1. Wingate University PA Program
TRANSFORMATIVE COMPETENCY-BASED QUALITY IMPROVEMENT (QI) EDUCATION ACROSS THE CURRICULUM
Wingate University PA Program
R. Boeschel MSHS, PA-C, E. Maupin MMS, PA-C & S. Wolf MS PAS, PA-C

2. Objectives
Discuss the rationale for incorporating competency-based QI education across the curriculum
Examine a longitudinal strategy that includes classroom instruction, learning outside the classroom and culminates in a project-based capstone
Learn basic principles of survey development and evaluation via a hands-on experience
Evaluate assessment artifacts and measurement tools associated with a comprehensive QI strategy

3. THE NEED FOR QI EDUCATION

4. Call to Arms Institute of Medicine (IOM) Call for academic reform
To Err is Human
Crossing the Quality Chasm: A New Health System for the 21st Century
Call for academic reform

5. IOM 6 Care Delivery Areas for QI Focus
Patient Safety
Effective Care
Patient-centered Care
Timely Care
Efficient Care
Equitable Care
(IOM 2001)

6. Present Day Need for QI Initiatives
Public Health
Globalization of medicine
Healthcare accessibility
Healthcare Systems
Patient Safety
Medical Technology
Comprehensive Care

7. Need for QI Education Documented gap Addressing the gap
70.7% of programs introduce students to the principles of QI in the didactic year
38% report no student participation in QI projects
Addressing the gap
ARC- PA
NCCPA
PAEA
AAPA
(Kindratt and Orcutt 2017)

8. Accreditation Standards for QI in PA Education
The Accreditation Review Commission on Education for Physician Assistant Standards (ARC-PA 2012)
B2.13
“include instruction in patient safety, quality improvement, prevention of medical errors, and risk management.”
The Accreditation Review Commission on Education for Physician Assistant Standards (ARC-PA 2019)
B2.16
“The curriculum must include instruction in:
a) patient safety,
b) prevention of medical errors,
c) quality improvement, and
d) risk management.”

9. Competencies for the PA profession
Medical
knowledge
Patient Care
Practice-based learning and improvement
System based practice
Interpersonal & Communication Skills
Professionalism

10. Proposed Core Competencies for New PA Graduates
(PAEA 2018)

11. QI EDUCATION ACROSS THE CURRICULUM

12. QI Curriculum in Medical Education
Key Themes for Success
Barriers
Learners need to actively participate in a QI experience
Learners should have access to a faculty member with QI experience
PA Program and faculty commitment
Lack of time for QI curriculum
Lack of resources
Lack of expert faculty experience
No standardized approach to instruction with PA education
Making it relevant and interesting for students
(Berkowitz et al. 2014)

13. General QI Curricular Approach
QI Focused Lectures
Online Modules
QI Focused Student Projects
QI Focused Capstone Projects
(Berkowitz et al. 2014)

14. QI Education Across the Curriculum
PA 580: Research, Epidemiology, Statistics
PA 528: Healthcare Issues II
Didactic Phase
PA 620:
Capstone I
PA 720:
Capstone II
Clinical Phase
Apply Concepts of QI & Patient Safety to Practice
Active Participant & Leader in QI Initiatives as a Provider
Practice Ready

15. Didactic Phase Instructional Methods
PA 580: Research, Epidemiology, Statistics
In Class
Lectures
Journal club/Documentary discussions
Clinical scenarios
Student presentations
Out of Class
Discussions
Individual research
PA 528: Healthcare Issues II
Modified TeamSTEPPS training
Class discussion
Case scenarios/analysis
Roleplaying exercises
Regular team meetings to prepare for class activities
Personal reflection

16. Clinical Phase Instructional Methods
PA 620: Capstone I
Institute of Healthcare Improvement (IHI) Modules
QI Initiative Capstone Project identification & selection
Survey workshop
PA 720: Capstone II
Pilot study of survey tool
Literature review
Evaluation of pilot study
Paper and oral presentation

17. SURVEY DEVELOPMENT AND EVALUATION

19. Relevant Terminology Survey Questionnaire Pilot Study/Pilot Survey
Defined as the measure of opinions and experiences of a group of people through the asking of question
Questionnaire
Defined as a set of printed or written questions with a choice of answers, devised for the purposes of a survey or a statistical study
Pilot Study/Pilot Survey
Defined as “A small-scale test of the methods and procedures to be used on a larger scale (Porta, Dictionary of Epidemiology, 5th edition, 2008).

20. Survey Workshop Fundamentals*
Data collection logistics
Instrument design and construction
Embedded instructions
Question development
Response options
Timetable for administration and follow-up
Analysis of survey results
*Adapted from Association of American Medical Colleges Medical Education Research Certificate Course 2013

21. Writing Questions: Where do you begin?
What do you want to learn?
What can the respondents tell you?
What questions will help you answer your research question?
Mentoring is key!

22. Common Problems with Student Surveys
Number of questions
Unanswerable questions
Double-barreled questions
Unclear references or excessive jargon
Implicit negatives
Biased questions
Leading questions
Inappropriate response options
Unprofessional in appearance
Instructions unclear
Cumbersome to complete

23. ~ The Josiah Macy Jr. Foundation
“We do a very good job of teaching the biologic and physical sciences as the basis for the practice of medicine, but we have not done as well incorporating other content such as patient safety, quality improvement, and population health in our teaching. We need to broaden and integrate our curriculum across the educational continuum.”
~ The Josiah Macy Jr. Foundation

24. WHERE DO WE GO FROM HERE…

25. End Goals
Develop new PA graduates which practice evidence-based medicine and utilize clinical guidelines while embracing a true understanding of QI initiatives
Encourage PA graduates to initiate and lead QI focused projects
Endorse quality value-based care

26. QUESTIONS?

27. References
The Accreditation Review Commission on Education for Physician Assistant. Accreditation Standards For Physician Assistant Education (4th ed.). pa.org/wp-content/uploads/2016/10/Standards-4th-Ed. Published 2010, updated Accessed February 25, 2019.
The Accreditation Review Commission on Education for Physician Assistant. Accreditation Standards For Physician Assistant Education (5th Ed.). pa.org/wp-content/uploads/2019/09/Standards-5th-Ed-Sept-2019-fnl.pdf. Published Accessed September 27, 2019.
Agency for Health Care Research and Quality. TeamSTEPPS Accessed September 30, 2019.
Berkowitz O, White SE, Goldgar C, Brisotti MF, Warner ML. Defining quality improvement education for physician assistants. The Journal of Physician Assistant Education. 2014;25(4):55-60.
Boucher N, McMillen M, Gould, J. Agents for change: Nonphysician medical providers and health care quality. The Permanente Journal. 2015;19 (1):
Institute of Healthcare Improvement. IHI Open School Online Courses. Updated Accessed September 30, 2019.
Institute of Medicine (U.S.). Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001.
Kindratt TB, Orcutt VL. Development of a quality improvement curriculum in physician assistant studies. The Journal of Physician Assistant Education. 2017;28(2):
Physician Assistant Education Association.Core Competencies for New Physician Assistant Graduates. Competencies-for-New-PA-Graduates_FINAL_ pdf. Published Accessed September 29, 2019.
National Commission on Certification of Physician Assistants. Competencies for the physician assistant profession. Published 2005, updated Accessed March 1, 2019.
Ramos J. 5 ways QI can create stronger PAs. Published June 29, Accessed February 28, 2019.