퀄리티 아카데미의 교사들: 교수들이 보건시스템과학을 가르칠 수 있도록 준비하기 위한 학습공동체 접근(Acad Med, 2016)

The Teachers of Quality Academy: A Learning Community Approach to Preparing Faculty to Teach Health Systems Science
Elizabeth G. Baxley, MD, Luan Lawson, MD, Herbert G. Garrison, MD, MPH, Danielle Walsh, MD, Suzanne Lazorick, MD, MPH, Donna Lake, RN, BSN, MEd, PhD, and Jason Higginson, MD

 

문제 Problem

오늘날 의학에서 가장 큰 어려움 중 하나는, 환자 안전과 품질을 개선하고, 의료 전문가와 의료 전문가들이 봉사하는 환자 및 지역사회 간의 협력적 파트너십을 강조하기 위해 [전달 시스템을 혁신하는 것]이다. 의료 교육자의 경우, 미래의 의사가 트리플 에이밍 목표(인구 건강 및 환자의 진료 경험 향상과 1인당 비용 절감)를 충족할 수 있도록 준비하는 것이 가장 중요하다. 그러나 주요 보고서는 시스템 기반 실습, 커뮤니케이션 및 팀워크 기술에서 의사들 사이에 이러한 목표를 달성하기 위해 필요한 결함이 있음을 확인했다.1 따라서 의학교육에는 환자 안전, 품질 개선(QI), 전문성, 인구 보건과 관련된 보건 시스템 과학(HSS) 역량 달성이 포함되어야 한다.2
One of the greatest challenges in medicine today is transforming the delivery system to improve patient safety and quality and to emphasize collaborative partnerships among health professionals and the patients and communities they serve. For medical educators, a major priority is preparing future physicians to meet Triple Aim goals (improving population health and patients’ experience of care while reducing per capita costs). However, key reports have identified deficiencies among physicians in systems-based practice, communication, and teamwork skills, all of which are needed to meet these goals.1 It is, therefore, vital that medical education include attainment of health systems science (HSS) competencies related to patient safety, quality improvement (QI), interprofessionalism, and population health.2

보건직업 커리큘럼에 HSS를 통합하려는 노력이 늘고 있지만 변화 속도는 더디다. 졸업생들이 증거 기반 진료를 준비하고 QI 프로세스를 구현하며 안전상의 오류와 격차를 인식하고 이에 대응하기 위해 체계적인 커리큘럼을 변경한 의과대학은 거의 없다. 이를 해결하기 위한 핵심 과제는, [교수들이 새로운 전달 시스템을 준비하는 데 필요한 지식과 기술을 갖추지 못했기 때문에], 최적의 치료 환경을 조성하는 방법을 이해하고 실천하며 가르칠 수 있는 교수진을 식별하는 것이다. 4,5 또한 오늘날의 임상 교수진은 (빠르게 변화하는 환경에서 진료도 하면서), HSS를 배우면서 동시에 가르쳐야 하는 어려움을 겪고 있다.
Although efforts to integrate HSS into health professions curricula are increasing, the rate of change has been slow. Few medical schools have instituted systematic curricular changes to prepare their graduates to provide evidence-based care, implement QI processes, and recognize and respond to errors and gaps in safety.3 A key challenge to addressing this is identifying faculty who understand, practice, and can teach students how to create optimal care environments, as most are not equipped with the knowledge and skills necessary to prepare for the emerging delivery system.4,5 Additionally, today’s clinical faculty are challenged with teaching HSS at the same time as they are learning it themselves, while simultaneously delivering care in a rapidly changing environment.6

조직 목표와 일치하는 [경험적 학습]은 임상 수준에서 품질과 안전의 개선을 달성하는 동시에 교육생의 교육과 역량을 향상시킬 수 있습니다.5 그러나...

