Bridges Curriculum Ambassadors Summer 2014 @UCSFBridges Introduction Curriculum Ambassador: Sidra Bonner; Advisors: Dr. Pankaj Vij, Dr. Lindsay Mazotti Results Methods/Assessment Discussion Nearly half of the adults in the United States suffer from chronic disease and a third are obese. Rationale for Lifestyle Medicine Curriculum: 1. Healthy People 2020 calls for increased provider counseling around diet and exercise. 2. Studies demonstrate that medical trainees lack knowledge and confidence to provide adequate dietary education 1 . 3. Medical students as health coaches can improve patient health 2 . Main Aims of Lifestyle Medicine Curriculum 1. Provide a working knowledge about lifestyle medicine topics to learners. 2. Improve learner confidence discussing diet, physical activity, stress and sleep with patients. Eight third-year medical students in the Kaiser Longitudinal Integrated Clerkship were enrolled in the curriculum. The curriculum had 2 main components: 1. 8 hours of lifestyle medicine instruction on diet, exercise and health coaching. 2. Student-initiated Phone Encounters (3 per student) with adult, non-pregnant patients who had a BMI >25 Assessment: - Lecture satisfaction - Students confidence with lifestyle medicine knowledge, pre and post curriculum. - Patient demographics and tasks completed during Phone Encounters. - Implementation of curriculum increased learner confidence in all measured areas. - Providing students with ‘Lifestyle Medicine toolbox’ allowed for completion of specific tasks. - Learner feedback included: - Registered dieticians involvement in didactic sessions. - Conducting in-person encounters due to difficulty of reaching patients over the phone. - Increased time focused on stress management and sleep hygiene. - Lifestyle Medicine allows learners to engage patients in the ‘action’ stage of behavioral change. 1. Herring, S.J., Kalet, A.L., Shah, N.R., Sood, M. & Vetter, M.L. (2008). What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge. Journal of the American College of Nutrition, I27, 287-298. 2. Leung, L.B., Busch, A.M, Nottage, S.L., Arellano, N., Gliberman, E., Busch, N.J., & Smith, S.R. (2012). Approach to Antihypertensive Adherence: A feasibility study on the use of student health coaches for uninsured hypertensive adults. Journal of Behavioral Medicine, 38, 19-27. References 0 1 2 3 4 5 Discussing the topic of weight loss with patients. Discussing diet and exercise with patients. Creating diet plans for individual patients. Conducting telephonic health check-ups and interventions. Writing an exercise prescription. Counseling patients on mindfulness and stress reduction. Lifestyle Medicine Curriculum and Learner Confidence Pre-Curriculum Post-Curriculum * * Future Directions for Bridges - Kaiser Workplace Clinical Environment: - Ground School: Lifestyle Medicine fundamentals and Health Coaching. - Project Setting: Outpatient Internal Medicine clinic with four preceptors. - Project Aim: Reduce BMI amongst non-pregnant pre-diabetic patients. - Student Role: Roaming health educator, who provides lifestyle medicine consults to patients. *= Statistically significant at p<.05 0 1 2 3 4 Clinical Applications of Lifestyle Medicine Stress Management and Sleep Plant Based Diets and Phytonutrients Nutrition 101 and Diet Planning Exercise and Medicine Health and Welnness Coaching Introduction to Lifestyle Medicine Chronic Disease Fundamentals Mean Evaluation of Overall Didactic Session (1=Poor, 2= Fair, 3= Good, 4= Very Good, 5= Excellent) Lecture Satisfaction Data Learner Confidence Data
Curriculum Ambassador: Sidra Bonner; Advisors: Dr. Pankaj Vij, Dr. Lindsay Mazotti
This is what a text box looks like. Don’t use less than 24 pt font for the text box.
Copy this for the different sections.
• Use bullets to help set off lists and make sure they line up and are consistently formatted across the poster.
If you need to change the shape of the section headings, you can do so, please don’t change the background color or use less than 30 pt font.
