Faculty Advisor CallMarch 7, 2011

Please type your name(s) and the university/organization you represent in the chat box!

Example: Jaime, Loyola University - Chicago

Objective: Meet other Faculty Advisors, share ideas, tools, and resources, and learn updates from the IHI Open School team

Agenda

• Introductions/Review WebEx (5 min)

• IHI Open School Team Updates (15 min)

• Loyola University – Chicago (20 min)

• Discussion (20 min)

1. Click on the arrow above the screen2. Click on the screen and your name will appear!

What are you doing for National Patient Safety Awareness Week?

What are you doing forNational Patient Safety Awareness Week?

Agenda

• Introductions/Review WebEx (5 min)

• IHI Open School Team Updates (15 min)

• Mentor Matching Tool

• New! Patient Safety 106: Culture of Safety

• Upcoming Events

• Loyola University – Chicago (20 min)

• Discussion (20 min)

• IHI Open School students want mentors• New IHI.org website is in development• We’ve created a matching tool called “Find a Mentor”• IHI.org users can opt-in to be a mentor for students

o Specify your areas of expertise• Students will be able to search this list of mentors • Then, students can send a message through IHI.org to invite

users to consider their mentor requests• Mentors have the option to accept or decline requests from

prospective student mentees

“Find a Mentor”

1. Go to the IHI Preview site https://preview.ihi.org and sign-in using your current IHI.org log in.

2. Click the “Welcome, [your name]” link at the top of the screen.3. Click “Edit My Profile” under the photo.4. Click the “Personalization Options” tab that’s grayed out.5. Check the box next to “Include my profile in the Find a Mentor

Directory on IHI.org” and under “Share Your Expertise,” begin typing a subject/topic (auto-fill may complete your selection) or click on the tag to browse the options. Click “Save Changes.”

**Please sign-up by Mar 15th **

Summary of Steps

Step #1: Go to the IHI Preview Site & Sign-In

Please note the new IHI.org is still in development, so the Mentor Matching Tool is one of the only fully developed areas.

Step #2: Click the “Welcome, [your name]”

Step #3: Click “Edit My Profile” under the photo

Step #4: Click the “Personalization Options”

Step #5: Check the box next to “Include my profile in the Find a Mentor Directory on IHI.org” and under “Share Your Expertise,” begin typing a subject/topic (auto-fill may complete your selection) or click on the tag to browse the options. Click “Save Changes.”

1. Go to the IHI Preview site https://preview.ihi.org and sign-in using your current IHI.org log in.

2. Click the “Welcome, [your name]” link at the top of the screen.3. Click “Edit My Profile” under the photo.4. Click the “Personalization Options” tab that’s grayed out5. Check the box next to “Include my profile in the Find a Mentor

Directory on IHI.org” and under “Share Your Expertise,” begin typing a subject/topic (auto-fill may complete your selection) or click on the tag to browse the options. Click “Save Changes.”

**Please sign-up by Mar 15th **

Summary of Steps

Email Us Your feedback

• Thank you for signing up to be a mentor to students. Expect to hear from students starting in April 2011.

• Please email comments or questions about the idea or opt-in process to openschool@ihi.org

• Patient Safety 106: Introduction to the Culture of Safetyo Lesson 1: The Power of Speaking Up o Lesson 2: What Is a Culture of Safety? o Lesson 3: How Can You Contribute to a Culture of Safety?

• Co-authors: o Michael Leonard, MD, Principal, Pascal Metricso Allan Frankel, MD, Principal, Pascal Metrics

How does this affect the IHI Open School Certificate of Completion?• Now, this course is required in order to earn the IHI Open School

Basic Certificate of Completion• If you’ve already earned the certificate, you are not required to

complete the course to keep your certificate status

New Course!

Chapter Network

285Chapters

IHI Open School Progress

• 50,000+ students and residents are registered on IHI.org

• 17,000+ students and residents have completed at least one course

• 1,000+ students and residents have earned the IHI Open School Basic Certificate of Completion

Upcoming Events

• Mar 16: IHI Open School England Event (Birmingham, UK)─ To register, visit https://maverick.sym-online.com/registrationforms/openschool/

• Mar 17: Southeast Regional Event (Columbia, SC)─ For more information, email khubbard@scha.org

• Mar 29: IHI Open School Chicago Regional Event (Chicago, IL)─ To register (free), email openschool@ihi.org

• Mar 20-22: Improving Care in the Office Practice & Community (Dallas, TX)─ For more information, visit www.ihi.or > Programs > Conferences & Seminars

• Mar 25: Introduction to High Reliability Organizations (Virtual)─ Webex connection information will be shared in the Chapter Notes Newsletter

─ Featuring Kathleen Sutcliffe, MSN, PhD

─ Hosted by the University of Michigan Chapter

Agenda

• Introductions/Review WebEx (5 min)

• IHI Open School Team Updates (15 min)

• Loyola University – Chicago (20 min)

• Discussion (20 min)

A Vertically Integrated Curriculum on

Quality of Care and Patient Safety

Loyola University Chicago

Stritch School of Medicine

Jaime Belmares-Avalos, MD, MPH

Loyola University Chicago• Founded in 1870 as St. Ignatius’ College

• Preparatory academy

• It survived the Great Fire of 1871

• Starts offering a 4 year College Curriculum in 1881

• It adds a School of Medicine in 1906.• Would later fuse with Illinois Medicine

College and Bennett Medical College in 1908

• 1909. A new charter formally designates it as Loyola University.