  • 의과대학은 종종 이러한 기술에 대한 교수진을 개발할 자원과 인프라가 부족하며, 시간에 대한 competing demands는 교수들로 하여금 종합적인 HSS 훈련을 받기가 어렵게 만든다.
  • 기존의 많은 훈련 프로그램들은 여행travel을 요구하고 일상 업무에서 시간을 빼앗는다.
  • 또한, 교육 과정 참가자는 각기 다른 기관에서 오기 때문에, 이는 임상 제공 환경의 맥락에서 이러한 기술을 배울 기회를 제한합니다.
  • [품질 및 안전 교육자 아카데미]와 "혁신" 또는 "가치" 기관과 같은, 교육 기관 내 이니셔티브의 일부 사례가 보고되었지만, 이는 널리 확산되지 않았다.7,8
  • 마지막으로, 교직원을 위한 HSS 훈련 프로그램의 효과적인 계획 및 구현은 [강력한 평가 전략의 부족]에 의해 제한된다.9

 

Experiential learning that is aligned with organizational goals can help achieve improvements in quality and safety at the clinical level while also improving the education and competency of trainees.5 Yet,

  • schools often lack the resources and infrastructure to develop faculty in these skills, and competing demands on time make it difficult for faculty to undertake comprehensive HSS training.
  • Many existing training programs require travel and take time away from daily work.
  • Additionally, course attendees come from different institutions, which limits their opportunity to learn these skills in the context of their clinical delivery environment.
  • Some examples of intrainstitutional initiatives have been reported, such as the Quality and Safety Educators Academy and “innovation” or “value” institutes, but these are not widespread.7,8 
  • Finally, effective planning and implementation of HSS training programs for faculty is limited by a paucity of robust evaluation strategies.9

접근법
Approach

이스트 캐롤라이나 대학의 브로디 의과대학(ECU)은 변화하는 의료 전달 시스템에서 일하는 의대 학생들을 더 잘 준비시키기 위해 미국 의학 협회(AMA)로부터 5년 상을 받았다. 이 상을 사용하여, 우리는 의료의 변화를 가속화하기 위한 재설계 교육을 위한 REACH라는 이름의 이니셔티브를 개발했습니다. 이 이니셔티브의 목표는 모든 의대생을 대상으로 통합된 종방향 HSS 커리큘럼을 구현하는 것이었다. REACH 프로젝트 팀에는 다양한 전문 분야의 임상 교육자 6명, 간호사 교수진 1명, 프로그램 관리자 1명이 포함되었다.
The Brody School of Medicine at East Carolina University (ECU) received a five-year award from the American Medical Association (AMA) to better prepare medical students for working in a changing health care delivery system. Using this award, we developed an initiative entitled REACH, for Redesigning Education to Accelerate Change in Health Care. The goal of this initiative was to implement an integrated, longitudinal HSS curriculum for all medical students. The REACH project team, responsible for the design and implementation of all components of the initiative, included six clinical educators from various specialties, one nurse faculty member, and one program manager.

우리는 [HSS 역량에 대한 전문지식을 갖춘 교수진]을 새로운 커리큘럼의 구현에 필요한 전제조건으로 간주했다. 그래서 2014년 1월, 우리는

  • HSS 역량을 준비하는 데 필요한 교육학 및 교육과정 설계에 능숙해지면서
  • 일선 임상 변혁을 선도할 교수진을 준비한다

...는 이중의 목표를 가지고 TQA를 설립했다.

We deemed having a critical mass of faculty with expertise in HSS competencies as a necessary prerequisite to the implementation of the new curriculum. So in January 2014, we established the TQA with the dual goal of

  • preparing faculty to lead frontline clinical transformation while
  • becoming proficient in the pedagogy and curriculum design necessary to prepare students in HSS competencies.

다른 학교에서 발견되는 다양한 의학 교육자 아카데미 모델과 유사하게, TQA의 목표는 교육자로서 교직원을 지원하고, 교육적 우수성을 육성하고, 커리큘럼 혁신을 가속화하고, 교육적 장학금을 확대하는 것을 포함했다. 
Similar to various Academy of Medical Educators models found at other schools, the objectives of the TQA included supporting faculty as educators, fostering teaching excellence, accelerating curricular innovations, and expanding educational scholarship.10 

TQA는 다음과 같은 점에서 독특했다

  • [의학 교육]과 [보건 시스템] 간의 연계,
  • 공통 HSS 커리큘럼 개발을 위한 참가자의 집단 참여,
  • 교수진들이 practice and teach하는 임상 환경의 맥락에서 부서와 기관 간에 아이디어를 교환할 수 있는 포럼의 제공

Unique to the TQA were

  • the linkage between medical education and the health system,
  • participants’ collective participation in the development of a common HSS curriculum, and
  • provision of a forum for faculty to exchange ideas across departmental and institutional lines all within the context of the clinical environment in which they practice and teach.

