Creating an Elective at Baylor: Four Steps to Success

October 2013

Here at the IHI Open School, we like to highlight innovative work from our Chapter network, which is why we jumped at the opportunity to learn more about how the IHI Open School Chapter at Baylor College of Medicine in Houston, Texas, is striving to integrate quality improvement (QI) and patient safety (PS) into its school’s curriculum.

Baylor started on this journey to change the curriculum in 2010. The Chapter’s founding member, Joshua Liao, helped launch a required pre-clinical safety course for medical students. Chapter members have played a large role in that course’s success, writing exam questions, collecting student feedback, and integrating that feedback to improve the course. Last October, the Chapter decided to build on that course and create an elective that would include the entire IHI Open School catalog and provide hands-on experience in PS and QI.

Here’s how they made it happen during the past year …

By Dennis Shung and Mitchell Peterson, IHI Open School Chapter Leaders, Baylor College of Medicine

Our journey began as members of the IHI Open School Chapter at Baylor when we became interested in PS and QI as first-year medical students. We obtained the IHI Open School Basic Certificate in Quality & Safety and then served as teaching assistants for the inaugural year of the safety course. After the course ended, we sought other ways to become involved in the hands-on application of QI and PS, but it was difficult to find practical exposure in the clinical setting.

That’s when we decided to create this new elective.

We began with Step 1: Finding faculty who were willing to serve as champions to educate students at our affiliated institutions. Directed by our faculty sponsor Dr. David Berger, we approached Dr. Anne Gill in the undergraduate medical education office. Dr. Gill was the faculty champion who enthusiastically directed us to other faculty members already involved in resident QI/PS educational initiatives. Dr. Diana Stewart at the Michael E. Debakey Veterans Affairs Medical Centers (MEDVAMC) and Dr. Brent Mothner at Texas Children’s Hospital also proved to be invaluable. These faculty champions helped us to flesh out a vision for the clinical elective for medical students.

We then commenced with Step 2: Needs assessment and literature review. A needs assessment highlighted the gaps in the current curriculum and, more importantly, the level of student interest in a practical clinical elective. Thankfully, survey results supported the development of the elective. Our literature search for clinically based QI curricula yielded few published initiatives, so we decided to design our own curriculum for a four-week clinical elective.

Galvanized by the results of the needs assessment, we moved to Step 3: Development of the clinical elective curriculum. We decided to base the curriculum on the IHI Open School QI modules and require a project that is meant to apply the principles of QI to a real-life improvement issue. We also added a White Belt Lean training session and a QI basics workshop based on the IHI Open School modules. The Course Director would select a project for each student, and learners would have the opportunity to participate in additional activities, such as a Root Cause Analysis (RCA), a Rapid Process Improvement Workshop (RPIW), and hospital-wide quality improvement projects. Additionally, the VA Chief Residents for Quality and Patient Safety would hold a weekly journal club with the students, and students would participate in hospital-wide patient safety rounds. Students would be required to shadow non-physician staff members to promote teamwork and communication, and attend executive-level committee meetings to better understand multi-disciplinary initiatives in place at the institution to improve quality and prevent adverse events.

Finally, in Step 4, once we had fleshed out our proposal for the clinical elective, we presented it to the medical school curriculum committee. We received approval in August 2013, with the start date of the first rotation at the end of September. 

As we reflect on this process, we recognize that enthusiastic faculty champions, institutional support, and the IHI Open School were critical to our success. The IHI Open School provided a valuable core curriculum, and the Chapter at Baylor has provided a strong base to cultivate student leadership and interest in QI and PS. We hope this elective will provide hands-on exposure that will inspire physician trainees to pursue future careers in improvement and safety.​ 

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