1. Structure of Workshops
Assessing the Impact of Quality Improvement Skills Workshops for Medical School Students
Kevin P. Shah, Jaden R. Kohn, Matthew Stampfl, Grace Wey, Brandon Ho, Diana Stewart, MD, MBA
The Institute for Healthcare Improvement (IHI) Open School Chapter – Baylor College of Medicine
Introduction
Methods
Results
Data was collected from 46 learners at the three workshops – RCA (13 MS1, 1 MS2, 1 MS3, 1 MS4), Handoffs (14 MS1), and Process Mapping (11 MS1, 4 MS2, 1 PA).
13% of learners had previously received formal instruction on these topics: 1 Handoffs learner, 2 Process Mapping learners, and 3 RCA learners.
Learners’ confidence in performing QI/PS skills was assessed via 5-point Likert scale. Improved confidence was seen for each skill: Handoffs (mean difference 2.43, p<0.0001), Process Mapping (mean difference 1.50, p<0.0001) and RCA (mean difference 1.69, p<0.0001).
Overall, 82.6% of learners agreed that the workshops were useful and 91.3% of learners were likely to recommend the workshop to other colleagues.
Qualitative feedback indicated that students were interested in attending the QI/PS workshops to gain practical skills, become exposed to hospital operations, and to learn about the essentials of improvement science.
Feedback regarding workshops was constructive with several recommendations for the future: (1) smaller discussion groups, (2) availability of handouts to take home, (3) increase use of multimedia, and (4) practice skills within time constraints.
It is estimated the medical errors are currently the third leading cause of death in the United States.5
Trends within healthcare over the last decade have resulted in a tremendous increase in the collection of data pertaining to quality improvement and patient safety (QI/PS). Much of this data is centered on clinical outcomes, however, and less data is readily available regarding medical education.3,4
The World Health Organization (WHO) and Association of American Medical Colleges (AAMC) have encouraged medical schools to incorporate QI/PS in healthcare into standard curriculum required for all students.1,7
Studies have shown that medical students have a low level of QI/PS exposure and knowledge. 2
There is a large amount of variation within the teaching of QI/PS to students in terms of types of skills taught, the amount of material covered, the stage of training at which material is taught, and teaching methodology.6
There is need for the development of a standard QI/PS curriculum and for further research to be conducted regarding the impact that various methodologies of teaching QI/PS skills to medical schools students can have in reducing the morbidity and mortality of patients.6
The BCM IHI Open Chapter hosted three QI/PS workshops during the school year
Pre- and post-surveys were used to assess changes in knowledge and attitudes within QI/PS
Relevance of Material
Practicality of Material
Overall Quality of Workshop
Confidence in Applying Skill Taught at Workshop
Future Ideas & Suggestions for Improvement of Workshops
Administration of Pre-Workshop Survey
Learners Taught QI/PS Skill(s)
Learners Practice Hands-On Application of QI/PS Skill(s)
Administration of Post-Workshop Survey
Structure of Workshops
Root-Cause Analysis (RCA) Workshop
Length: 2 Hours
Location: Michael E. DeBakey VA Medical Center (MEDVAMC) and Baylor College of Medicine (Houston, TX)
Instructors: Chief Residents in Quality & Safety, MEDVAMC
Topics Covered:
Fundamental purpose and steps of RCA
RCA Tools: process maps, fishbone diagrams, "the five why's"
Hands-On Application:
Students identified root causes of mock adverse event and interviewed individuals involved (role-played by residents)
Analysis of gathered information and development of recommendations to prevent similar events from occurring in the future
Handoffs Workshop
Length: 1 Hour
Location: Baylor College of Medicine (Houston, TX)
Instructors: Medical Students with experience in QIPS initiatives
Importance of Handoffs
Performing an Effective Handoff using IPASS (Illness Severity, Patient Summary, Action list, Suggestions, Synthesis) methodology
Students practice non-medical handoff scenario
Students practice medical handoffs scenarios
Reflection through individual and group feedback about each handoff
Process Mapping Workshop
Location: Ben Taub General Hospital Emergency Center (Houston, TX)
Instructors: Nursing faculty and a medical student with experience in QIPS initiatives
Methodology of process mapping using standard flowchart symbols
Students shadowed physicians, patients, and ancillary healthcare providers
Development of a process map based on data gathered
Identification of potential areas of improvement and sharing of recommendations to staff/faculty
Objectives
Assess learner’s knowledge and attitudes regarding QI/PS skills
Ascertain whether students had received formal instruction in these QI topics prior to the workshop
Obtain feedback on the quality of workshops hosted by the Baylor College of Medicine (BCM) Institute for Healthcare Improvement (IHI) Open School Chapter
Acknowledgements
We would like to thank members of the Institute for Healthcare Improvement (IHI) Open School Chapter as well as students at Baylor College of Medicine that participated in the workshops.
References
Conclusion & Future Research
Association of American Medical Colleges. Integrating quality improvement and patient safety across the continuum of medical education. Report of an Expert Panel
Blasiak, R. C., Stokes, C. L., Meyerhoff, K. L., Hines, R. E., Wilson, L. A., & Viera, A. J. (2014, January 21). A Cross-Sectional Study of Medical Students’ Knowledge of Patient Safety and Quality Improvement. North Carolina Medical Journal (NCMJ),75(1),
Institute of Medicine (US). Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: a new health system for the 21st century. National Academy Press.
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To err is human: building a safer health system (Vol. 6). National Academies Press.
Makary M. A., Daniel M. Medical error—the third leading cause of death in the US. BMJ2016; 353 :i2139.
Teigland, C. L., Blasiak, R. C., Wilson, L. A., Hines, R. E., Meyerhoff, K. L., & Viera, A. J. (2013). Patient safety and quality improvement education: a cross-sectional study of medical students’ preferences and attitudes. BMC medical education, 13(1), 1.
Walton, M., Woodward, H., Van Staalduinen, S., Lemer, C., Greaves, F., Noble, D., B Ellis, L Donaldson & Barraclough, B. (2010). The WHO patient safety curriculum guide for medical schools. Quality and Safety in Health Care, 19(6),
Our results indicate that workshops are useful to teach QI/PS principles to medical students, and that these workshops significantly improve learners’ confidence in performing QI skills.
Qualitative feedback illustrated the value of the workshops for learners to develop and apply these practical QI/PS skills throughout their healthcare training.
As IHI workshops continue to be held for medical students each year, there is potential for long-term follow-up with workshop attendees to determine the relevance and practicality of learned QI skills throughout clinical training, residency, and beyond.