또한, 보건전문직학생들이 train받을 때 종종 겪는 [사일로 효과를 완화하기 위해], 우리는 다른 건강 전문 학교의 교직원을 TQA로 모집하여 전문적 학습 커뮤니티를 설립했다.

Additionally, to mitigate the silo effect in which health professions students are often trained, we recruited faculty from other health professions schools to the TQA to establish an interprofessional learning community.

 

2014년 3월부터 11월까지 여섯 개의 이틀짜리 세션이 이어졌고, HSS의 주요 주제(그림 1)를 다루었다. TQA 훈련 설계에서는 온라인, 교육적, 소규모 그룹 및 경험적 학습을 QI 프로젝트의 완료와 결합하여 학습 세션의 개념을 일상 작업의 컨텍스트로 연결하였다.

A lead-in period from January to mid-March 2014 allowed participants to independently complete the Institute for Healthcare Improvement Open School Basic Certificate in Quality and Safety to ensure a shared foundational knowledge framework. Six 2-day learning sessions followed (from March to November 2014), covering key HSS topics (Figure 1). The TQA training design used a mix of online, didactic, small-group, and experiential learning coupled with the completion of a QI project to hardwire the concepts from the learning sessions into the context of daily work.

 

TQA 참가자들은 REACH 프로젝트 팀원들의 조언을 받아 소규모 그룹으로 활동하여 세션 간 QI 프로젝트에 대한 동료 피드백과 지원을 제공하였다. QI 활동 및 HSS 커리큘럼 개발과 관련된 학술 제품은 QI 프로젝트의 검토 기준을 개발하는 ECU 기관 검토 위원회와의 파트너십을 통해 장려되고 촉진되었다. 대부분의 TQA 참가자들은 2015년 1월 21일 QI 심포지엄에서 공식적으로 자신의 연구 결과를 발표했다.
TQA participants worked in small groups, mentored by REACH project team members, to provide peer feedback and support for QI projects between sessions. Scholarly products related to both QI activities and HSS curriculum development were encouraged and facilitated by a partnership with the ECU’s institutional review board through which criteria for the review of QI projects were developed. Most TQA participants formally presented their work at a campus-wide QI symposium on January 21, 2015.

ECU의 교육대학은 REACH와 제휴하여 커리큘럼을 설계하고 전달을 위한 새로운 교육학적 방법을 창조하는 기술 개발을 제공하는 의학 교육학 Credentials를 만들었다. 2014년 6월부터 2015년 5월까지 3개의 온라인 대학원 과정에서는 교육 리더십, 커리큘럼 개발 및 교육 효과 평가 분야에서 교수진의 역량을 강화하였다(그림 1). 이러한 과정에서의 학습은 참여 동료 및 과정 리더의 input을 받아 새로운 커리큘럼 제품을 개발함으로써 시행되었다. 모든 TQA 참여자는 새롭게 시행된 ECU 의학교육의 날(2015년 4월 22일)에 HSS와 관련된 커리큘럼 혁신을 완료하였다.
ECU’s College of Education partnered with REACH to create a Credential in Medical Education that provided skill development for designing a curriculum and creating new pedagogical methods for delivery. Three distinct online graduate courses (from June 2014 to May 2015) promoted faculty skills in educational leadership, curriculum development, and assessment of educational effectiveness (Figure 1). Learning in these courses was enforced through the development of new curricular products with input from participating peers and course leaders. All TQA participants completed a curricular innovation related to HSS for presentation at the newly implemented ECU Medical Education Day (April 22, 2015).

TQA의 총 예산은 500,187달러였으며, 41만 4,044달러의 자금 지원 교수 출시 시간, 57,000달러의 REACH 프로젝트 팀 계획 및 멘토링 노력을 지원했으며, 자료, 명예 및 기타 물류 요구에 대한 비용 29,143달러였다. 의과대학에서 제공한 자금은 교수 방출 시간을 지원했고, REACH 프로젝트 팀원의 TQA 비용과 방출 시간은 AMA 보조금 기금을 통해 지원되었다.
The total budget for the TQA was $500,187, with $414,044 funding faculty release time, $57,000 supporting REACH project team planning and mentoring efforts, and $29,143 covering materials, honoraria, and other logistical needs. Funds provided by the medical school supported faculty release time, while TQA expenses and release time for REACH project team members were supported through AMA grant funds.

프로그램 평가에는 다음이 포함됩니다.

