a doctor on their first day is “Nobody knew I was starting today.” At the end of their first few weeks in the job, we want new interns to feel that they made the right decision to study medicine and for other doctors starting new jobs we want them to feel that they accepted the right position.
First impressions are key. The initial enthusiasm that interns experience to have “finally made it” can be either lifted or ruined, depending on their start.
What happens during the first few days can determine the long-term perception of the job and the organization. Studies have shown that a large number of employees quit within 6 months of taking up a job. And they often cite a poor onboarding process or lack of clarification about their role as the key reason for doing so.
Regardless of whether there is a formal process in place or not, onboarding is going to happen. The real issue is the quality of the experience. When onboarding is done well it sets up new doctors for long-term success. If an orientation simply consists of handing the new intern a pile of forms to fill out on their first day, then there are going to be future problems, which is where a buddy program may come in handy.
Implementing a buddy program in medicine can be part of an effective onboarding program that provides new doctors with a way of resolving questions regarding work processes. Some of which may be difficult to predict and/or hard to deal with in a formal orientation seminar. This socialization and support can make a big difference.
Well executed buddy programs complement the existing formal orientation talks and employee handbooks by allowing the new doctor to ask questions of an expert (the buddy), to make sense of the information they have received and address gaps in information that the orientation program has not identified.
They also allow for a transfer of “real-world” knowledge that would be difficult to do in a handbook or orientation seminar. Buddies are better situated to deal with the “profane” aspects of the workplace, the hidden rules and processes.
Tip Number 2 For Implementing a Successful Buddy Program in Medicine – Get the Buddies to Create the CheckList
Buddies are the real experts in how to do the job. Because they have been living it and doing it for the past year or so. They are therefore better situated to create a more effective checklist for the buddy program because they can still remember the things that they found difficult or surprising to do in the first few weeks.
To do this I recommend sitting down with your prospective buddies a few weeks out from the transition and engaging them in a discussion about being a potential buddy. Explain what you are seeking from them (see below) and then ask them to help you generate a checklist.
By all means, have a list of things you might think are important. But be prepared to alter this based on the buddies feedback.
Here’s a classic example.
When I was an intern (many moons ago now) it was quite common for interns to have one or two small books that they could carry around with them in their pocket as reference guides for how to deal with certain clinical situations.
When I was putting together my own buddy program in medicine, I asked my potential buddies what sort of books they would recommend to new interns to buy. The buddies uniformly told me that they would not recommend purchasing a book either in a physical or digital format. Instead, they recommended that new interns use the Med App* that their hospital had purchased for them that had a wealth of information curated for them and tailored to local needs.
Tip Number 3 For Implementing a Successful Buddy Program in Medicine – Sell the Buddies on the Benefits of the Program
The buddy program in medicine is not only valuable to the new doctor. Its obviously also an opportunity for existing doctors to develop skills as a mentor and may foster the early development of a range of people management and leadership skills.
From a bottom-line point of view, a well-executed buddy system will likely reduce the number of doctors leaving a hospital or organisation, particularly early. And this will save the hospital a lot of money in re-recruitment costs. But it also means to the buddy that they are investing in a stable workforce that means they are less likely to need to step in to fill gaps on the roster.
At a deeper level, buddy systems can improve employee engagement with the organisation which can be a vital component of instilling a positive workplace culture. Which in itself is likely to lead to better outcomes in terms of both patient care and cost.
|Benefits To Buddy||Benefits To New Doctor|
|Recognition||One-on-one assistance and single point of comfortable contact|
|Expand Network||Jumpstart on networking|
|Opportunity To Lead||Smoother acclimation|
|Fresh Perspective||Knowledge of “how things really get done”|
Tip Number 4 For Implementing a Successful Buddy Program in Medicine – Have a Clear Exit Strategy
Hospitals and health care networks are busy spaces and constantly changing. Rosters are open to disruption. On a practical level, it’s likely that your buddy and their new doctor pair only have a limited time when they will be in the same location before one or the other might be working somewhere else.
Buddies may be worried about the commitment you are asking for.
So I recommend being clear about this issue in your discussion with both the potential buddies and new doctors. I recommend asking for a minimum one-month commitment from your buddies. This will usually permit an intense initial one-week buddying experience followed by some regularly weekly catch-ups to address any ongoing gaps.
Who Makes a Good Buddy?
A buddy is someone who partners with a new doctor during their first few weeks or months of employment. He or she is a colleague assigned to assist the new doctor to get through this period. They can provide insight into the daily activities of the hospital and help the new doctor fit in more quickly.
A buddy also potentially gives the new doctor a psychologically safe opportunity to offer confidential feedback about how their onboarding process is going. For these reasons the closer the buddy is to the new doctor in terms of peer relations the better.
An effective buddy is a good communicator, has an interest in the development of others and is the type of doctor the organisation hopes to emulate (fits with the value system). They will generally take the new doctor around their hospital and orientate them and introduce them to key people who can help them out.
Tip Number 5 For Implementing a Successful Buddy Program in Medicine – Choose Good Buddies and Support Them
A Good Buddy
- Is known as a good performer and well regarded;
- Is willing and able to mentor others;
- Has the time to be available;
- Knows the new doctors job;
- Is a peer of the new doctor;
- Has good communications and interpersonal skills.
A good buddy should be a good representative of the culture and values of the hospital and organisation and be familiar enough with the formal and informal organizational structures to be a reliable source of information.
