1. Opportunity Discussion Methods For More Information
Workflow Analysis of Interprofessional Medical Education in the Clinical Learning
Environments to Improve Learning and Clinician Well Being
Northeastern University
Catarina Smith1; Nicole Nehls1; Adam Schleis1; Margo M. Jacobsen, BA1; Paul Han, MD, MPH2; Thomas Van Der Kloot, MD3; Peter Bates, MD3; Robert Bing-You, MD, MBA3; Awatef Ergai, PhD4; James C. Benneyan, PhD1
1Healthcare Systems Engineering Institute; 2Department of Medical Education, Maine Medical Center; 3Center for Outcomes Research and Evaluation, Maine Medical Center; 4Southern Polytechnic College of Engineering and Engineering Technology, Kennesaw State University
Contact Information:
Healthcare Systems Engineering Institute
Opportunity
Workflow Observation
Resident Interruptions
Resident Informal Learning
Discussion
Background
Resident Workflows
Workflow Observation
Residents:
iPACE and non-iPACE have a similar number of task changes per hour (iPACE: 8.7, Non-iPACE 8.6)
iPACE spends 40% more time in either medical team or interdisciplinary discussion
Non-iPACE spends twice (2.11) as much time on documentation
RNs:
iPACE and non-iPACE have similar number of task changes/hour (iPACE: 14.5, Non-iPACE 16.5)
Unlike non-iPACE units, iPACE RNs have the opportunity to attend educational sessions
Resident Interruptions
Non-iPACE residents are interrupted 63% more often than iPACE
iPACE interruptions take proportionally longer to address, and have less added value
Resident Informal Learning
Attendings & residents are primary sources of informal learning despite interdisciplinary unit.
Medical students and interns are primary recipients
Average duration of informal learning event was 1.18 minutes
Average perceived added value of informal learning event was 2.99 out of 5
ACGME identifies interprofessional education as an integral part of a successful clinical learning environment (CLE)
ACGME CLER program gives feedback to accredited teaching hospitals
Health systems are reassessing and rethinking their graduate medical education programs and their clinical learning environments
Objective
To evaluate nurse and resident workflows to better understand how workflows, interruptions, and informal learning take place in regular patient units compared to a highly collaborative interprofessional patient unit
Methods
Study Setting:
637-bed hospital in Portland, ME
47 internal medicine residents
Interprofessional Partnership to Advance Care and Education (iPACE) Unit:
12-bed unit
All bedside rounds with full care team
Group reflective learning
Observations:
Observed 1 resident or nurse per day for:
Time spent on various tasks
Interruptions
Inter- & intra-professional informal learning
Communication between team members
Data Collection:
Medical students recorded informal learning event details such as the time, activity, teacher(s), student(s), and duration.
Noted if the event was solicited or unsolicited and to what degree it added value (Likert scale 1-5) or was missed.
Nurse Workflows
For More Information
Silverstein, S., Benneyan, J., et al., Systems Process Analysis of Graduate Medical Education in Clinical Learning Environments. Working paper to be submitted to Journal of Graduate Medical Education
Smith, C., Benneyan, J. et al., Workflow Analysis of Interprofessional Medical Education in the Clinical Learning Environments to Improve Learning Outcomes and Patient Safety. Working paper to be submitted to Journal of Graduate Medical Education
192 documented events in iPACE, between 7:30 am and 12:30 pm
73.1% of informal learning events were unsolicited