  • QI 이니셔티브에 대한 진행 중인 작업, 교육 모듈의 커리큘럼 통합, TQA 완료 후 1년 동안 및 1년 동안 학술성과물의 추적
  • QI, 환자 안전, 전문직 간 관행 및 교육에 대한 참가자의 지식, 태도 및 행동을 평가하는 1년 간격의 사전-사후 교육 조사.

Program evaluation includes

  • tracking ongoing work on QI initiatives, the incorporation of educational modules into the curriculum, and the production of scholarly products during and one year after completing the TQA, as well as
  • immediate and one-year pre- and posttraining surveys assessing participants’ knowledge, attitudes, and behaviors in QI, patient safety, and interprofessional practice and education.

 

성과 Outcomes

의도한 성과와 영향 Intended outcomes and impact

초기 학습 세션 이후 TQA에 전념한 교수진 31명; 경쟁적인 시간 요구로 인해 4명의 교수진(13%)이 감소하면서 4개의 건강 과학 프로그램에서 27명의 TQA 참가자가 프로그램을 완료했다. TQA 참가자의 인구통계학적 특성은 표 1에 제시되어 있다. 참여자 26명(96%)이 [품질 및 안전에 관한 열린학교 기본자격증]을 이수하고, 6개 학습 세션에 모두 참여하였다. 모든 참여자는 QI 프로젝트를 완료하여 지역 의료 시스템과 지역사회에서 돌봄 전달의 일부 측면을 개선하는 20가지 이니셔티브에 기여하였다(목록 1). 

Thirty-one faculty committed to the TQA after the initial learning session; the subsequent attrition of 4 (13%) faculty members due to competing time demands resulted in 27 (87%) TQA participants from four health science programs completing the program. Demographic characteristics of the TQA participants are shown in Table 1. Twenty-six (96%) participants completed the Institute for Healthcare Improvement Open School Basic Certificate in Quality and Safety and participated in all six learning sessions. All participants completed their QI projects, contributing to 20 different initiatives that improved some aspect of care delivery in the local health care system and community (List 1).

 

 

이 모든 QI 프로젝트는 [성과 향상 지속 의학교육]을 위한 자격을 얻었으며, 각각은 CME에 20 크레딧 시간을 벌었다. 모든 참가자들은 세 개의 대학원 과정에 등록하고 종방향 HSS 커리큘럼에 포함할 커리큘럼 구성요소를 제출하였다. 8명(30%)은 공식 교육(2015년 5월)이 끝날 때까지 의료 교육 자격 증명을 이수했으며, 다른 이들은 계속 이러한 요건을 이수하고 있다. 26명(96%)은 캠퍼스 전역의 QI 심포지엄에서 QI 프로젝트를 발표했고, 25명(93%)은 ECU 창립 의료교육의 날에 커리큘럼 기여를 제시했다.

All of these QI projects qualified for Performance Improvement Continuing Medical Education, each earning 20 credit hours of continuing medical education. All participants enrolled in the three graduate courses and submitted curriculum com ponents to include in the longitudinal HSS curriculum. Eight (30%) completed the Credential in Medical Education by the end of the formal training (May 2015), while others continue to complete these requirements. Twenty-six (96%) presented their QI project at the campus-wide QI symposium, and 25 (93%) presented their curricular contributions at ECU’s inaugural Medical Education Day.


목록 1 List 1

2014년 3월 ~ 2015년 5월, 이스트캐롤라이나 대학교 Brody School of Medicine 참가자들의 QI(품질 향상) 이니셔티브 및 의료 교육 제품
Quality Improvement (QI) Initiatives and Medical Education Products of Teachers of Quality Academy (TQA) Participants, Brody School of Medicine at East Carolina University, March 2014–May 2015

TQA 참가자 QI 이니셔티브환자 집중

  • 진료전환 관리 개선을 통한 가정의학 실습에서 노인 환자 재전송 감소
  • 교육을 통한 저혈당 및 위해 감소 및 내과 진료 시 주문 세트 사용 증가
  • 학술적 정신의학 실습에서 자살 위험이 있는 환자에 대한 치료 전환 개선
  • 약물 투여 지연을 줄이기 위해 마취 후 치료실에서 소아 중환자실로 인계 절차 개선
  • 소아병동 거주자의 안전지능 보고 시스템 활용도 증대
  • 다원적 입원 환자 라운드에서 임상 윤리 관점 통합 개선

