“What Do I Do?”—Discussing Difficult, Realistic Scenarios and the General Competencies During New Housestaff Orientation

This educational activity is a scenario-based, small-group discussion session implemented during new housestaff orientation to introduce and operationalize the ACGME Six General Competencies in realistic clinical contexts. Learners engage in facilitated discussions centered on difficult, practice-relevant dilemmas commonly encountered early in residency or fellowship training, such as managing unfamiliar patients, responding to ethical conflicts, and making decisions under uncertainty during call assignments. Through collaborative problem-solving and guided reflection, participants apply competency domains—including patient care, professionalism, systems-based practice, and ethical decision-making—to simulated clinical scenarios. The session is designed to reduce anxiety associated with early clinical responsibilities, promote interprofessional communication, and enhance learners’ ability to utilize institutional policies and system resources effectively. Pre- and post-session assessments are used to evaluate knowledge acquisition and perceived preparedness for clinical practice.

Target Learners 

• New housestaff during institutional orientation, including: 

• • First-year residents (interns) 

• • Incoming fellows 

• The activity may also be adapted for: 

• • Resident conference sessions 

• • Early-stage graduate medical education onboarding programs 

Equipment / Materials Needed 

• Facilitator’s Guide 

• Scenario handouts (case-based discussion materials) 

• Pre-test assessment forms 

• Post-test assessment forms 

• Session evaluation forms 

• Writing utensils for participants 

• Small-group discussion space (tables or breakout rooms) 

• Optional: 

• • Flip charts or whiteboards for group reporting 

• • Timing device to manage scenario discussions and breaks 

Estimated Time to Complete Activity 

Total Session Time: Approximately 2.5 hours