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Authors

Sherry Liang, BA, Oregon Health and Science University (OHSU) Reem Hasan, MD PhD, OHSU Division of Internal Medicine Christopher Terndrup, MD, OHSU Division of Internal Medicine Sherril Gelmon, DrPH, OHSU and Portland State University School of Public Health, Matthew DiVeronica, MD, Veteran Affairs Portland Health Care System

Introduction

Institutions are reforming undergraduate medical education to equip medical students with the knowledge and skills to engage in health systems improvement, but knowledge of best practices is limited. At Oregon Health and Science University (OHSU), a medical student-led project was created to design, implement and evaluate a novel improvement curriculum for pre-clinical students using the Institute for Healthcare Improvement Open School (IHIOS) Quality Improvement (QI) Practicum course. We present the findings on the educational outcomes of learners, the impact of a learner-led improvement project, and the barriers to implementation and sustainability.

Methods

This curriculum was piloted with seven medical students in the Student Navigator Project (SNaP), an 18-month program where students serve as patient navigators and medical assistants (MA) in OHSU primary care clinics. Acting in these roles across a longitudinal setting allows students to identify problems in clinical workflows and systematically address these issues through a team-based improvement project. Upon completing three IHIOS modules on improvement fundamentals, the students launched a project to decrease clinic wait times and led three mentored Plan-Do-Study-Act cycles. Students culminated their experience by submitting posters to various conferences and delivering an oral presentation to clinic staff.

Results

The curriculum was evaluated using a 17-question knowledge pre/post test, post-participation learner survey, and clinic staff satisfaction survey. All students had improved scores on the knowledge test with an average improvement of 5 points. All reported increased confidence in understanding and executing a project. Six students agreed or strongly agreed that they felt comfortable engaging with staff on improvement work, with all students stating they will likely be involved in future improvement work. Of the 12 MAs and 6 providers surveyed, 15 agreed or strongly agreed that student-led projects would help improve patient care in the clinic and 16 were open to helping students conduct a project.

Conclusion

This pilot study has demonstrated promising results from a novel curriculum for pre-clinical medical students to lead a clinical improvement project. The act of doing improvement work is important for building learner competence and confidence as they engage in systems thinking and take ownership of their ideas for change. This project demonstrates the value of leveraging medical students to accelerate curriculum development, increase learner buy-in, and expand the community of future physician improvers. Barriers to implementation and sustainability include the availability of faculty with requisite QI knowledge and capacity to mentor. To expand this model to all medical students, further work is needed to optimize resources and institutional support.

References

1. Berwick DM, Finkelstein JA. “Preparing Medical Students for the Continual Improvement of Health and Health Care: Abraham Flexner and the New ‘Public Interest’.” Academic Medicine. 2010.
2. Armstrong G, Headriick L, Madigosky W, Ogrinc G. “Designing Education to Improve Care.” The Joint Commission Journal on Quality and Patient Safety. 2012.
3. Madigosky W, Deitz G, Fink L. “IHI Open School Faculty Guide: Best Practices for Curriculum Integration.” Institute for Healthcare Improvement. 2017.

Back to the June 2019 issue of ACP IMpact