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Lowry LE, Merkebu J, Schall SE, Neubauer BE, Battista A. Picking Apart a Program Evaluation Committee: A Multiple Case Study Characterizing Primary Care Residency Program Evaluation Committee Structure, Program Improvement, and Outcomes. Cureus 2024; 16:e57439. [PMID: 38699123 PMCID: PMC11064101 DOI: 10.7759/cureus.57439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND As of 2014, the Accreditation Council for Graduate Medical Education (ACGME) mandates initiating a Program Evaluation Committee (PEC) to guide ongoing program improvement. However, little guidance nor published reports exist about how individual PECs have undertaken this mandate. OBJECTIVE To explore how four primary care residency PECs configure their committees, review program goals and undertake program evaluation and improvement. METHODS We conducted a multiple case study between December 2022 and April 2023 of four purposively selected primary care residencies (e.g., family medicine, pediatrics, internal medicine). Data sources included semi-structured interviews with four PEC members per program and diverse program artifacts. Using a constructivist approach, we utilized qualitative coding to analyze participant interviews and content analysis for program artifacts. We then used coded transcripts and artifacts to construct logic models for each program guided by a systems theory lens. Results: Programs adapt their PEC structure, execution, and outcomes to meet short- and long-term needs based on organizational and program-unique factors such as size and local practices. They relied on multiple data sources and sought diverse stakeholder participation to complete program evaluation and improvement. Identified deficiencies were often categorized as internal versus external to delineate PEC responsibility, boundaries, and feasibility of interventions. CONCLUSION The broad guidance provided by the ACGME for PEC configuration allows programs to adapt the committee based on individual needs. However, further instruction on program evaluation and organizational change principles would augment existing PEC efforts.
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Affiliation(s)
- Lacy E Lowry
- Internal Medicine, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Fort Sam Houston, USA
| | - Jerusalem Merkebu
- Health Professions Education, Henry M. Jackson Foundation for the Advancement of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Sarah E Schall
- Internal Medicine, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Fort Sam Houston, USA
| | - Brian E Neubauer
- Internal Medicine, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Fort Sam Houston, USA
| | - Alexis Battista
- Health Professions Education, Henry M. Jackson Foundation for the Advancement of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
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Kim JG, Gonzalo JD, Chen I, Vo A, Lupi C, Hyderi A, Haidet P, DeWaters A, Blatt B, Holmboe E, Thompson LR, Jimenez J, Madigosky W, Chung PJ. How a Team Effectiveness Approach to Health Systems Science Can Illuminate Undergraduate Medical Education Outcomes. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:374-380. [PMID: 38166319 DOI: 10.1097/acm.0000000000005619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
ABSTRACT Health care delivery requires physicians to operate in teams to successfully navigate complexity in caring for patients and communities. The importance of training physicians early in core concepts of working in teams (i.e., "teaming") has long been established. Over the past decade, however, little evidence of team effectiveness training for medical students has been available. The recent introduction of health systems science as a third pillar of medical education provides an opportunity to teach and prepare students to work in teams and achieve related core competencies across the medical education continuum and health care delivery settings. Although educators and health care system leaders have emphasized the teaching and learning of team-based care, conceptual models and evidence that inform effective teaming within all aspects of undergraduate medical education (including classroom, clinical, and community settings) are needed to advance the science regarding learning and working in teams. Anchoring teaming through the core foundational theory of team effectiveness and its operational components could catalyze the empirical study of medical student teams, uncover modifiable factors that lead to the evidence for improved student learning, and improve the link among competency-based assessments between undergraduate medical education and graduate medical education. In this article, authors articulate several implications for medical schools through 5 conceptual areas: admissions, the design and teaching of team effectiveness in health systems science curricula, the related competency-based assessments, and course and program evaluations. The authors then discuss the relevance of the measurable components and intended outcomes to team effectiveness in undergraduate medical education as critical to successfully prepare students for teaming in clerkships and eventually residency and clinical practice.