Stritch School of Medicine (SSOM)

• 1917. School of Medicine acquired the Chicago College of Medicine and Nursing.

• 1920. Accredited by the Council on Medical Education of the AMA.

• 1948. Formally designated Stritch School of Medicine in honor of Samuel Cardinal Stritch, Chicago’s Archbishop.

• 1969. SSOM moves to its present location at Maywood, IL.

Loyola University Chicago

Medical Center

• A teaching , tertiary-care, 570 licensed-bed

facility

– Level 1 trauma center

– Burn Center

– Pediatrics

– Bone Marrow Transplant, Solid Organ Transplant

(Kidney, Lung, Liver, Heart)

– Fully developed and implemented electronic

medical records

– Several residency and fellowship programs

Stritch School of Medicine

• Curriculum designed to fit active learning and early clinical experience.

• Curriculum includes a mixture of traditional and non-traditional courses.

• Great focus on problem-based learning and early introduction to clinical reasoning.

• New simulation center.

SSOM Curriculum

• First Year

– Structure of the Human Body

– Function of the Human Body

– Molecular Genetics

– Structure of the Human Body

– Patient Centered Medicine I

• Second Year

– Behavioral Medicine and Development

– Mechanisms of Human Disease

– Neuroscience

– Pharmacology and Therapeutics

– Patient Centered Medicine II

• Third Year– Family Medicine

– Medicine

– Obstetrics/Gynecology

– Pediatrics

– Psychiatry

– Surgery

– Patient Centered Medicine III

• Fourth Year– Neurology

– Subinternships

– ICU

– Wards

– Electives

Patient-Centered Medicine Courses

• PCM -1– Clinical and Catholic Bioethics

– Clinical Skills I and II

– Healthcare Systems and Delivery

– Behaviour and Health Promotion

– Personal and Professional Development

• PCM- 2– Mastering Clinical skills

– Basic ECG reading

– LegalMedicine

– Evidence Based Medicine

– Basic Standard Precautions and Infection control

• PCM -3– Difficult physician-patient

relationships

– Business, Professionalism and Justice

– Global Health

– End of Life care

Vertically Integrated Curricula

• Bioethics and Professionalism

• Disaster Preparedness

• End of Life

• Genetics

• Nutrition

• Prevention and Screening

• Radiology

How does Quality of Care (QoC) and

Patient Safety (PS) fit in all of this?

• AAMC 2001. Medical School Objectives

Project.

• Learning about Quality of Care must occur in

the course of, and as a part of, learning about

patient care.

• Medical Education should ensure that quality

of care issues and measurement tools are

practiced and properly taught, emphasized

and evaluated.

The Resident Side

• Continously updated standards for

educational curricula.

• Standards that residents be observed and

certified in procedures.

• Requirements for evaluation and feeedback.

• Limits on duty hours.

• And others…?

The Golden Question for

QoC and PS Curricula

What is the essential information that we

should expect a Medical Student

to know before graduation?

And the answer is….

Nobody knows!

From Alexander Nazem,

a medical student in 2008

• “I am a third-year medical student, and I learned a lot in the first half of medical school. But it is dawning on me that most of what I learned during those first two intense years could not prepare me for the many-tentacled beast that is the modern US health care system”

•“Yes, I have been taught how to approach, interview, and examine a patient. Yes, I have learned the ins and outs of pharmacology, microbiology, pathophysiology, cell biology, and biochemistry. In fact, thanks to a corps of excellent teachers and a medical school that truly cares about its students, I have been taught all of these things very well.

• “Everything I have learned has focused on making me a compassionate clinician who knows a lot about diseases, but too little about how to employ that knowledge reliably so that every one of my patients receives the right care every time.

From A. Nazem, med student. (cont’d )

•Students are naive in the best sense of the word. We do not know the way things are “supposed” to work… We are more likely to say, “This is broken. Let's fix it!”

•“I feel helpless when I start thinking about how to remedy these problems. In short, I am getting a great education in how to practice medicine but not in how to improve it”

•“The strong focus on teaching the hard sciences seems to come at the expense of the equally important social and managerial sciences that teach us how to make use of what we know as a profession. What are advanced tools good for without the systems and contexts in which to use them effectively?

