1. Linda A. Headrick, MD, MS, FACP February 26, 2013

2.  Describe the rationale for integrating improvement into the medical school curriculum  Explore how health professional schools can innovate to emphasize quality improvement as a fundamental physician skill

3. A Question for You

4. What factors were present that helped make that happen?

5. Safe Timely Effective Efficient Equitable Patient-Centered IOM 2001

6. deliver patient- centered care as members of an interdisciplinary team, emphasizing evidence- based practice, quality improvement approaches, and informatics IOM 2003

7. Habits of inquiry and improvement  Engage learners in challenging problems and allow them to participate authentically in inquiry, innovation, and improvement of care  Engage learners in initiatives focused on population health, quality improvement, and patient safety  Locate clinical education in settings where quality patient care is delivered, not just in university teaching hospitals Cooke, Irby, O’Brien & Shulman 2010

8. Teaching for Quality (Te4Q) Embed quality improvement & patient safety across the continuum of medical education www.aamc.org/te4q

9. Te4Q Goal Ensure that every medical school and teaching hospital in the U.S. has access to a critical mass of faculty that are ready, able and willing to engage in, role model and lead education in QI/PS

10. % US SOM Reporting IOM Goals Academic Med Suppl Sept 2010

11. Interprofessional Faculty Development Institute for Quality Improvement and Patient Safety Important Update: The 2013 IPEC Faculty Development Institute has reached maximum capacity. Please complete the Waitlist FormWaitlist Form

12. Health Affairs 2012

13. “Retooling” Expectations Create a medical/nursing school partnership Secure support from academic and health system senior leadership Integrate quality improvement and patient safety into core curricula Engage students in hands-on improvement work in partnership with a health care partner Test changes in iterative cycles Participate in collaborative support activities

14. Retooling for Quality and Safety Case Western Reserve University Johns Hopkins University Penn State University University of Colorado University of Missouri University of Texas Health Sciences Center, San Antonio

15. Changes in Core Curricula 1374 student encounters 87% interprofessional Innovations in the – Classroom – Simulation center – Clinical setting

16. Innovations in the Classroom Large group – Penn State: Team-based learning to analyze a medical error and recommend system changes – CWRU: Interprofessional quality “Grand Rounds” with poster session, & structured reflection Small group – San Antonio: Weekly interprofessional QI seminar

17. Innovations in the Simulation Center Interprofessional communication & teamwork – Johns Hopkins & CWRU: SBAR – Colorado: TeamSTEPPS Interprofessional work around specific clinical issues – Colorado: Sepsis bundles in ICU – Missouri: Falls prevention

18. Innovations in the Clinical Setting Involving students in clinical QI – CWRU (nursing) – Colorado (nursing & medicine) Involving students in patient safety – San Antonio: Collected data about hand-washing – Missouri: Individualized patient falls prevention

19. Clinical QI at Colorado UCH: student identified interprofessional clinical issues Prevention of Patient Falls Patient-Centered Communication Using Whiteboards Improving ICU to Unit Transitions Prevention of Decubitus Ulcers Improving Discharge Process CHCO: on-going hospital-based project Improving use of Patient Identifiers Handoff Communication Hand hygiene

20. Outcomes at Children's Hospital CO (over 2.5 years) 158 nursing students completed the experience 34 medical students completed the experience 1716 hours of work on hospital QI projects – Collection of over 16,000 data points 30% reduction in patient identification errors for 2011

21. Continuum of Education in Quality and Safety Faculty Integration/Role Modeling Resident Demonstrated Basic Competency Medical School Graduate Applications Beginning Medical Student Foundation Concepts, Skills & Values

22.  Able to deliver effective patient-centered care  Honest with high ethical standards  Knowledgeable in biomedical sciences, EBM, and social/cultural issues  Critical thinkers; problem-solvers  Able to communicate  Able to collaborate  Committed to improving quality and safety  Committed to life-long learning and professional formation

23. MU SOM Continuum in Quality and Safety Year 1 White Coat Ceremony Partners in Education – Partners in Care Year 2 Interprofessional Quality & Safety Year 3 Patient Safety Conferences TIIPS (Internal Medicine clerkship) Year 4 ACT Curriculum Quality/Safety Electives

25. “Medical students proposed safety interventions that were more robust than those suggested by event reporters regarding similar events within our health system (p<0.0001).”

26. Independent Online Modules on Patient Safety, QI and Fall Risk Reduction Interprofessional Simulation: Preventing Falls in Hospitalized Patients Bedside Fall Risk Assessment by Student Dyad & Customized Patient Education Plan Interprofessional Debrief Retooling for Quality and Safety

27. QMHC 2009

29.  Meaningful integration into required curricula  Assessment  Critical mass of prepared faculty  Exemplary care for patients and exemplary learning for health professionals

30. Experiential Clinically relevant Evaluated www.aamc.org/te4q

31. 1.Reaction 2.(a) Modification of attitudes/perceptions (b) Acquisition of knowledge/skills 3.Behavioral change 4.(a) Change in organizational practice (b) Benefits to patients/clients. Adaptation of Kirkpatrick (1967) by Barr et al, 2005

32. Expert educators to create, implement, and evaluate training and education in QI/PS for students, residents and colleagues www.aamc.org/te4q