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Mitgang E, Nimako KT, Qamruddin J. Quality of care reform: a case for systems thinking and human centred design capabilities. BMJ 2023; 383:2108. [PMID: 38081645 DOI: 10.1136/bmj.p2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Elizabeth Mitgang
- World Bank Group, Health Nutrition and Population, Washington, DC, USA
| | | | - Jumana Qamruddin
- World Bank Group, Health Nutrition and Population, Washington, DC, USA
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Lim RBT, Hoe KWB, Tan CGL, Zheng H. A Systematic Review on the Effectiveness of Systems-Based Practice Curricula in Health Professions Education. Eval Health Prof 2023; 46:242-254. [PMID: 37439658 DOI: 10.1177/01632787231188182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
This systematic review aims to evaluate the effectiveness of systems-based practice (SBP) curricula from the perspective of health professions students and workers. A total of 8468 citations were sourced from six electronic databases and manual searches conducted independently by two researchers, of which 44 studies were eventually included. A meta-analysis using a random effects model and a meta-synthesis using the thematic synthesis approach were conducted. Most studies targeted medical students, residents, and resident physicians from various clinical specialties. Almost half of all studies focused on didactic or knowledge-based interventions to teach SBP. About a third of all studies measured non-self-evaluated knowledge change, clinical abilities, and clinical outcomes. Both meta-analysis and meta-synthesis results revealed positive outcomes of increased knowledge of SBP, increased recognition of SBP as a core competency in one's profession, and increased application of SBP knowledge in one's profession. Meta-synthesis results also revealed negative outcomes at the institutional and teacher/health professions level. This review highlights the importance of SBP education and supports the effectiveness of SBP curricula. There is a need to address the negative outcomes at the institutional and teacher/health professions level. Moreover, future studies could investigate the integration of self-assessment outcomes with comparison to some external standard.
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Affiliation(s)
- Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kenneth Wee Beng Hoe
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Claire Gek Ling Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Kirkegaard A, Mitchell L, Ball L, Williams LT. Developing the EQUIPED approach to quality management using multi-grounded theory. Nutr Diet 2023; 80:273-283. [PMID: 36278267 PMCID: PMC10953428 DOI: 10.1111/1747-0080.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/05/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to develop a theoretical approach to quality management for dietetics services operating in primary care settings in Australia. METHODS Multi-grounded theory was used to develop a theoretical approach to quality management across three phases. A preliminary approach was developed in the first phase using empirical data outlining quality management activities employed by primary care dietetics services. In the second phase, the preliminary approach was matched to theoretical data captured from the Australian National Safety and Quality in Primary and Community Healthcare Standards, the Quality in Nutrition Care Model for Dietitians, and complex adaptive systems theory. Central concepts were defined and described in the final phase. RESULTS Seventeen small (n = 7) and medium-large (n = 10) dietetics services from all Australian states and territories, except Tasmania, participated. The theoretical approach to quality management comprised 107 rules organised into six attractors (culture, integrated care, evidence-based care, safe environment and care, client partnerships and personalised care) and 10 governance elements. Rules had one or more foci that aimed to: improve quality within the service (internally focused), improve care by influencing other healthcare professionals (externally focused), improve the client relationship (client-focused), or monitor and respond to external systems (system-focused). CONCLUSIONS The theoretical approach developed in this study produced a set of rules that primary care dietetics services can use to inform quality management activities. The use of multi-grounded theory should be investigated in other healthcare disciplines and settings to address quality.