Results
Methods/Assessment
Discussion Nearly half of the adults in the United States suffer from chronic disease and a third are obese. Rationale for Lifestyle Medicine Curriculum: 1. Healthy People 2020 calls for increased
provider counseling around diet and exercise. 2. Studies demonstrate that medical trainees
lack knowledge and confidence to provide adequate dietary education1.
3. Medical students as health coaches can improve patient health2.
Main Aims of Lifestyle Medicine Curriculum 1. Provide a working knowledge about lifestyle
medicine topics to learners. 2. Improve learner confidence discussing diet,
physical activity, stress and sleep with patients.
Eight third-year medical students in the Kaiser Longitudinal Integrated Clerkship were enrolled in the curriculum. The curriculum had 2 main components: 1. 8 hours of lifestyle medicine instruction on
diet, exercise and health coaching. 2. Student-initiated Phone Encounters (3 per
student) with adult, non-pregnant patients who had a BMI >25
Assessment: - Lecture satisfaction - Students confidence with lifestyle medicine
knowledge, pre and post curriculum. - Patient demographics and tasks completed
during Phone Encounters.
- Implementation of curriculum increased learner confidence in all measured areas.
- Providing students with ‘Lifestyle Medicine toolbox’ allowed for completion of specific tasks.
- Learner feedback included: - Registered dieticians involvement in
didactic sessions. - Conducting in-person encounters due
to difficulty of reaching patients over the phone.
- Increased time focused on stress management and sleep hygiene.
- Lifestyle Medicine allows learners to engage patients in the ‘action’ stage of behavioral change.
1. Herring, S.J., Kalet, A.L., Shah, N.R., Sood, M. & Vetter, M.L. (2008). What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge. Journal of the American College of Nutrition, I27, 287-298.
2. Leung, L.B., Busch, A.M, Nottage, S.L., Arellano, N., Gliberman, E., Busch, N.J., & Smith, S.R. (2012). Approach to Antihypertensive Adherence: A feasibility study on the use of student health coaches for uninsured hypertensive adults. Journal of Behavioral Medicine, 38, 19-27.
Leung, L.B., Busch, A.M, Nottage, S.L., Arellano, N., Gliberman, E., Busch, N.J., & Smith, S.R. (2012). Approach to Antihypertensive Adherence: A
feasibility study on the use of student health coaches for uninsured hypertensive adults. Journal of Behavioral Medicine, 38, 19-27.
References
0 1 2 3 4 5
Discussing the topic of weight loss with patients.
Discussing diet and exercise with patients.
Creating diet plans for individual patients.
Conducting telephonic health check-ups and interventions.
Writing an exercise prescription.
Counseling patients on mindfulness and stress reduction.
Lifestyle Medicine Curriculum and Learner Confidence
Pre-Curriculum Post-Curriculum
*
*
Future Directions for Bridges
- Kaiser Workplace Clinical Environment: - Ground School: Lifestyle Medicine
fundamentals and Health Coaching. - Project Setting: Outpatient Internal
Medicine clinic with four preceptors. - Project Aim: Reduce BMI amongst
non-pregnant pre-diabetic patients. - Student Role: Roaming health
educator, who provides lifestyle medicine consults to patients.
*= Statistically significant at p<.05
0 1 2 3 4
Clinical Applications of Lifestyle Medicine
Stress Management and Sleep
Plant Based Diets and Phytonutrients
Nutrition 101 and Diet Planning
Exercise and Medicine
Health and Welnness Coaching
Introduction to Lifestyle Medicine
Chronic Disease Fundamentals
Mean Evaluation of Overall Didactic Session (1=Poor, 2= Fair, 3= Good, 4= Very Good, 5= Excellent)
• Low Health Literacy (LHL) is associated with increased ED use, poor medication adherence, and increase all-cause mortality
• Doctors made aware of a patient’s LHL were three times more likely to use recommended communication strategies [1]
• The Brief Health Literacy Screen (BHLS) is a validated 3 question tool integrated into nursing intake at Vanderbilt [2]
• Goal: Do a needs and feasibility assessment for integrating health literacy screening into provider practice at SFGH.
