— Medical resident John Kim, left, met weekly during his one-month rotation in January with faculty members Clarence H. Braddock III, associate dean for medical education, and Patrick Gibbons, a former resident who now serves as associate director of the quality improvement medicine elective Braddock leads.
Residents care for the hospital’s quality by rotating into new clinical elective
Clarence H. Braddock III, associate dean for medical education and associate professor of medicine/general internal medicine, said he and colleagues “thought long and hard on how to offer residents an effective strategy to become an agent of change in the area of quality and think beyond the traditional box of clinical or even basic science rotations. We didn’t want to just have them tag along or just observe existing quality or safety projects. We really wanted them to see how the hospital is run and to become a part of that process, using their advanced adult learning skills and rigorous research methodologies.”
So for one month, one second or third year resident participates in the Medicine Residency Elective in Quality Improvement, Patient Safety, and Organizational Change. (“No interns, we want them to have enough experience with the system to develop ideas about it,” Braddock explained).
The bottom line: “The overarching goal of the elective is to provide mentored practice and growth in residents’ knowledge, skills, and attitudes in quality improvement, patient safety, and organizational change,” said Braddock.
The residents pick a project, sometimes an antidote to a problem they’ve encountered in patient care, such as, “I wish we had a better way of getting clinical lab results.” Last August resident Prateeti Khazanie “was interested in improving physician responses to nursing pages during off hours. She decided she should stay overnight and shadow the nurses, residents and other staff as caregivers on the units decided whom to contact for arising patient issues,” said Braddock. On call interns pitched in to collect the paging data.
For the first project, resident Jason Adams explored ways to use the electronic health record to support and improve observed to expected (O/E) mortality measures. A recent project involves using the Epic EHR to track what percentage of patients have well-controlled blood pressure.
Braddock said the residents use a full palette of analytic tools in basic, clinical and social sciences, including newly developed social network analysis methodologies, and meet weekly with Braddock and with Patrick Gibbons, a new Department of Medical faculty member and recent chief resident who serves as associate rotation director with Braddock.
The residents complete directed reading projects, and they learn of the existing tools in place throughout the hospital. Some of the residents, Braddock said, really didn’t know about the Quality Improvement Patient Safety Committee when they started, but they attend a meeting of the group, and meet with its physician leader, Joe Hopkins. Each participant meets with other hospital leaders, including Chief of Staff Bryan D. Bohman and Kevin Tabb, vice president for medical affairs.
The program is currently limited to a single Department of Medicine resident each month. Doing the numbers, Braddock said there is probably capacity to give about half of the Department of Medicine residents a one-month slot in the program, and he says he hopes the program can be extended to other clinical departments as well.
“And even beyond that there is spinoff to all residents. The participants “go into the call room and talk about what they are learning and doing and thus spread the gospel of organizational improvement.”
The course was an outgrowth of an effort among the faculty to find ways to help residents learn about roles beyond patient care, said Braddock, who also serves as associate chair, organizational improvement and medical director for quality (medicine).
Khazanie, a 2006 graduate of Duke University medical school hoping for an academic career in cardiology, said she expects the rotation will be especially valuable when she becomes chief resident in the summer “and will need to start thinking about the big picture issues.” But any resident who takes the course will understand that quality improvement is “not just another tedious form to be filled out. It starts to make sense,” she said. (As for the results of her project, she said the electronic health record is helping staff to more easily identify whom to call off hours.)
“The residents are learning skills they’ll find useful as leaders in medicine, whether they apply the research methodology in an academic career, or apply their enthusiasm and new skills by joining a hospital quality committee. They’re learning strategies that will help them improve patient care not only for their own patients soon and in the future, but also strategies for improving care in the clinics and hospitals where they’ll be practicing for years to come, Braddock said.