Buddies Should Not Be
A buddy is definitely not a supervisor and probably should not be a mentor (at least in the first few months). This helps to make the task of the buddy more limited and definable.
Learning how to be an effective buddy can be useful as a foundation step to learning how to be a mentor or supervisor. The buddy is are available to answer straightforward questions about how the hospital operates. It is important to make clear to both the new doctor and the buddy that the buddy is not being asked to develop the new doctor and is not accountable for performance. This makes the buddies role easier in terms of being able to support the new doctor without fear of reprisal.
If a doctor does not want this extra responsibility, then they should not be assigned the buddy role. Some doctors simply don’t want the responsibility or are not ready.
Worse, some doctors are not well suited temperamentally for the role. A doctor who is known to be someone who gossips at work is probably not a good fit for a buddy role. The last thing a new doctor wants to hear about is gossip and speculation in their first few weeks.
For a successful buddy program in medicine, buddies should have the skills and knowledge to be able to:
- Teach or tutor, for e.g. explain an unfamiliar task;
- Explain tactical matters, such as how to submit a time-sheet and where the pathology forms go;
- Talk about and explain the hospital’s structure, written as well as unwritten rules;
- Share insights on how things are done in the hospital;
- Involving the new doctor in social activities, such as coffee and lunch with new team.
In my experience, most doctors who put their hand up to be a buddy already have these skills for the most part. But they may still be somewhat anxious about whether they are doing a good job.
Buddies can benefit from some training and support in their role. But probably the best thing that can be provided is a suggested list of tasks and a timeline for completing them as I have highlighted above.
As part of your succesful buddy program in medicine, I recommend scheduling regular sessions with your buddies throughout the timeframe of the buddy program so you can support them, find out how the program is going and help troubleshoot any issues. This can normally be done as a group meeting.
Tip Number 6 For Implementing a Successful Buddy Program in Medicine – Give Guidance About How Often the Buddy Should Meet With the New Doctor
Generally speaking, the buddy is encouraged to meet more frequently with the new doctor e.g. daily for the first week, weekly for the first month, monthly for the next few months and formally exit from the relationship.
For your particular buddy program in medicine, it is helpful to set a solid time frame for when the relationship finishes. A month is okay, 3 months is good, 6 months is great if you can manage it.
Emphasise to your buddies that during the first few meetings that they should work to help with urgent and practical questions. As the relationship matures and the new doctor finds their feet the explaining turns into more of the “why things are done this way around here.”
Tip Number 7 For Implmenting a Succesful Buddy Program in Medicine – Troubleshoot Problems With Buddy Programs
There are some practical problems with buddy programs in medicine, particularly when assigning buddies in hospitals. Firstly, there are often not enough experienced buddies to go around. Especially if you have 100+ new interns starting all at the same time. Secondly, often those who are identified to act as buddies are taking leave or moving on at the same time as when the new doctors are arriving.
One way to get smart about this issue is to gather information and consider the level of readiness of the new doctors. There are likely to be some in this group that require more support than others. Typically some may have already studied at the hospital as students or worked in the hospital already and have a level of familiarity. These new doctors can probably more safely be assigned less experienced buddies and you can save your best buddies for the completely new doctor.
As part of your buddy program in medicine, set up regular training and check-ins with your buddy group can identify gaps and issues. This can be triangulated with sessions with the new doctors themselves.
Tips for Being a Buddy
If you are asked to be a buddy, here are some tips that can help you:
- Keep a list and timetable of what things the new doctor needs to know or be shown;
- Be patient. Relationships take time to develop. Your new colleague is unlikely to open up to you until they have spent a bit of time getting to know you and you have earnt their trust;
- You are not the expert on everything, instead think about who else can answer questions you don’t know the answer to and introduce them to the new doctor;
- Don’t try to cover everything at once. Remember the new doctor is going to feel overwhelmed in the first few weeks. So try to avoid cognitive overload. Leave the deeper discussion till later;
- Stay positive. New doctors will grow into their roles in time with appropriate support and confidence is infectious. Maintain a positive, teaching attitude;
- If possible try to identify the new doctor’s personality and communication style and adapt;
- Be open and don’t judge. Your new doctor is relying on you to be a safe place to get answers to their many questions.
Remember. Despite the best efforts of the manager who asked you to be a buddy. Sometimes buddy relationships don’t work out. Don’t be afraid to approach your manager to express concern and/or suggest an alternative buddy.
Creating a buddy program in medicine for new doctors requires some time investment and buddy choice should be carefully considered. However, this is not a difficult or expensive option to implement.
Make sure you’ve chosen a willing and effective buddy; create some documents to support them and the new doctor. Set an end date for the formal buddy relationship. Watch for the things that do not work so you can guide both the experienced and new doctors.
A buddy system can dramatically reduce the time a new doctor requires to be productive and aid retention. An additional benefit of a buddy program is that it allows for corporate knowledge sharing and positive recognition for the buddy.
What’s the Difference Between Buddying and Mentoring?
There are a number of key differences between buddying and mentoring. The relationship in buddying tends to be more superficial, social and focused on helping to solve immediate problems. The time frame of a buddying relationship is generally more limited than in mentoring. As a buddy, you may be asked to work with your new colleague for a week to a few months. In contrast, mentoring relationships in medicine tend to last for many months and generally years. The relationship, therefore, becomes deeper over time and is focussed on the mentor imparting their knowledge and experience to the mentee to assist the mentee in their development in their role.
*The author declares that they are an investor in Med Apps the company that produces the Med App Application.