At the 25th Annual IHI National Forum, the IHI Open School team decided to present a different type of session. Instead of one or two people lecturing to an audience, we crowdsourced the knowledge and had a debate.
In two sessions, both titled “Getting By With a Little Help From … Students?,” we asked Forum attendees to debate whether students were actually helpful to institutional quality improvement projects. We covered three topics (time, interprofessional challenges, and goal alignment) in Session A and three topics (training, project sustainability, and normalizing deviance) in Session B. Here’s a summary of our two lively (and fun!) sessions:
Session A
Time: Students and professionals have time to work on quality improvement projects together.
Pro:
- More and more, these activities are expected of students, so you need to find ways to use and leverage your dedicated time.
- It's a win-win: Students have the time and professionals have the expertise to share.
Con:
- Students need to learn the basics first and they still have a long way to go.
- Organizations just use students as cogs, so it’s not really valuable to either side.
Best one-liner from the debate: "If we cannot teach quality, we cannot teach medicine."
Interprofessional: It's impossible to get students and professionals from different disciplines to work together on a quality improvement project.
Pro:
- It’s too hard to change the curriculum.
- Students don't have good baseline knowledge of what different disciplines do and how they work together.
Con:
- It is possible — and it's already happening! There’s no substitute for the different perspectives everyone brings a different perspective to the team.
- Quality improvement projects, in fact, present a unique opportunity to engage students in work across the disciplines.
Best one-liner from the debate: "We challenged the assumption that these students physically needed to be together. This generation knows how to connect online."
Goal Alignment:
Students can meaningfully contribute time to a health system's quality improvement goals.
Pro:
- We pride ourselves on continued life-long learning. Students have time and they are the ones that really connect with patients.
- Students come in with fresh eyes. Students don't see the silos and are willing to challenge the status quo.
Con:
- Small, PDSA cycles are good and that’s a difficult concept for students to understand. They just want to make huge changes!
- Students are very focused on their own needs and on their own life. Students have eyes, but their glasses are fogged. (Our job as instructors is to erase a little bit at a time so they can finally see.)
Best one-liner from the debate: "Students have fresh eyes, but their glasses are fogged."
Session B
Training/Knowledge: Students have the knowledge they need to participate in quality improvement projects.
Pro:
- Students are outsiders (less bias, more patient-centered view, decreased personal agenda) and QI requires fairly simple knowledge that students already have.
- It takes only one or two hours to give students the basics they need.
- Students are now actually getting this education because of new regulatory requirements.
- Students already have a lot of experience with working in groups, which is very helpful for QI projects.
Con:
- QI is based on understanding context and culture, and students won't know about those yet because they aren't in an organization for long enough.
- Students simply don't have the subject matter expertise.
- There is wide variation in curricula, which presents unique challenges.
- Medical students are too focused on their grades.
Best one-liner from the debate: "The grade is important, but the experience is really what's driving students."
Project Sustainability: Student-led quality improvement projects always end soon after a student moves on.
Pro:
- Students have a desire to create a nice little package with a bow on it, a sense of accomplishment, and they see an end to every project. They very rarely think of the handoff when they start the project.
- Students think too much about themselves and how "they" have made improvements.
Con:
- It's up to us to design the projects that make it easy to pass it on. They are not short projects. We need to recognize that students are a hugely valuable resource for projects!
- Don't be narrow-minded; students know how to network and make connections with others who will take on projects.
Best one-liner from the debate: "Why not focus on little, tiny, short projects?"
Normalizing Deviance: Students bring fresh eyes to existing work processes that professionals often overlook.
Pro:
- Students or those outside of the process often are the ones who come up with the “a-ha” moments. Professionals might know the process is stupid, but they don't want to put themselves out there.
- Students do a lot of work in research and the evidence, and can bring that knowledge to the table.
Con:
- Students may not have the right eyes. Students come with some biases. As many of them are type-A people, they don't necessarily have the patient perspective.
- Professionals don't often overlook things; it's important for professionals to move around to different areas to make sure their perspectives stay fresh.
Best one-liner from the debate: "Explaining to students why something won't work is a valuable exercise in itself.”