•“Education in systems thinking, quality improvement, patient safety, and interdisciplinary teamwork and interdisciplinary teamwork must be integrated into the earliest phases of training, while students are still malleable and while those ideas can still shape how students view the world of health care.

JAMA. 2008;300(21):2463-2464. doi: 10.1001/jama.2008.767

Designing a Curriculum

• Group of Interested Faculty

• Thorough literature review

– Curriculum being implemented at other Medical and Nursing schools

– WHO and international experiences

– IHI Open School

– Others

• Discussion with outside Faculty

• Internal discussion

The Philosophical Principles

• We think that QoC and PS skills are just as essential as traditional biomedical courses traditionally taught in medical school

• Thus, they are important enough to be introduced early in the course of Medical Education

• The only way to ensure internalization of these material is to spread the contents throughout the whole of the Medical School Curriculum

• QoC and PS should have both dedicated (e.g. independent) and integrated (embedded) contents in the medical school curriculum.

Our ultimate goal

• We want our students to recognize QoC and PS knowledge and skills as essential to their future development and activities as physicians.

• This is because in order to be effective physicians who provide optimal, safe and high quality care the knowledge and skills are needed to not only diagnose, treat, and care for their patients, but also to diagnose, treat, and care for their practices, and the systems in which they will practice.

• The reason for this is that they are a largedeterminant of whether their care will be safe, orhigh quality and of how their patients will do both in the short and long term.

Designing a curriculum (again…)

• Choose essential topics and objectives

• Decide on appropriate modality of delivery

• Decide on grading methodology

• Convince people

• Get to work!

• And not necessarily in that order

Mapping the curriculum – 1st year

Yr Objective Web-

based?

Lecture Prac-

ticum

Other

1To define Quality in Healthcare, as described by the U.S. Institute of Medicine X

1To list 5 components of Quality in Healthcare, as described by the U.S. Institute of Medicine

X X

1To define Patient Safety, as described by the U.S. Institute of Medicine X X

1To describe a high quality and safe healthcare as an intrinsic ethical requirement to the practice of healthcare.

X X

1To compare and contrast the characteristics of effective and ineffective teams X

Mapping the curriculum – 2nd year

Yr Objective Web-

based?

Lecture Prac-

ticum

Other

2 To describe the status and scope of

harms caused by medical errors in

the U.S., as evidenced by the current

literature

X X

2 To define the meaning of an adverse

event, a serious adverse event and

an adverse drug event, as described

by the U.S. National Patient Safety

Foundation

X X

2 To describe the difference between

structural, process and outcome

quality measures

X

Mapping the curriculum – 3nd year

Yr Objective Web-

based?

Lecture Prac-

ticum

Other

3 To define a near miss, a violation, and

a complication in healthcare, as

described by the U.S. National Patient

Safety Foundation

X X

3 To explain how underuse, overuse, and

misuse contribute to healthcare quality

and safety problems.

X X

3 To describe Loyola´s policy for disclosure of medical error X X

3 To describe how the complexity of a

system creates the potential for

systemic errors.

X X

3 To describe and utilize a root cause

analysis as an error management tool. X

Mapping the curriculum – 3nd year(Cont’d)

Yr Objective Web-

based?

Lec-

ture

Prac-

ticum

Oth

er

3 To describe the characteristics of high reliability

organizations. X

3 To list examples of highly reliable processes they

have witnessed during their clinical experience. X

3 To describe the use of a Fault Tree Analysis and a

Failure Mode and Effect Analysis as error proofing

tools.

3 To list the barriers to achieving high reliability in

healthcare X X X

3 To define human factors engineering and describe

its use as a tool to improve patient safety X X

3 To list the ideal characteristics of a quality indicator X X X

3 To list the seven basic quality improvement tools in

healthcare. X X X

Challenges and opportunities

• Full implementation

– How to integrate the “clinical” component into the

curriculum

• Integration with Nursing and GME

• Creating and nurturing more Faculty

• Integration into the wider institutional life

– E.g. Research?

– E.g. “Using” student projects to point out opportunities

for improvement throughout the system.

– Honors programs?

MANY thanks…

• The QoC/PS Group at Stritch:

– Aaron Michelfelder, MD

– Paul Hering, MD

– Michael Koller, MD

– Theresa Kristopaitis, MD

• The PCM-1 Group:

– Diane Stancik

– Sandra Cavalieri

– James Winger, MD

– Amy Blair, MD

• Many Others:

– Jorge Parada, MD, MPH

– Gregory Gruener, MD, MBA

– Chad Whelan, MD

– Robert Cherry, MD,MS

– Sean Greenhalgh, MD

– Our facilitators for the PCM groups

– And really, many others….

Agenda

• Introductions/Review WebEx (5 min)

• IHI Open School Team Updates (15 min)

• Loyola University – Chicago (20 min)

• Discussion (20 min)

Thank you for joining the Faculty Advisor call

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