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Featured Topics and Speakers
Featured Topics and Speakers
What is quality improvement and patient safety? Why is quality and safety important in healthcare? Is there online education on quality and safety for medical residents?
Our guest is Amber Clevenger, GME Quality Manager at The Ohio State University College of Medicine. Our host is Todd Unger, Chief Experience Officer at the AMA.
speaker
Anger: Hello and welcome to the AMA Update video and podcast. Quality improvement is an important part of every physician’s job. Today we’re going to talk about what it looks like for physicians just starting their careers in residency. My guest today is Amber Clevenger, GME quality manager at The Ohio State College of Medicine in my hometown of Columbus, Ohio. I’m Todd Unger, chief experience officer for the AMA in Chicago. Amber, thank you so much for joining us today.
Clevenger: Thank you so much for having me, Todd. I’m excited to talk with you about a topic that’s so important to learners.
Anger: There are many things to think about when starting out as a resident, and quality improvement may not necessarily be the first thing that comes to mind. Amber, what role should residents expect to play in quality improvement and patient safety at their institution?
Clevenger: This is what I call an essential role and active engagement as frontline healthcare workers. I recognize that, especially as participants in the reporting culture of their institution, frontline healthcare workers such as residents and fellows early in training are in a unique position within the clinical environment to identify both latent and active errors that may lead to patient safety concerns and to find opportunities for quality improvement. So, I always encourage them to take an empowered and active role as engaged reporters. See it, say something. So stay involved.
Anger: Do you think residents are ready to take on this responsibility right out of medical school, or do they tend to have more training or need more training to get started?
Clevenger: I think I need more training because the experience I get during medical school is limited, and although I’ve started my clinical training, I’m still in the hierarchy of medicine and the level of responsibility may not be as high as it would be if I became a resident or an in-house resident.
So I want to not only provide them with the education and the tools to be active participants in quality improvement and patient safety, but also give them permission and authority and remind them that this is an important role they have to play and that they need to feel a sense of responsibility to their patients.
Anger: This is important and essential because the Accreditation Council for Graduate Medical Education also requires that residents receive training in quality improvement and patient safety. How does your institution meet these requirements?
Clevenger: We take a multimodal approach. We start with trainees completing a quality curriculum — a quality patient safety curriculum from GCEP. Then we reinforce those educational principles through workshops. I provide the educational sessions, and we also provide hands-on application of the tools and methods through the quality improvement coaching that I provide.
We also have some mock scenarios. To provide a concrete organizational connection to Ohio State, I offer mock root cause analysis sessions with actual de-identified patient safety cases, so that trainees can really learn not just the tools, but the process and the spirit and the intent of the activities that we undertake to keep patients safe and optimize outcomes.
Anger: We all know that residency can be a very challenging experience, with a lot to learn. It can be hard to keep residents engaged, especially in this type of training. How do you deal with it?
Clevenger: The key is to stay relevant and stay relevant to where they are, and when you introduce new methods and new tools, medical schools today have a greater variety of what residents bring to the table when they come into training, to what extent have they engaged in quality improvement using those tools that are in their toolbox?
So when I teach a new tool, like cause and effect for root cause analysis, or fishbone, or aka Ishikawa diagram, I usually ask the students, “Tell me about the problem you’re working on. What’s the pebble in your shoe?” And then I use this really great QI tool to unpack that pebble and see where is the potential for a project here.
At the very least, this will be very cathartic and memorable because, while they may be frustrated by simple changes in process and the challenges that come with transitions of care, you will teach them practical uses of these tools that will actually impact the care they are providing to their patients.
Our trainees are right here in the field. They’re on the front lines. So every time they come into the hospital, patient outcomes are their number one priority. If they can learn how to improve outcomes, we’re already welcoming them in.
Anger: That’s great. I’m curious: What feedback (positive or negative) have you received from residents that has changed the way you think about graduate medical education?
Clevenger: It didn’t occur to me until we really had honest conversations with even the most experienced residents, even the residents who are very active with me on high-level committees in the area of quality improvement and patient safety, that they didn’t see themselves as full-fledged members with a voice at the table, but that’s exactly why I want them to be involved: I want them to be fully active participants, full voting members if they’re on a quality committee, for example.
The hierarchy in healthcare dictates who has a voice and who has a seat at the table. So for someone like me, it’s really important to remind trainees that you have that seat, because it’s really important to hold that seat. You see things that other people don’t. You see opportunities, you see errors with patient safety. So your insight is invaluable in our efforts to optimize the care that we provide to our patients in the safest and most effective way possible.
But it’s really about nurturing them and making them realize that this could be a future career for them. If they really want to get involved, let them. Get involved, learn as much as you can, and be an active leader in quality improvement and patient safety as well. Be a leader of change.
Anger: I love that too, but I just don’t take it for granted. You have to allow your mind to kind of shift, like you say, to have a new seat at the table.
Clevenger: that’s right.
Anger: Amber, thank you so much for sharing your thoughts on this topic. Graduate medical education is a very important focus for the AMA. We recently launched an entirely new curriculum in the AMA GME Competency Education Program on Quality Improvement and Patient Safety. ama-assn.org/gme-programs Learn more and see how easy it can be to meet ACGME requirements.
That’s it for today’s episode. We’ll be back with another AMA update soon. Subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thank you for joining us today. Take care!
Disclaimer: The viewpoints expressed in this video are those of the participants and do not necessarily reflect the views or policies of the AMA.