TQA Participant QI InitiativesInpatient Focused

  • Reducing readmissions among geriatric patients in an academic family medicine practice through improved management of transitions of care
  • Reducing hypoglycemia and harm through education and increased use of order sets on an internal medicine inpatient service
  • Improving transitions of care for patients at risk for suicide in an academic psychiatry practice
  • Improving handover procedures from postanesthesia care unit to pediatric intensive care unit to reduce delays in medication administration
  • Increasing utilization of the safety intelligence reporting system by residents on a pediatric ward service
  • Improving integration of a clinical ethics perspective in multidisciplinary inpatient rounds

급성 질환 관리 집중

  • 12세 미만 아동의 급성 맹장염 방사선순서 프로세스 개선
  • 지역 병원 응급 부서에서 탑승하는 정신과 환자 간의 적절한 의약품 조정 증가
  • 거주자 간의 수술 이력 및 신체 기록 개선
  • 췌장 절제술 환자의 수술 후 회복의향상 구현
  • 환자 동의 수술 멸균의 신뢰성 향상으로 의료기관 서비스에 관개 보호
  • 입원 재활치료실 수면 무호흡증 검사 강화
  • 아동 응급실 체류기간 단축을 위한 간호의정서 활용

Acute Care Focused

  • Improving the radiographic ordering process for acute appendicitis in children under 12 years of age
  • Increasing appropriate medication reconciliation among boarding psychiatric patients in a regional hospital emergency department
  • Improving surgical history and physical documentation among residents
  • Implementing an enhanced recovery after surgery protocol among patients with pancreatic resection
  • Improving reliability of patient-consented surgical sterilization resulting in tubal ligation on an academic obstetrical service
  • Enhancing screening for obstructive sleep apnea on an inpatient rehabilitation unit
  • Utilizing nursing protocol orders to decrease length of stay in a children’s emergency department

앰뷸런스 연습 집중

  • 세 가지 임상 실습 현장(가족의학, 내분비학, 아동 정신의학)에서 노쇼율 감소 - 세 가지 구별되지만 관련성이 있는 프로젝트 및 팀이었다.
  • 유방암 방사선 치료를 위한 선량 목표 표준화
  • ECU 소아 외래 환자 센터의 스페인어권 환자에 대한 차별 감소 및 관리 개선
  • 영유아 및 산후 평가를 위한 가정방문 추천 강화
  • 감염성 심내막염 의심 평가 시 심초음파 심초음파 부적절한 사용

Ambulatory Practice Focused

  • Reducing no-show rates at three clinical practice sites (family medicine, endocrinology, and child psychiatry—these were three distinct, but related, projects and teams)
  • Standardizing dose objectives for radiotherapy in breast cancer
  • Reducing discrimination and improving care for Spanish-speaking patients in the ECU Pediatric Outpatient Center
  • Enhancing home visit referrals for infant and postpartum assessment
  • Reducing inappropriate use of transesophageal echocardiography in evaluation of suspected infective endocarditis

TQA 참여 의료 교육 제품 문제 기반 학습/팀 기반 학습 사례

  • 의료 오류 인식 및 인식
  • 입원 인슐린 투약의 QI/환자 안전
  • 암 관리: 의료 오류, 전문 교육 및 증거 기반 의학
  • 빈곤, 특권, 전문성
  • ECU 간호대학 학생들과의 팀 기반 관리

TQA Participant Medical Education ProductsProblem-Based Learning/Team-Based Learning Cases

  • Recognizing and acknowledging medical error
  • QI/patient safety of inpatient insulin dosing
  • Cancer care: medical error, interprofessional education, and evidence-based medicine
  • Poverty, privilege, and professionalism
  • Team-based care with ECU College of Nursing students

교육 모듈

  • 팀 STEPS 훈련 및 QI 올림픽
  • 환자안전에 대한 점원직위반 교육법 위반
  • 시스템을 통한 환자 흐름 시뮬레이션 모델링
  • 안전한 처방 관행 및 의약품 조정
  • 고부가 가치, 비용 절감형 관리 구축

Educational Modules

  • TeamSTEPPS training and QI Olympics
  • Flipping the clerkship didactic on patient safety
  • Simulation modeling of patient flow through system
  • Safe prescribing practices and medicine reconciliation
  • Creating high-value, cost-conscious care

