Practice-based Learning

Overview: 3^rd-year residents will select a project that improves the quality of care delivered to the patients served in their clinic.

The R3 will choose the project based on their experiences and observations delivering care.  The specifics of the project should be discussed with a faculty sponsor familiar with that area of the clinic’s functioning. 

Specific examples are included below.

Goal: Resident will gain experience in practice-based improvement by participating in a project that improves the quality of care delivered to patients.

Objective: The resident will follow the steps below to choose and implement an appropriate project:

A)  Setting aims – “What are we trying to accomplish?”  The resident will identify an opportunity for improving the quality of care delivered to patients in the clinic where they work.  The R3 will discuss and refine the project with a faculty sponsor familiar with that area of the clinic’s functioning.  The time frame and the specific patient-population affected should be clearly defined.

Example 1, I notice a lot of patients aren’t getting screening for abdominal aortic aneurysms according to USPSTF guidelines.  I want to look at all the patients in pod 2 who meet screening guidelines.   Carroll Haymon’s interests in geriatric populations and preventative medicine make her a good adviser.

Example 2, Before Epic, we had a number of useful patient handouts that I frequently gave patients.  Now I rarely ever give patient handouts.  I want to determine barriers to providing after visit summaries to patients.  I will look at pod 3.  Carol Cordy has an interest in patient education . . .

Example 3, Working with the 3^rd year medical student always slows me down and makes me late to see patients.  I want to identify and develop a list of “best practices” to maintain efficiency while working with a medical student.  Mark would be a good adviser since he is the director of the 3^rd year clerkship.

B)  Establishing measures – “How will we know that change is an improvement?”  All improvements require change, but not all changes are improvements.  The R3 and faculty will identify specific measures to determine if a change actually leads to an improvement.  This may not work for every project, but I encourage you to consider what quantifiable outcome can be measured.

Ex 1, I will identify all pod 2 patients who meet AAA screening guidelines and calculate the percent appropriately screened.  I will recalculate this percentage 4 months after I implement my change.

Ex 2, I will look at 1 week of patient encounters from the providers in pod 3 and see how many included after visit summaries.  I will repeat this calculation after my intervention

Ex 3, I will query the charts of all the R3’s who have worked with a medical student in the past month.  I will compare the difference between the patients’ scheduled appointment times and the actual time the R3 saw them.  After I implement my “best practice” teaching, I will repeat this to assess for improvement.

C)  Selecting the change or changes – You and your adviser will determine which method or change is most likely to result in useful information or a sustainable improvement.

Ex 1, You and Carroll agree to involve Mary Siebert’s expertise in terms of mining useful data from Epic.  You obtain consent from the other PCPs in the pod and decide to call all patients who meet the criteria for AAA screening and assess barriers to having this performed.  You decide to call patients directly rather than simply alerting the PCPs of the deficiency.

Ex 2, You decide that the old patient handouts need to be scanned into Epic as “smartphrases” and made available clinic-wide.  You also decide to contact a select group of patients to find out their opinion on the usefulness of receiving a patient handout.

Ex 3, You decide to collect suggestions from faculty and R3’s from several other programs and speak at an R3 morning.  You also make the list of best practices available on the website.

D)  Implementation  – Initiate the change you’ve chosen.

E)  Analysis – Synthesize the results.  “Did your change lead to a quantifiable improvement?” 

F)  Sharing your findings – The R3’s will present the findings of their project at a clinic-wide meeting prior to graduation.

G)  Spreading changes – Not all projects will get to this stage, but some projects that are especially successful can be implemented across different pods or clinics.

Timeline:

RRC requirements:

“Management of Health Systems

They must participate in projects to improve the quality of care and service delivered to the FMC patient population.

Practice-based Learning and Improvement

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Residents are expected to develop skills and habits to be able to meet the following goals:

(1) identify strengths, deficiencies, and limits in one’s knowledge and expertise;
(2) set learning and improvement goals;
(3) identify and perform appropriate learning activities;
(4) systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement;
(5) incorporate formative evaluation feedback into daily practice;
(6) locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems;
(7) use information technology to optimize learning; and,
(8) participate in the education of patients, families, students, residents and other health professionals.”