Abstract
IntroductionThe Association of American Medical Colleges’ (AAMC) initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13 to “identify system failures and contribute to a culture of safety and improvement.” We set out to determine the feasibility of using medical students’ action learning projects (ALPs) to expedite implementation of evidence-based pathways for three common patient diagnoses in the emergency department (ED) setting (Atrial fibrillation, congestive heart failure, and pulmonary embolism).MethodsThese prospective quality improvement (QI) initiatives were performed over six months in three Northeastern PA hospitals. Emergency physician mentors were recruited to facilitate a QI experience for third-year medical students for each project. Six students were assigned to each mentor and given class time and network infrastructure support (information technology, consultant experts in lean management) to work on their projects. Students had access to background network data that revealed potential for improvement in disposition (home) for patients.ResultsUnder the leadership of their mentors, students accomplished standard QI processes such as performing the background literature search and assessing key stakeholders’ positions that were involved in the respective patient’s care. Students effectively developed flow diagrams, computer aids for clinicians and educational programs, and participated in recruiting champions for the new practice standard. They met with other departmental clinicians to determine barriers to implementation and used this feedback to help set specific parameters to make clinicians more comfortable with the changes in practice that were recommended. All three clinical practice guidelines were initiated at consummation of the students’ projects. After implementation, 86% (38/44) of queried ED providers felt comfortable with medical students being a part of future ED QI initiatives, and 84% (26/31) of the providers who recalled communicating with students on these projects felt they were effective.ConclusionUsing this novel technique of aligning small groups of medical students with seasoned mentors, it is feasible for medical students to learn important aspects of QI implementation and allows for their engagement to more efficiently move evidence-based medicine from the literature to the bedside.
Highlights
initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13
We set out to determine the feasibility of using medical students' action learning projects
initiatives to advance patient care have become widespread in healthcare
Summary
We designed three educational innovations that stressed bidirectional alignment by pairing senior practitioners in the emergency department (ED) with teams of six third-year medical students on three separate QI initiatives designed to develop clinical pathways for congestive heart failure, pulmonary embolism, and atrial fibrillation The rationale for such an approach is to pair the experience and knowledge of veteran practitioners with the learning mindset and fresh perspective of medical students to create novel solutions, improving quality of care.[6] Involving future-oriented learners in the processes of QI better enables organizations to proactively adapt to continually evolving regulations vs reacting from the top-down with entrenched approaches to meeting standards of care.[7] Involving future-oriented learners in the processes of QI better enables organizations to proactively adapt to continually evolving regulations vs. reacting from the top-down with entrenched approaches to meeting standards of care.[7]
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