From the 2022 HVPA National Conference
Lonika Sood MD (Washington State University College of Medicine), Ashley Edwards BS, Skyler Burke BS, Jacob Mansfield BA
There is an urgent need to address the cost of health care and reduce harm to patients and communities within the US. Engagement of clinicians, amongst a multitude of stakeholders, is particularly important to address this issue. While graduate medical education has been facile in including these principles and practices within its expectations of learners, the process has been slower at the level of medical schools. We describe a longitudinal curriculum on patient safety/ high value care/ quality improvement (PS/HVC/QI) at a new community-based MD program situated within a university with a land grant mission.
At the Washington State University College of Medicine, an important milestone for the MD program is to ‘Propose interventions to improve health care delivery considering patient safety practices and quality improvement methods’. We situate principles of health systems science within a 4-year long leadership in medicine and healthcare certificate as well as integrate it within the formal clinical curriculum.
During years 1 & 2, students are introduced to healthcare delivery concepts. Upon entering the third year, they are enrolled within a 10-week course on PS/HVC/QI that is situated in the first half of a Longitudinal Integrated Clerkship (LIC). The course is delivered asynchronously requiring students to engage with relevant papers, videos, podcasts, and reflective assignments. At the mid-way point, a synchronous session allows for students to meet within their smaller learning communities with structured reflections that are facilitated by local community preceptors. Students complete an assignment based on proposing a quality improvement project focused on a near miss/ adverse event/ low value care witnessed during their clerkship. These concepts continue to be threaded throughout the fourth year during required rotations and a transition to residency elective.
Our institution is in the third year of delivering this curriculum. Each year, we have adjusted the material and assignments based on course evaluation data. Students have felt able to apply these principles in their clinical environments, and value the time spent with their peers during synchronous sessions.
This curriculum offers opportunities to apply knowledge and skills in authentic clinical settings. An LIC model allows for students to be embedded within a practice or institution over the course of a year, thereby offering the opportunity for identifying sub-optimal care but also being able to reflect on how to remedy such instances at the systems level. An asynchronous course further offers the opportunity for self-paced learning. Challenges have included limited opportunities for deliberate practice and feedback, competing responsibilities including clinical course work and challenges of navigating a clinical environment that may not be poised for change.
An early introduction for medical students to the principles of PS/HVC/QI is important although the healthcare outcomes are challenging to track. Giving the students the language and skills to navigate these concepts will prepare them for engaging in this work at the postgraduate level. By gaining foundational knowledge and firsthand expertise designing and completing a QI project, learners can more readily recognize areas for improvement and have the skills necessary to enact change.