4) Barriers to Education: q Physical q Language q Cognitive
q Altered q Emotional
q Agitated q Uncooperative
q Other_________
1) How often do you have someone help you read hospital materials? q Always (1) q Often (2) q Sometimes (3) q Rarely (4) q Never (5) q [Refuse] 2) How often do you have problems learning about your medical condition because of difficulty understanding written information? q Always (1) q Often (2) q Sometimes (3) q Rarely (4) q Never (5) q [Refuse]
3) How confident are you filling out medical forms by yourself? q Extremely (5) q Quite a bit (4) q Somewhat (3) q A little (2) q Not at all (1) q [Refuse] q [Does not apply, I don’t fill out forms
• Discussed current health literacy screening practices with nursing, physician, IT, and ancillary staff.
• Screened 28 patients using the BHLS within 24 hours of admission
• Consolidated current educational assessment and added BHLS to develop new nursing educational assessment
• Verified new educational assessment meets all regulatory requirements
Results • 42.8% of patients screened had inadequate health literacy • 42.7% of poor health literacy patients
reported more barriers to education vs. 27% patients with adequate literacy
• BHLS identified more patients with reading/writing or cognitive difficulty
Reduced average # of mouse clicks per patient from 4 clicks/patient to 3.6 clicks/patient Acknowledgements
References
Discussion • Implementation of new screening would allow improved data
collection, provider awareness, and targeted interventions • Next steps include single unit nurse piloting and establishing
widespread nurse leadership buy-in, testing of educational toolkit appropriate for patients with LHL to improve effectiveness of discharge education
Warm thanks to Richard Santana, RN, Craig Wong, RN, Jenson Wong, MD, Seth Goldman, MD, Joe Clement, RN, Jen Burke, RN, and Reginald Hortinela, RN for their invaluable support and guidance.
[1] Cawthon et al. “Implementing routine health literacy assessment in hospital and primary care patients. Jt Comm J Qual Patient Saf. 2014 Feb;40(2):68-76. [2] Seligman et al. Physician notification of their diabetes patients' limited health literacy. A randomized, controlled trial. J Gen Intern Med. 2005 Nov;20(11):1001-7.
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
The clinical setting can be difficult to navigate for an early learner. We have taken steps to ease that transition by establishing clear roles for these learners and providing guidance at the SFVAMC Surgical Co-Management workplace. Furthermore, we have taken steps to accustom workplace faculty and staff to the presence of an early learner in order to create baseline expectations as well as a better understanding of how students can contribute to the improvement of systems and patient care.
• Embedded self into each workplace setting on a daily basis to acquaint staff and faculty with the experience of having early learners
• Through observation and participation, determined objectives/roles for an early learner in numerous clinical settings with different professionals
• Established good relationships with stakeholders in the Department of Orthopedics to convince of the value of medical students on the team
• Identified discrete skills/activities a student can develop in this workplace
• Conducted interviews to assess faculty comfort & satisfaction with student presence
• Reported experiences, thoughts, and reflections via Daily Debriefs
• Created an iBook to guide students through their experience and provide workplace-specific, high-yield clinical knowledge
• Surgical Co-Management – Workplace Experience SFVAMC (iBooks) • Orthopedics faculty, residents and staff formed very positive opinions
about the presence of an early learner on the team. They worked to help identify roles and responsibilities for students with given capabilities, and created multiple additional learning opportunities with enthusiasm
• Guiding tips and principles have been published in the iBook to speed student transition into the workplace, as well as reduce the time spent on training by faculty
Methods
Results
Introduction Developed By: Onur M. Yenigun, MS2 and Dr. Heather Nye
Examples of Work
Discussion • Two 1st year medical students will rotate through the Surgical Co-
Management workplace this Fall. They will utilize the iBook and provide feedback
• The iBook is meant to be a dynamic resource that will be revised as students utilize it and provide feedback
• We demonstrate that students in areas traditionally not open to early learners can have a positive impact
• This model demonstrates zero sum game and can be used in other surgical services
Donald Richards (MS2), Glenn Foster, RN, Dr. Lydia Leung M.D.