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Affiliation(s)
- Amy Kirkegaard
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| | - Lana Mitchell
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| | - Lauren Ball
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| | - Lauren T. Williams
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
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Macdonald G, Asgarova S, Hartford W, Berger M, Cristancho S, Nimmon L. What do you mean, 'negotiating?': Patient, physician, and healthcare professional experiences of navigating hierarchy in networks of interprofessional care. J Interprof Care 2023:1-12. [PMID: 37161739 DOI: 10.1080/13561820.2023.2203722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Interprofessional collaborative practice is a phenomenon that can be fraught with power dynamics between professions, within professions, and between professionals and patients. In the literature, the dominant notion is that conflicting viewpoints and interests arising from unequal power dynamics can be resolved through negotiation. This study examined COPD patients, health professionals, and physician experiences of negotiation within 10 interprofessional collaborative COPD care teams. Physicians, patients, and healthcare professionals each had strikingly different conceptions and experiences of negotiating their perspective with other team members. Our study suggests that negotiation is an idealized notion rather than a relational process embedded in interprofessional collaborative practice. Importantly, we found that the ability and opportunity to negotiate one's perspective is heavily influenced by one's position in the workplace division of labor and professional hierarchy. We conclude that "negotiation" is only one approach among many in navigating interprofessional relations. Further, the rhetorical and ideological appeal of "negotiation" may overstate its role in interactions in interprofessional care settings, and lead to a misunderstanding of the power dynamics at play. It may be naïve to assume team members can control their situation through the competitive assertion of their individual perspective in a rational debate. Unfortunately, adopting the language of negotiation uncritically may not offer relevant solutions to structural and collective problems within a healthcare workplace.
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Affiliation(s)
- Graham Macdonald
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Sevinj Asgarova
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Wendy Hartford
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Mary Berger
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Sayra Cristancho
- Centre for Education Research & Innovation, University of Western Ontario, London, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
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System Citizenship: Re-Envisioning the Physician Role as Part of the Sixth Wave of Professionalism. Am J Med 2023; 136:596-603. [PMID: 36889491 DOI: 10.1016/j.amjmed.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
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Colbert CY, French JC, Brateanu A, Pacheco SE, Khatri SB, Sapatnekar S, Vacharathit V, Pien LC, Prelosky-Leeson A, LaRocque R, Mark B, Salas RN. An Examination of the Intersection of Climate Change, the Physician Specialty Workforce, and Graduate Medical Education in the U.S. TEACHING AND LEARNING IN MEDICINE 2022; 34:329-340. [PMID: 34011226 DOI: 10.1080/10401334.2021.1913417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/07/2021] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
Issue: As U.S. healthcare systems plan for future physician workforce needs, the systemic impacts of climate change, a worldwide environmental and health crisis, have not been factored in. The current focus on increasing the number of trained physicians and optimizing efficiencies in healthcare delivery may be insufficient. Graduate medical education (GME) priorities and training should be considered in order to prepare a climate-educated physician workforce. Evidence: We used a holistic lens to explore the available literature regarding the intersection of future physician workforce needs, GME program priorities, and resident education within the larger context of climate change. Our interinstitutional, transdisciplinary team brought perspectives from their own fields, including climate science, climate and health research, and medical education to provide recommendations for building a climate-educated physician workforce. Implications: Acknowledging and preparing for the effects of climate change on the physician workforce will require identification of workforce gaps, changes to GME program priorities, and education of trainees on the health and societal impacts of climate change. Alignment of GME training with workforce considerations and climate action and adaptation initiatives will be critical in ensuring the U.S. has a climate-educated physician workforce capable of addressing health and healthcare system challenges. This article offers a number of recommendations for physician workforce priorities, resident education, and system-level changes to better prepare for the health and health system impacts of climate change.