연습/시뮬레이션

  • 진료 시뮬레이션 전환 개선
  • 수술 사무원의 안전성 향상: 시스템의 접근 방식
  • 오류 분석과 QI를 가르치기 위한 시뮬레이션된 근본 원인 분석
  • 보건 및 지역사회 자원 실천의 사회적 결정 요인
  • PCMHs에서의 핫스팟팅 연습, 전문가 간 교육 및 인구 건강 측면 지원

Exercises/Simulations

  • Improving transitions of care simulation
  • Improving safety in the surgery clerkship: a system’s approach
  • Simulated root cause analysis to teach error analysis and QI
  • Social determinants of health and community resources exercise
  • Hotspotting exercise in PCMHs, with interprofessional education and population health aspects

Abbreviations: ECU indicates East Carolina University; TeamSTEPPS, Team Strategies and Tools to Enhance Performance and Patient Safety; PCMH, patient-centered medical home.


 

11명(41%)의 참가자가 9차례의 전국 컨퍼런스에 참석했으며, 7명(26%)은 TQA 학습 세션 중 두 차례에서 교수로 활동했다. 19명(70%)은 TQA 참가자들이 기여하는 교육 모듈의 통합 및 평가를 포함하여 HSS에서 의대생 교육과정의 설계 및 전달에 공식적으로 참여하고 있다.
Eleven (41%) participants presented their work at nine national meetings, and seven (26%) served as faculty in two of the TQA learning sessions. Nineteen (70%) have been formally engaged in the design and delivery of the medical student curriculum in HSS, including the integration and evaluation of educational modules contributed by TQA participants.

 

예상치 못한 결과 및 영향
Unanticipated outcomes and impact

 

TQA의 몇 가지 결과는 우리의 초기 목표를 초과했다. 교육 초기에는 많은 TQA 참가자들이 의대생 교육과정을 넘어 HSS의 교육 이니셔티브 개발에 새로운 지식과 기술을 적용하기 시작했다. 이러한 영향은 전공의 핸드오프 교육을 위한 새로운 모듈, 질병 및 사망률 컨퍼런스에 대한 시스템 분석 통합, 전공의에 의한 환자 안전 보고 시스템의 강화된 사용, 거주자와 간호 및 공중 보건 학생을 위한 QI 선택 사항의 개발에서 입증되었다(목록 1). 6명(22%)의 참가자가 AMA의 의료 교육 이니셔티브의 신속한 변화를 지원하는 HSS 교과서의 챕터 저자가 되었다. HSS 개념에 초점을 맞춘 국가고시 개발에 2명(7%)이 기여하고 있다.
Several outcomes of the TQA exceeded our initial objectives. Early into their training, a number of TQA participants began to apply their new knowledge and skills to the development of educational initiatives in HSS beyond the medical student curriculum. This impact was demonstrated by new modules for resident hand-off training, the integration of systems analysis into morbidity and mortality conferences, the enhanced use of the patient safety reporting system by residents, and the development of QI electives for residents and nursing and public health students (List 1). Six (22%) participants became chapter authors for a textbook on HSS that was supported by the AMA’s Accelerating Change in Medical Education Initiative. Two (7%) are contributing to the development of a national examination focused on HSS concepts.

또한, ECU 보건과학부 전체에서 의학 교육 인증(Credential in Medical Education)이 주목을 받았으며, 이는 현재 진행 중인 캠퍼스 전체의 보건 직업 교육(Credential in Health Professionals Education)의 승인과 시행으로 이어졌다. 매년 의료 및 간호학과 학생들을 위한 QI 올림픽을 포함하여 보건 과학 캠퍼스 전반에 걸친 새로운 전문직 간 교육 노력은 강화된 전문직 간 교육 협력의 영향을 강조한다.
Additionally, the Credential in Medical Education gained attention across the ECU’s health science division, leading to the approval and implementation of an ongoing campus-wide Credential in Health Professions Education. New interprofessional education efforts across the health science campus, including an annual QI Olympics for medical and nursing students, highlight the impact of enhanced interprofessional education collaboration.

