D4: Bridging the gap between undergraduate and postgraduate education

1. 19th Annual International Forum on Quality and Safety in Healthcare This presenter has nothing to disclose April 10, 2014 Open School D4: Bridging the gap between undergraduate and postgraduate education Jo-IngeMyhre, MD and Jessica Perlo, MPH

2. Meet Dan

3. Took Courses & Created a Chapter • IHI Open School working group • Motivated and passionate volunteers • Weekly meetings

4. Leveraged Faculty Partnership with institutional leadership, secured a mandate Georgetown Center for Patient Safety Georgetown Masters in Health System Administration Georgetown School of Medicine - Remove barriers - Buy faculty time - Encourage learners to participate

5. Recruited Interprofessional Members

6. Focused on Institutional Priorities • Engaged students/trainees in projects that were central to the strategic plan of their health care organization • For them, this meant: • Resident handoffs • Central line blood stream infections • Hospital readmissions • DVT prophylaxis improvement • Post discharge communication with community primary care physicians • Hand hygiene • Central line air embolism prevention • Private partnership with an industry partner

7. Built the Case for Resident Involvement • System dysfunction is never more evident than when one is in training. • Because of the unfortunate nature of our training system, trainees are often blamed for system errors • Because of this front line view, there is a tremendous will for change among trainees. • They are tremendously agile in their thought processes and are not attached to an ingrained status quo. • They rarely have the opportunity to work in an interprofessional manner.

8. Practicum example: CLABSI • Team structure: • Health system administration student: project manager, Daniel Bitman, BS • Physician champion: medicine resident, Daniel Alyeshmerni, MD • Nursing champion: Elizabeth Giunta, RN • Medical student: Orlando Sabbag, MSIII Peter Aleksandrov, MSIII • Nursing student: Lindsay Gingras • Barriers: time, focus, maintaining momentum • Results: • On vascular surgery unit, CLABSI rate ~ 3.2/1000 device days to 0 CLABSI rate for over one year

9. Continued Professional Growth Presented work at conferences Quality Improvement Chief Resident, DC VA VA Quality Scholar Fellowship IHI Improvement Advisor Training Cardiology Fellowship, UMI Faculty Advisor to UMI Chapter

11. Dan’s Experience OS Courses OS Practicum IHI IA, VA Quality Scholar * Adapted from Ogrinc G, et al. A framework for teaching medical students and residents about practice-based learning and improvement. Acad Med. 2003; 78(7): 748-756

12. Actual State OS Courses OS Courses OS Courses * Adapted from Ogrinc G, et al. A framework for teaching medical students and residents about practice-based learning and improvement. Acad Med. 2003; 78(7): 748-756

13. Early Postlicensure Barriers Junior Doctor/Residents’ busy schedules Not enough mentors who feel comfortable providing guidance Lack of interest among trainees or belief that QI/PS is unimportant Trainees’ transient presence on certain units or rotations Lack of time to teach basic foundational principles of quality and safety Lack of infrastructure (data managers, statisticians) Lack of support from residency leadership regarding perceived value of these activities

14. Graduate Training Success Factors Health system culture embraces the idea that residents and junior doctors are critical to quality and safety. Engaged, capable facultyare willing to mentor. Training projects are aligned with quality and safety institutional goals. Early student exposure to QI concepts can create champions and a pathway for application once they enter the delivery system Ongoing, experiential learning opportunities allow deep practice.

15. IHI Open School Mission “Advance health care improvement and patient safety competencies in the next generation of health professionals worldwide.”

16. The IHI Open School

17. IHI Open School Courses • 23online courses developed by world-renowned experts in the following topics: • Improvement Capability • Patient Safety • Person- and Family-Centered Care • Triple Aim for Populations • Quality, Cost, and Value • Leadership • Mobile App for iPhone and iPad

18. Certificates • Certificate of Completion • 30 contact hours available for nurses, physicians, and pharmacists

19. Community 200,000+ students, residents, and professionals 638Chapters in 67 countries 167 Chapters (26%) are located in hospitals or health systems

20. Quality Improvement Practicum (QI201) • Learner-driven quality improvement projects • Within local clinical setting • Opportunity to apply gained knowledge • Project Examples: • Reducing wait times • Improving hand hygiene compliance rates • Improving medication processes and implement checklists

21. Combining QI&PS with Leadership Training and EBM Jo Inge Myhre, MD Teaching assistant ”KLoK” University of Oslo Medical School

22. Aim of KLoK Through KLoK you’ll aquire knowledge and skills in EBM, leadership and quality improvement. This will aid you in your future professional role as an individual as well as a member/leader of teams.

23. Course overview • 1. sem.: Introduction to patient safety (lecture) • 6. sem.: Leadership and patient safety (seminar) • 7. sem.: One week course in EBM (with exam) • 10. sem.: EBM, Leadership and QI, Lectures, seminars and individual assignments during rotations in both hospitals and primary care • Critical analysis of scientific publication and or guideline • Patient satisfaction • ”The patient’s journey” • 11. semester: • Lectures and seminars • Group based assignment (QI Project proposal) • 12. semester: • ”Survival week” • Student-BEST – Interprofessional simulation day • OSCE

24. Our experience It’s hard to teach one subject without the others Making it as clinical as possible is crucial Invite students in the process Create mechanism for continuous evaluation of the course

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