• At the SFGH Family Health Center it is estimated that out of the ~12,000 patients, less than 100 patients account for 60-70% of health care cost.
• These patients often have complicated
chronic illness, psychosocial circumstances and are unable to adequately care for themselves. Thus they end up Hospitalized or Emergency Department often.
• The Chronic Care Management Team at SFGH’s Family health Center Serves as a potential buffer for these patients in efforts to improve their health status as well as their independence.
Methods / Examples of Work Results
Objectives Discussion
Figure 1. Graphical Representation of the number of times participated in a particular activity this summer.
• Identify and risk stratify patients who are referred to the CCM team or identified through the high utilizer list.
• Engage patients and care providers in a relationship that will provide maximal therapeutic potential for patient.
• Identify better ways to serve patient population.
Tangible Results 1) Patient panel was doubled and meaningful
relationships were established. 2) Patient Satisfaction Survey (5 domains) 3) Bio-Metrics Excel file to track patient’s BP,
HR, WT and Blood Glucose over time. 4) Initial Chart Review and Data Construction
of 100 hospital identified High Utilizers.
Intangible results: 1) New understanding of the phrase “people
are really sick” 2) Making the connection between the chart
patient and the actual patient 3) Learning the holes through which patients
fall through, precipitating their high utilizer status.
100
80
12
12 5 4 4 2 2
Ac#vity Breakdown High U-lizer Data
Phone Calls
Chart Review
Chart Prep
Clinic Visits
Hospital Visits
Health Coaching/Med Rec Home Visits
Family visits
Overall Health Self Management
Health Care Team
Health System Naviga-on
Health Literacy
Patient Satisfaction Survey Domains
Figure 2. The names of the general categories from which patient satisfaction survey questions are derived.
This summer experience with QI at the SFGH Family Health Center was able to provide me with an extremely unique experience that was as educational as it was confidence boosting. Joining and contributing to a team that provided patient care in this manner gave me insight into our health care system like no other experience could.
• The Interprofessional Inpatient Patient Aligned Care Team (iPACT) was created to pilot daily interprofessional beside rounds on the Medicine service at the San Francisco VA Medical Center.
• The team includes an attending, resident, two interns, 3rd and/or 4th year medical students, social worker, pharmacist, and a Project RED nurse.
Future Directions
Before Intervention
Nurse participation rate increased from 60% to 80% after intervention.
After Intervention
Most patients were from Hem/Onc floor
• There is no consistent, effective way to promote participation of bedside nurses in iPACT morning rounds.
Problem Identification
Methods 1) Conducted structured observations and
interviews with key stakeholders to: • identify a problem and its causes; • outline current and ideal process maps; • identify recommendations and challenges; • collect baseline and post-intervention data.
2) Utilized Plan-Do-Study-Act (PDSA) cycle.
Weeks 1 2 3 4 5 6 7 8
Problem Identification & Analysis
Process maps
Intervention and Evaluation
Final report
Baseline data collection Post-intervention data
collection
• Not all nurses were informed of iPACT model;
• Team did not have a consistent daily protocol to identify and communicate with bedside nurses in advance of seeing a patient.
Problem Analysis
• To apply quality improvement principles to redesign the system so that bedside nurses are included on daily interprofessional rounds.
Purpose
• Outreach to nursing units about iPACT model;
• Use of online Bed Management System to retrieve name and hospital mobile number of each patient’s bedside nurse before rounds;
• Assignment of consistent, core team member to retrieve information and call bedside nurse (hospital mobile number) 2-3 minutes before team arrives at patient’s room.