TQA가 새로운 QI 전문가를 개발한 것으로 인정받는 것은 이후 참가자 한 명이 Vidant Medical Center의 품질 담당 선임 의료 책임자로 임명되고 다른 한 명이 ECU Physicals의 부 의료 책임자로 임명되어 Brody School의 임상 관행을 위한 QI 노력을 주도함으로써 입증된다. 프로그램의 영향을 예시하는 사례는 한 TQA 참가자가 수술 후 조기 회복 프로그램을 구현하여 고품질의 결과를 유지하면서 선택된 시술 비용을 크게 절감하는 결과를 초래한 것으로 입증된다. 장기 결과를 평가하는 데 도움이 되는 의대생 참여뿐만 아니라 다른 외과의사와 케이스에 대한 이러한 개입의 후속 확산은 TQA의 임상적 및 교육적 영향을 보여준다.
Recognition of the TQA as having developed new QI experts is evidenced by the subsequent appointment of one participant as the senior medical director for quality for Vidant Medical Center and another as the associate medical director of ECU Physicians, leading QI efforts for the Brody School of Medicine’s clinical practices. A case that exemplifies the program’s impact is illustrated by one TQA participant’s implementation of an early recovery after surgery program that resulted in dramatic reductions in cost for selected procedures while maintaining high-quality outcomes. The subsequent spread of this intervention to other surgeons and cases, as well as medical student engagement to help assess its long-term outcomes, demonstrates the clinical and educational impact of the TQA.

25명(93%)의 참가자가 교육 후 설문조사를 완료했다. 응답자 25명 중 20명(80%)은 향후 QI 프로젝트를 선도하는 업무를 계속할 것으로 예상했습니다. 23명(92%)의 응답자는 QI 원칙을 가르치는 데 편안하거나 매우 편안했습니다. 향후 QI 원칙의 통합에 대한 질문에 응답자들은 각각의 임상(18/19; 95%), 강의(21/25; 84%), 학술(18/24; 75%) 활동에서 유의하거나 상당한 수준으로 이를 수행할 것으로 기대했다.

Twenty-five (93%) participants completed the posttraining survey. Twenty of the 25 (80%) respondents expected to continue their work leading future QI projects. Twenty-three (92%) respondents were either comfortable or very comfortable teaching QI principles. Asked about incorporation of QI principles going forward, respondents expected to do so in their respective clinical (18/19; 95%), teaching (21/25; 84%), and scholarly (18/24; 75%) activities to a significant or substantial degree.

다음 단계
Next Steps

의대생들을 위한 HSS 커리큘럼을 제정하기 전에, 우리는 HSS 개념을 가르칠 준비가 된 교직원의 코호트가 필요하다고 생각했다. 우리는 이 중요한 요구를 해결하기 위해 TQA를 설계했다. 우리는 15개월 간의 교육 제도 훈련 프로그램에 참여하기 위해 이 학습 커뮤니티에 다양한 전문직 간 교수 코호트를 모집했다. 기술되고 구현된 바와 같이, TQA는 [HSS 역량을 준비하는 데 필요한 교육학 및 커리큘럼 설계에 능숙]해지면서, [일선 임상 변혁을 선도할 교직원을 준비]한다는 이중 목표를 달성했다. 프로그램에 대한 열정은 우리의 초기 목표를 초과한 결과와 영향을 초래했으며, 이는 이 분야에 대한 관심이 널리 퍼져 있음을 시사한다.
Prior to instituting an HSS curriculum for medical students, we deemed a cohort of faculty prepared to teach HSS concepts necessary. We designed the TQA to address this critical need. We recruited a diverse, multispecialty cohort of interprofessional faculty to this learning community to participate in a 15-month intrainstitutional training program. As described and implemented, the TQA achieved the dual goal of preparing faculty to lead frontline clinical transformation while becoming proficient in the pedagogy and curriculum design necessary to prepare students in HSS competencies. Enthusiasm for the program resulted in outcomes and impact that exceeded our initial objectives, suggesting that interest in this area is widespread.

TQA를 완료한 이후, 참가자들은 환자 치료에 대한 팀 접근 방식을 모델링하고 QI 이니셔티브와 환자 안전 노력을 선도하며 새롭게 부상하는 종방향 HSS 커리큘럼의 구성 요소를 기여해왔다. 참가자들은 또한 여러 학술 프레젠테이션을 통해 학습과 성과를 전파했습니다.
Since completing the TQA, participants have been modeling a team approach to patient care, leading QI initiatives and patient safety efforts, and contrib uting the building blocks of the emerging longitudinal HSS curriculum. Participants have also disseminated their learning and accomplishments through multiple scholarly presentations.

