To redefine health care, first you must redefine medical education. That’s the premise of an innovative initiative at East Carolina University’s Brody School of Medicine.
“We want to produce graduates better prepared to work in a rapidly changing health care system that is more focused on quality and safety,” says Elizabeth (Libby) Baxley, MD, Senior Associate Dean for Academic Affairs at the school.
To do this, Brody has designed a three-pronged model that is changing the way medical students learn about safety, quality, population health, and interprofessionalism. Brody, which educates 320 medical students each year, was one of 11 schools that in 2013 received a $1 million grant from the American Medical Association to invest in innovative curricular change. The grant ends in 2018.
The effort has three components:
- Training the trainers, through a newly created Teachers of Quality Academy
- Incorporating quality, safety, and teamwork throughout the entire medical school curriculum
- Creating a specialized distinction for students who take additional training in quality and safety, called the Leaders in Innovative Care Scholars (LINC)
Baxley and Luan Lawson, MD, Assistant Dean of Medical Education at Brody, have been leading the school’s work in the first two years of the grant. They used the IHI Open School to help create the content for the program.
“The financial support [from the grant] has been instrumental in planning the larger curriculum,” Lawson says. “But the ability to integrate IHI modules into the longitudinal curriculum has been very easy for us. It’s allowed us to highlight several important aspects of health care system science.”
Before they focused on the students’ learning, however, Baxley and Lawson had to work with the faculty.
Teachers of Quality Academy
“One of the challenges to getting this content into a curriculum is that faculty were never taught this,” says Baxley. “Many times, they are still learning it themselves.”
To help train faculty in health care system science, Baxley and Lawson launched a 15-month program — modeled after IHI’s Breakthrough Series — for more than 30 physician, nursing, allied health, and public health faculty. Faculty completed six learning sessions, worked on a longitudinal quality improvement project within their clinical area, and earned their IHI Open School Basic Certificate. (Learners earn the Basic Certificate after completing the 16 core courses within the Open School.) Faculty also presented their work on clinical improvement (including projects on improving access, improving medication reconciliation, and reducing harm for hypoglycemic patients) at a system-wide quality symposium in January of 2015.
Originally, Brody was planning on offering the Teachers of Quality Academy just once, but may offer it again because interest is high among faculty who didn’t get the chance to participate.
After exposure to the Open School modules, faculty started using them with their students within courses and clerkships. Faculty overseeing residents, fellows, and nursing students did the same thing. At Brody, that set the stage for an innovative longitudinal curriculum for all medical students.
Innovative Longitudinal Curriculum
Completion of the Open School Basic Certificate was already approved as a requirement at Brody before the grant, but Baxley saw this as an opportunity for deeper integration.
“It’s considerably more challenging, logistically, to embed the courses within an entire curriculum instead of just one course,” says Baxley. “We put some aspects of population health into Microbiology, for example, and patient-centered care into our Doctoring course. We thought it was important that it wasn’t a set-aside requirement. Each Open School module is linked with a specific, experiential learning activity, kind of like a flipped classroom.”
(See Figure 1 for more detail about the curriculum.)
“The Open School courses are high-quality material,” says Baxley. “In my experience, they are the right length and have good clinical connections. The modules are accessible, online, and you don’t have to create them. That’s what makes it easy for other schools to pick them up.”
And there’s one other important reason Baxley wanted to use the courses: “Students,” she says, “really like them.”
Taj A. Nasser, a second-year medical student, explained why.
“The IHI modules have been very eye-opening, meaningful, and interesting,” he says. “One of my favorites thus far has been [QI 104] The Life Cycle of a Quality Improvement Project. Viewing the big picture of a quality improvement project with a fascinating real-life example allowed me to better grasp the essence of quality improvement.”
Baxley and Lawson also worked with IHI to create a pre- and post-test for all students to complete so administrators could determine how much long-term knowledge students gained from the courses.
“The goal, really, is to prepare our students to be learners and professionals in the 21st century,” Lawson says. “They need these skills to provide safe and cutting-edge patient care.”
LINC Scholars Program
For students who want to go even deeper into quality and safety education, Brody offers an eight-week immersion between the first and second years of medical school for up to 10 students. Those students then continue their advanced learning and experience in health care system science and leadership during their last three years of medical school. The end result? These students graduate with a Distinction in Health System Quality and Leadership. Students have to apply to be part of the program.
Again, Baxley and Lawson embedded an Open School course into the education.
“For example, we found to be perfectly designed for something we wanted to have them do anyway — to complete a patient shadowing/navigation exercise,” Baxley says.
Students completed the module and then applied their learning to describe the experience of the health care encounter from the perspective of the patient and family. They analyzed the steps and touch points in each encounter, identifying what worked well and opportunities for improvement.
In June, students presented their findings to a group including patient advisors at Vidant. The results, Baxley says, were remarkable. She even received a thank-you note from one of the advisors.
“We are really expanding our view about who our faculty are,” Baxley says. “I would consider these patient advisors to be faculty. So are our other quality leaders at our health system. So are process engineers from our College of Engineering and health services management faculty in our School of Allied Health."
Students say they value being able to see health care teams in action as they coordinate and deliver care.
“That field experience, and the Open School module on teamwork and communication (PS 103) helped me better understand the functioning dynamics and different elements of effective teams,” says Zach Williams, a second-year medical student at Brody.
Baxley and Lawson are already looking at ways to scale up the LINC program as part of the longitudinal curriculum for all Brody students. And they are looking at ways to make the education more interprofessional, perhaps even extending the LINC program to nursing and other disciplines.
“This program is about teaching these new health system competencies as, simply, just the way we do things, not as a separate and unrelated curriculum,” Baxley says. “We think in teams. We think in systems. We think about what needs to be in place to prevent harmful errors from ever occurring.”
Editor’s Note: For more information about this initiative, contact Libby Baxley at email@example.com.