Linda A. Headrick, MD, MS, FACPFebruary 26, 2013

Describe the rationale for integrating improvement into the medical school curriculum

Explore how health professional schools can innovate to emphasize quality improvement as a fundamental physician skill

What factors were present that helped make that happen?

SafeTimely

EffectiveEfficient

EquitablePatient-

CenteredIOM 2001

deliver patient-centered care

as members of an interdisciplinary team,

emphasizing evidence-based

practice,quality improvement

approaches, and informatics

IOM 2003

Habits of inquiry and improvementEngage learners in challenging problems and allow them to participate authentically in inquiry, innovation, and improvement of careEngage learners in initiatives focused on population health, quality improvement, and patient safetyLocate clinical education in settings where quality patient care is delivered, not just in university teaching hospitals

Cooke, Irby, O’Brien & Shulman 2010

Teaching for Quality (Te4Q)

Embed quality improvement & patient safety

across the continuum of

medical education

www.aamc.org/te4q

Te4Q Goal

Ensure that every medical school and teaching hospital in the U.S. has access to

a critical mass of faculty that are ready, able and willing to engage in, role model

and lead education in QI/PS

% US SOM Reporting IOM Goals

Academic Med Suppl Sept 2010

Interprofessional Faculty Development Institute for Quality Improvement and Patient Safety

Important Update: The 2013 IPEC Faculty Development Institute has reached maximum capacity. Please complete the Waitlist Form

Health Affairs 2012

“Retooling” Expectations• Create a medical/nursing school partnership• Secure support from academic and health system

senior leadership• Integrate quality improvement and patient safety

into core curricula• Engage students in hands-on improvement work

in partnership with a health care partner• Test changes in iterative cycles• Participate in collaborative support activities

Retooling for Quality and Safety• Case Western Reserve University • Johns Hopkins University• Penn State University• University of Colorado• University of Missouri• University of Texas Health Sciences Center,

San Antonio

Changes in Core Curricula

• 1374 student encounters• 87% interprofessional• Innovations in the– Classroom– Simulation center– Clinical setting

Innovations in the Classroom

• Large group– Penn State: Team-based learning to analyze a

medical error and recommend system changes– CWRU: Interprofessional quality “Grand Rounds”

with poster session, & structured reflection

• Small group– San Antonio: Weekly interprofessional QI seminar

Innovations in the Simulation Center

• Interprofessional communication & teamwork– Johns Hopkins & CWRU: SBAR– Colorado: TeamSTEPPS

• Interprofessional work around specific clinical issues– Colorado: Sepsis bundles in ICU– Missouri: Falls prevention

Innovations in the Clinical Setting

• Involving students in clinical QI– CWRU (nursing)– Colorado (nursing & medicine)

• Involving students in patient safety– San Antonio: Collected data about hand-washing– Missouri: Individualized patient falls prevention

Clinical QI at Colorado• UCH: student identified interprofessional

clinical issues• Prevention of Patient Falls• Patient-Centered Communication Using

Whiteboards • Improving ICU to Unit Transitions• Prevention of Decubitus Ulcers• Improving Discharge Process

• CHCO: on-going hospital-based project• Improving use of Patient Identifiers• Handoff Communication• Hand hygiene

Outcomes at Children's Hospital CO (over 2.5 years)

• 158 nursing students completed the experience

• 34 medical students completed the experience

• 1716 hours of work on hospital QI projects–Collection of over 16,000 data points

• 30% reduction in patient identification errors for 2011

Continuum of Education in Quality and Safety

Able to deliver effective patient-centered care

Honest with high ethical standards Knowledgeable in biomedical sciences,

EBM, and social/cultural issues Critical thinkers; problem-solvers Able to communicate Able to collaborate Committed to improving quality and safety Committed to life-long learning and

professional formation

MU SOM Continuum in Quality and Safety

“Medical students proposed safety interventions that were more robust

than those suggested by event reporters regarding similar

events within our health system (p<0.0001).”

Independent Online Modules on Patient Safety, QI and Fall Risk Reduction

Interprofessional Simulation: Preventing Falls in Hospitalized Patients

Bedside Fall Risk Assessment by Student Dyad& Customized Patient Education Plan

Interprofessional Debrief

Retooling for Quality and Safety

QMHC 2009

0

2

4

6

8

10

12

2006-2007 2007-2008

Mean quality improvement skill level measured by QI Knowledge Assessment

Tool (QIKAT)

Precourse-participating medical students

Postcourse-participating medical students

Postcourse-control medical students

prec

ours

e Q

IKA

Tno

t off

ered

'06-

'07

Meaningful integration into required curricula

AssessmentCritical mass of prepared facultyExemplary care for patients and

exemplary learning for health professionals

ExperientialClinically relevant

Evaluated

www.aamc.org/te4q

1. Reaction2. (a) Modification of attitudes/perceptions(b) Acquisition of knowledge/skills 3. Behavioral change4. (a) Change in organizational practice(b) Benefits to patients/clients.Adaptation of Kirkpatrick (1967)

by Barr et al , 2005

Expert educators to

create, implement, and evaluate training and

education in QI/PS for students, residents and

colleagueswww.aamc.org/te4q