TQA 참가자 및 프로그램 기획자를 위한 중요한 다음 단계는 

  • (1) 종단적 HSS 커리큘럼의 완전한 구현을 위하여 자문교수 및 기여자로 추가적 통합incorporation
  • (2) 'Leaders in Innovative Care Scholars'의 학생리더십 트랙을 포함하여 참여 확대
  • (3) TQA 참여가 환자 치료, 교육 및 역할 모델링에 미치는 영향에 대한 심층적인 평가를 계속한다.
  • (4) TQA 참가자의 다음 코호트 모집(HSS 전문지식을 갖춘 교수진의 임계 질량을 달성하기 위한 필요성)

Important next steps for TQA participants and program planners include

  • (1) further incorporation as faculty advisors and contributors to the full implementation of the longitudinal HSS curriculum;
  • (2) expanded involvement with the Leaders in Innovative Care Scholars student leadership distinction track;
  • (3) continued in-depth evaluation of the impact of TQA participation on patient care, teaching, and role modeling; and
  • (4) the recruitment of the next cohort of TQA participants (a necessity for achieving a critical mass of faculty with HSS expertise).

헬스케어의 성과를 최적화하려면 교육자가 의료 교육과 의료 제공 개혁의 조정을 지원하는 HSS 원칙을 배우고 가르쳐야 한다. TQA의 초기 결과는 HSS 역량에 초점을 맞춘 교수 개발 학습 커뮤니티를 구현하면 다양한 참가자 코호트를 참여시키고, 필요한 교수 지식과 기술을 구축하여 기관에 가치를 더하며, 보건 전문가 프로그램 전반에 걸쳐 새로운 전문가 간 파트너십을 만들 수 있음을 시사한다. 

Optimizing health care outcomes will require educators to learn and teach HSS principles that support the alignment of medical education and health care delivery reform. The early outcomes from the TQA suggest that implementing a faculty development learning community focused on HSS competencies can engage a diverse cohort of participants, add value to the institution by building requisite faculty knowledge and skills, and create new interprofessional partnerships across health professions programs.

 

 

 


Acad Med. 2016 Dec;91(12):1655-1660.

 doi: 10.1097/ACM.0000000000001262.

The Teachers of Quality Academy: A Learning Community Approach to Preparing Faculty to Teach Health Systems Science

Elizabeth G Baxley 1Luan LawsonHerbert G GarrisonDanielle WalshSuzanne LazorickDonna LakeJason Higginson

Affiliations collapse

Affiliation

  • 1E.G. Baxley is senior associate dean for academic affairs and professor of family medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina. L. Lawson is assistant dean of curriculum, assessment, and clinical academic affairs and assistant professor of emergency medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina. H.G. Garrison is associate dean for graduate medical education and professor of emergency medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina. D. Walsh is associate professor of surgery, Division of Pediatric Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina. S. Lazorick is associate professor of pediatrics and public health and health services researcher, Brody School of Medicine at East Carolina University, Greenville, North Carolina. D. Lake is clinical associate professor of nursing, Graduate Nursing Sciences and Leadership Concentration, East Carolina University College of Nursing, Greenville, North Carolina. J. Higginson is associate professor of pediatrics and chief, Division of Neonatology, Brody School of Medicine at East Carolina University, Greenville, North Carolina.

Free PMC article

Abstract

Problem: Although efforts to integrate health systems science (HSS) topics, such as patient safety, quality improvement (QI), interprofessionalism, and population health, into health professions curricula are increasing, the rate of change has been slow.

Approach: The Teachers of Quality Academy (TQA), Brody School of Medicine at East Carolina University, was established in January 2014 with the dual goal of preparing faculty to lead frontline clinical transformation while becoming proficient in the pedagogy and curriculum design necessary to prepare students in HSS competencies. The TQA included the completion of the Institute for Healthcare Improvement Open School Basic Certificate in Quality and Safety; participation in six 2-day learning sessions on key HSS topics; completion of a QI project; and participation in three online graduate courses.

Outcomes: Twenty-seven faculty from four health science programs completed the program. All completed their QI projects. Nineteen (70%) have been formally engaged in the design and delivery of the medical student curriculum in HSS. Early into their training, TQA participants began to apply new knowledge and skills in HSS to the development of educational initiatives beyond the medical student curriculum.

Next steps: Important next steps for TQA participants and program planners include further incorporation as faculty advisors and contributors to the full implementation of the longitudinal HSS curriculum; expanded involvement with the Leaders in Innovative Care Scholars student leadership distinction track; continued in-depth evaluation of the impact of TQA participation on patient care, teaching, and role modeling; and the recruitment of the next cohort of TQA participants.

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