By Lizabeth Martin, MD, and Byron Joyner, MD, MPA
University of Washington School of Medicine
Quality and patient safety (QPS) measures have become essential dimensions of medical practice. The public sector demands them, regulatory bodies mandate them, and providers are increasingly recognizing their importance. In addition, the Accreditation Council for Graduate Medical Education (ACGME) has identified the quality domains of systems-based practice and problem-based learning as requirements to achieve competency in medical training.
Unfortunately, there is little consensus about the best way to educate trainees in these important topics. So in Washington, we’ve decided to test using the IHI Open School online curriculum.
The University of Washington Housestaff Quality and Safety Council (HQSC) is a multispecialty, trainee-led organization comprising 26 residents and fellows from the University of Washington Medical System. Each of the trainees has been nominated by his or her program directors based on achievement and interest in quality health care delivery. The HQSC is supported by faculty directors with varying expertise in QPS improvement. The Council was developed 1) to improve patient care by developing quality improvement initiatives; 2) to serve as a conduit of communication to trainees system-wide; and 3) to educate members through formal curricula in safety and quality improvement. The residents also gain practical experience by serving on various hospital quality committees and engaging in QPS improvement at a systems level.
We used the IHI Open School online courses as a framework to meet the educational objectives of this group. We developed a 12-month curriculum based upon the selection of 12 thematic meeting topics in QPS. (See Figure 1 below.) Council members prepare for each monthly meeting by completing the corresponding IHI Open School modules. At the meeting, an expert speaker makes a presentation and then leads a group discussion that helps emphasize critical concepts. The rich discussion creates a connection between the Council members and safety and quality leaders at our institution.
For example, the topic for January 2013 is “Human Factors.” In preparation for the meeting, the HQSC members will complete PS 102: Human Factors and Safety, one of the 19 IHI Open School online modules. At the meeting, an expert speaker from our institution will deliver a 20-minute presentation on this topic, which will be followed by 15-20 minutes of discussion.
We designed the curriculum so that those who complete the monthly modules will earn the IHI Open School Basic Certificate in Quality & Safety. We hope to develop a second tier of the curriculum, which would consist of pairing landmark QPS journal articles to the monthly thematic topics. For example, To Err Is Human, published by the Institute of Medicine in 1999, may be the corresponding reading assignment for the meeting on “Quality Improvement.” This assignment would be intended for the second-year Council members who had completed the IHI coursework the prior year. We hope that developing a tiered curriculum will facilitate ongoing participation from Council members who are involved for more than one year. In addition, this may add depth to the monthly discussion.
Initial feedback from the HQSC has been positive. “The basic structure and approach of the IHI modules are ideal for someone who is starting out in QI or needs an initial understanding,” says Lesta Whalen, a pediatric ICU fellow at Seattle Children’s Hospital. “The [IHI Open School] material is very useful in terms of my future career goals. It has enhanced my knowledge and has been valuable as a guide for topics and speakers for our Quality and Safety Council.”
“It is difficult,” Whalen adds, “to find formal educational materials for trainees who are interested in safety and quality.”
The University of Washington HQSC curriculum is designed to support the UW School of Medicine’s mission of “Patients Are First.” Our hope is that this training will facilitate continued housestaff involvement in QPS initiatives, facilitate dissemination of information, and promote resident involvement in quality improvement at a systems level. We feel there is great potential to use these materials for resident education in other settings, such as individual training programs in our system. We hope to develop tools to assess the efficacy of the curriculum, which may provide future direction as this group evolves.
We welcome comments and collaboration from other groups with similar educational interests and objectives. You can reach us by email.
Figure 1. Example of monthly curriculum for January-April (click to enlarge)