Recommendations / Interventions
Measurements
• Develop a strategy to quickly retrieve names and hospital mobile numbers of bedside nurses when the online system is not working.
• Investigate why rounds participation of bedside nurses on Hem/Onc floor is lower than other nursing units.
• Monitor bedside nurse satisfaction with the iPACT daily interprofessional rounds.
• Including bedside nurses on rounds is valuable to effective and patient-centered team care but logistically challenging.
Leading System-wide Change at SFGH at the Kaizen Promotion Office
Matthew Cummings (P3); Julie Wu (MS2); Dennise Rosas, MPH; William Huen, MD, MS, MPH
Results
Discussion
● Hospitals have begun implementing more efficient, patient-centered care models following passage of the Affordable Care Act.
● Lean: a quality improvement approach designed to eliminate waste from workflow through continuous improvement, or kaizen
● Kaizen Promotion Office (KPO): established 2012 at SFGH ○ Use and teach Lean principles with goals of decreasing wait times
and waste, increasing patient safety and satisfaction, increasing workplace communication, and increasing workplace organization and staff experience
○ Value streams in 6 departments: Outpatient Pharmacy; Urgent Care Center; Radiology; OR; 3M Surg Clinic; 4D Med-Surg Unit
○ 3P Workshops for transition to new hospital; Kaizen workshops ● Curriculum Ambassador (CA) program: a pilot program for the new
Bridges curriculum focused on experiential systems-based learning
Methods
● Week-long Kaizen events with department to identify wastes, brainstorm and test solutions, report prioritized solutions to the hospital
● Week-long Kaizen 3P workshops with staff, stakeholders to design the layout and flow of their department in the new hospital
● Lean principles represented by the Lean House:
● Value stream mapping: detail steps in process, time spent, work inputs
● Observations and data collection at the site
● Weekly check-in meetings and planning meetings for events
Participated in Kaizen events and 3P workshops: Emergency Department 3P Workshop; Maternal and Child Health 3P Workshop; Outpatient Pharmacy Kaizen; OR Documentation Kaizen. Results of two are highlighted below:
3P Workshop: Maternal and Child Health
● Current state (left), future state (right) ● Developed 7 priority areas for
transitioning to the new hospital:
Kaizen Event: Outpatient Pharmacy
● Introduced 11 new forms of
standard work ● Decrease in initially observed
prescription wait times ● Implemented color-coordination,
visual workflow management ● Cross-trained pharmacy techs for
flexible workflow coverage
1. Shared documentation system 2. Integrated rounding 3. Team-based assessments, care planning 4. Cross-training nursing staff 5. Patient/family-centeredness 6. Efficient, welcoming registration process 7. Integrated leadership, management,
governance structure
● Learned and applied the Lean Management method of continuous improvement and accountability
● Developed inter-professional communication and collaborative skills ● QI projects allow students to gain broad perspective of workflow in a hospital
and gain transferable skills to identify and address any major wastes ● Integrating systems-based experiential learning into medical curricula will
prepare students to practice medicine in the 21st-century
Maria Patanwala, Tiffany Chinn, Dia Yang, Anna Chodos, and Leigh Kimberg
Examples of Work
Results and Evaluation Plan
Methods Discussion and Future Steps
Background:
• The San Francisco Department of Public Health (SFDPH) is participating in the statewide Big Aims quality initiative aiming for a 77% breast cancer screening rate. The current county-wide screening rate is 74%.
• Maxine Hall Health Center (MHHC), an SFDPH primary care home that serves a large proportion of African American patients, has a screening rate of 64%. Screening rates for African American women at MHHC are even lower at 58%.
• The CDC reports that “Black women have the highest breast cancer death rates of all racial and ethnic groups and are 40% more likely to die of breast cancer than white women.”
Purpose:
• Learn about barriers for mammograms among African American women from patients and the health care team to compile ideas for change.
