From the 2022 HVPA National Conference
Glenn Moulder MD (University of Virginia School of Medicine), Jessica Dreicer MD, Paul Helgerson MD, Amber Inofuentes MD, Rebecca Kowalaski MD, Andrew Parsons MD MPH, Joshua Ferey MD, Zachary Scharf MD
The 2014 Clerkship Directors (CDs) in Internal Medicine Annual Survey affirmed the importance of teaching high-value care (HVC) principles and practice (1). Though more than 90% of CDs thought it important to teach HVC on clerkship, only 33% of schools reported having a formal curriculum. Lack of faculty time (68%) and expertise (53%) were major barriers to implementation (1). Here-in, we describe an innovative learning intervention utilizing patient-centered reflective practice and small-group sessions to teach clerkship students the principles of HVC and quality-improvement/patient safety (QIPS). Our intervention is nested within the clinical environment and utilizes two educational methods found to be particularly effective in teaching HVC and PS, structured reflection (2) and small group learning workouts which have been identified as a tool for implementing quality improvement initiatives (3).
We describe an innovative curricular intervention that clinical educators can use to teach HVC and QIPS within the clinical environment.
Third-year medical students enrolled in the internal medicine clerkship watched pre-recorded lectures (PRLs) to introduce the concepts of HVC and QIPS and describe the assigned workouts. Workouts were 1-2 page structured reflection exercises focused on topics of critical and timely importance to HVC and QIPS. Each student was required to complete one HVC and one QIPS workout of their choosing by applying the workout to a patient in their care (Figure 1). Students were asked to discuss the completed workout with their care team and then participate in small group debrief sessions facilitated by an expert faculty member. These group discussions facilitated group reflection and discussion on the specific HVC and QIPS topics, care team integration, and changes in patient management.
This curricular intervention was implemented in 2021 at two clinical campuses, UVA-Charlottesville and UVA-INOVA. To date, 214 medical students have each completed a HVC workout, QIPS workout, and participated in the facilitated small group debrief. Clerkship evaluations revealed that 96 of 166 (58%) students stated the PRLs provided necessary foundational knowledge for the workouts.
Furthermore, 89 of 172 (52%) students stated they agree or strongly agree that the QIPS workouts enhanced their ability to promote safe, high-quality care. Similarly, 93 of 173 (54%) respondents stated they agree or strongly agree the HVC workouts promoted their ability to promote HVC.
Using structured reflection and small-group debrief, we address the need for effective educational interventions focused on HVC and QIPS topics. While structured reflection (4) and workouts (5) have been implemented, here we describe exercises that can be facilitated in small group learning environments. As the workouts are targeted to specific HVC and QIPS needs described in the literature, we suspect this approach can be replicated at other institutions. Future efforts include the qualitative analysis of the workouts and the creation of a tool to assess HVC and QIPS competencies.
The practice of ensuring delivery of high-quality care to patients is a daily deliberate practice that involves all members of the healthcare team. This encompasses delivering care that is both safe and of high value. By engaging students in patient-centered reflective workouts, we hope to promote the delivery of high-value, safe clinical care now and in the future.