1. Teaching Medical Students Quality Improvement Projects Using Plan-Do-Study- Act Method Carrie Roseamelia, PhD Robert Ostrander, MD

2. Disclosures The authors declare that there are no conflicts of interest.

3. SUNY Upstate RMED Program Rural Medical Education Program Established 1989 to address needs of medically underserved communities Attracting young doctors to rural practice RMED Students Live and learn in rural communities in New York for 36 weeks Work side-by-side with local providers

4. RMED Curriculum Clerkship Clinical Rotations (15 weeks) –Fam Med (5), Surgery (8) & Emerg Med (2) Family Med Elective (15 weeks) –Patient Care Delivery (50%) –Case Discussion (30%) –Office Care Project (15%) –Professionalism (5)

5. Purpose of Learning Activity AAMC mandate Improve students clinical knowledge Improve clinical processes Barriers to Learning Activity Faculty interest Faculty training

6. Learning Objectives “PDSA" Activity Generate student leadership as project champion in activities that require interactions with the entire care team through the QI process. Teach students to research the clinical science and knowledge base about a particular problem, study the process of care in the clinical setting where they are learning, and integrate the knowledge gained in these two domains to improve patient care. Develop students ability to integrate multiple skill sets through the QI project.

7. PDSA Method Define a problem Design a focused intervention to test Carry out the test of change Study or assess the results Act on those assessment results

8. Teaching Method Use feedback techniques including questions for reflection, advice, and “brainstorming” to effectively mentor students though their QI projects

9. Description of Activity For the 2015 nine month program, each student will complete a somewhat structured project to improve some aspect of care in the office. Most physicians in practice will tell you that obstacles to providing the care they want stem much more often from issues with the delivery of care than from lack of knowledge or expertise. However, trying to improve things in a busy practice has been likened to “trying to change a flat tire while riding the bike.” This project is intended to make you familiar and give you some hands on experience with “short cycle change” or “Plan-Do-Study-Act” cycles. And, it also will provide you with a chance to make a difference in the practice where you are working.

10. Activity Steps Send introduction letter to students Present “Webinar” to students and preceptors Email correspondent according to the timeline, with phone calls as needed

11. Key Points for Students Impetus to Change Inspiration Imitation Inspiration

12. Key Points for Students Barriers to Change Inertia Too much weight given to Murphy’s Law Too busy to stop the bicycle & change the tire The enormity of the task

13. Key Points for Students PDSA not a controlled study In common: Hypothesis & measurement In contrast: Design & data analysis

14. Activity Timeline March 9: Pay attention from the start, become aware of practice processes; What things make you say to yourself, “There must be a better way” March 30: Talk with your preceptor, then submit 3 potential project outlines. Outlines should have: one sentence goal, one sentence description of the intervention, and a couple thoughts on measurements. Example: The goal is to improve diabetic foot exams. The intervention would be reminder posters in exam rooms. We would measure % of diabetics with foot exams at routine visits before and after, and physician satisfaction with the process. OR - Submit a project that will meet the criteria for your preceptor as a Part IV (PPM). PDSA activities are required to maintain Board certification, and a project with your preceptor can fulfill this.

15. Activity Timeline May 11: Select one project, submit a draft plan, include: Precise script Materials and possible brochure Number of patients/what time period Measurement details (before and after) Evaluation plan Hoped for/expected results, unexpected results, adverse effects, & how these will be assessed May 26: Submit finalized plan & timeline

16. Activity Timeline August 21: Submit results of “Study” and ideas for “Act” Upon feedback, move forward with “Act” “Act” may involve a second short cycle to complete independently, and report back at the end. (Some of the Part IV PPMs require this.)

19. Alison Stringham PDSA Project RMED 2015

20. Alison Stringham PDSA Project RMED 2015

22. Can this type of activity be modified to other clinical teaching settings? Can key points be preserved when time frame is compressed? Points for Group Discussion

23. Carrie Roseamelia, PhD roseamec@upstate.edu Robert Ostrander, MD rjostrand2@gmail.com Alison Stringham, MS4 rowella@upstate.edu

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