• Empower patients and the health care team: Create a tool to improve MEA-patient communication and education about mammography.
• Pilot a model for an inter-professional medical student workplace learning experience in the community health setting.
• Dissemination, Training, and Adoption of project at 2 community health centers with more training in progress
• Student insight into health disparities, primary health care system, and quality improvement process both at county and clinic levels.
• Inter-professional collaboration throughout process emphasizing team-based care approaches.
• Follow-up with clinics on whether staff comfort in discussing mammography has improved and how tools are utilized in practice.
• Explore changes in screening rates and patient awareness.
Learn about the SFDPH System and QI while working inter-professionally.
• Qualitative data collected from patients and health care teams about mammography screening through 21 Interviews and 1 Focus Group.
• Mammogram FAQs and Process Sheet to assist in conversations and education about mammograms in clinic.
• MEA/Staff Training to use cards and practice cultural humility
• Outreach materials to help increase patient awareness
• Initial follow-up suggests a need for further training and integration of materials into workflow at clinics.
• Disseminating tools, best practices, and data to other clinics.
• Adapt the tools developed in project for use in community outreach and education efforts to improve mammography rates.
Acknowledgments MHHC Staff for their generosity in allowing me to learn and work with them at their site. Patients for kindly taking the time to speak and share with me. Chinatown Public Health Center and Southeast Health Center for letting me present at their sites.
Results/Status Methods • 9% of neurosurgery patients are diabetic • Steroid taper required following neurosurgery increases likelihood of new/changed insulin • Teaching required to reduce hypoglycemic events • Current teaching scattered,often variable due to overlapping/undefined teaching roles. • 8L, relatively smaller unit homogenous patients provides easier test of change group. • limitation of setting due to unit variation in diabetic teaching. Pharmacists (not hospitalists) do most of the discharge management on 8L. Purpose: Assess inpatient diabetes teaching at discharge for patients going home on new or changed insulin regimen. Pilot small tests of change to improve and standardize current inpatient diabetes teaching in 8L (Neurosurgery) patients.
3/5 nurses never used Apex teaching materials 4/5 nurses never seen the blue education folder Most document their teaching in Apex (4/5) Survey done weekday in small group of nurses
Desirable Outcome: Standardized teaching Shared responsibilities among physician, pharmacy and nursing • Observed discharges with nursing/pharmacy • Surveyed nurses/pharmacists as to what each covered in discharge education • Decided on 6 areas to be covered at minimum for every discharge (glucometer, insulin-pen, and insulin sliding-scale use, hypoglycemia awareness and treatment, insulin storage and PCP follow-up) (input from UCSF Diabetes Resource Network) • Implemented 2 tests of change to observe effect of adding these criteria to discharge education. • Observed nursing/pharmacy cover “desired-6” criteria of diabetic teaching with select patients • Interviewed patients and checked diabetes understanding before they left the hospital • Solicited feedback from nurses and pharmacists
Examples of Work
• Visual aids pertinent for patient understanding • Printing education documents in Apex failed Missing graphics resulted in omission of hypoglycemic symptoms from handout Individual document search too time consuming Need 1 grouped item to print all pertinent handouts to improve ease of access • “Blue folder” handy: already contains ‘desired-6’ and is prettier than Apex handout • Achieved more reliable, standardized teaching with test of change discharges Some nurses had never seen blue folder, and did not know to look for handouts in Apex Once shown blue folder, really like it!
Discussion Collaborative effort required between nursing, hospitalists, pharmacists and RNs to improve discharge education. Inpatient diabetes an important piece for new insulin diabetes safety Moving forward, group to consider • Earlier teaching (not necessarily at discharge) • Patients gradually self-administering insulin under nurse supervision until proficiency shown at GM read, sliding scale interpretation, insulin pen use and self-injection • Creating physician order set in Apex that triggers diabetes teaching (so can be done separate to discharge orders)