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Affiliation(s)
- Colleen Y Colbert
- Cleveland Clinic Lerner College of Medicine of Case, Western Reserve University, Cleveland, Ohio, USA
- Office of Educator and Scholar Development, Education Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Judith C French
- Cleveland Clinic Lerner College of Medicine of Case, Western Reserve University, Cleveland, Ohio, USA
- General Surgery Residency Program, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andrei Brateanu
- Cleveland Clinic Lerner College of Medicine of Case, Western Reserve University, Cleveland, Ohio, USA
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susan E Pacheco
- Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Sumita B Khatri
- Cleveland Clinic Lerner College of Medicine of Case, Western Reserve University, Cleveland, Ohio, USA
- Respiratory Institute at Cleveland Clinic, Cleveland, Ohio, USA
| | - Suneeti Sapatnekar
- Cleveland Clinic Lerner College of Medicine of Case, Western Reserve University, Cleveland, Ohio, USA
- Robert T. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Voranaddha Vacharathit
- General Surgery Residency Program, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lily C Pien
- Cleveland Clinic Lerner College of Medicine of Case, Western Reserve University, Cleveland, Ohio, USA
- Office of Educator and Scholar Development, Education Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allison Prelosky-Leeson
- Office of Educator and Scholar Development, Education Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Regina LaRocque
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bryan Mark
- Department of Geography and Byrd Polar and Climate Research Center, Ohio State University, Columbus, Ohio, USA
| | - Renee N Salas
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Global Health Institute, Cambridge, Massachusetts, USA
- Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Roten C, Baumgartner C, Mosimann S, Martin Y, Donzé J, Nohl F, Kraehenmann S, Monti M, Perrig M, Berendonk C. Challenges in the transition from resident to attending physician in general internal medicine: a multicenter qualitative study. BMC MEDICAL EDUCATION 2022; 22:336. [PMID: 35501754 PMCID: PMC9063076 DOI: 10.1186/s12909-022-03400-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The attending physician in general internal medicine (GIM) guarantees comprehensive care for persons with complex and/or multiple diseases. Attendings from other medical specialties often report that transitioning from resident to attending is burdensome and stressful. We set out to identify the specific challenges of newly appointed attendings in GIM and identify measures that help residents better prepare to meet these challenges. METHODS We explored the perceptions of 35 residents, attendings, and department heads in GIM through focus group discussions and semi-structured interviews. We took a thematic approach to qualitatively analyze this data. RESULTS Our analysis revealed four key challenges: 1) Embracing a holistic, patient centered perspective in a multidisciplinary environment; 2) Decision making under conditions of uncertainty; 3) Balancing the need for patient safety with the need to foster a learning environment for residents; and 4) Taking on a leader's role and orchestrating an interprofessional team of health care professionals. Newly appointed attendings required extensive practical experience to adapt to their new roles. Most attendings did not receive regular, structured, professional coaching during their transition, but those who did found it very helpful. CONCLUSIONS Newly appointed attending physician in GIM face a number of critical challenges that are in part specific to the field of GIM. Further studies should investigate whether the availability of a mentor as well as conscious assignment of a series of increasingly complex tasks during residency by clinical supervisors will facilitate the transition from resident to attending.
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Affiliation(s)
- Christine Roten
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefanie Mosimann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Faculty of Health, Medicine & Life Sciences, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Yonas Martin
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Division of Medicine, Hôpital Neuchâtelois, Neuchâtel, Switzerland
| | - Felix Nohl
- Department of General Internal Medicine, Regionalspital Emmental, Burgdorf, Switzerland
| | - Simone Kraehenmann
- Division of General Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Matteo Monti
- Department of Internal Medicine and Medical Education Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Perrig
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Samuriwo R. Interprofessional Collaboration—Time for a New Theory of Action? Front Med (Lausanne) 2022; 9:876715. [PMID: 35372376 PMCID: PMC8971839 DOI: 10.3389/fmed.2022.876715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
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Schwartz AC, Dunn SE, Simon HFM, Velasquez A, Garner D, Tran DQ, Kaslow NJ. Making Family-Centered Care for Adults in the ICU a Reality. Front Psychiatry 2022; 13:837708. [PMID: 35401268 PMCID: PMC8987300 DOI: 10.3389/fpsyt.2022.837708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/25/2022] [Indexed: 12/29/2022] Open
Abstract
Despite the value of family-centered care (FCC) in intensive care units (ICUs), this approach is rarely a reality in this context. This article aims to increase the likelihood that ICU-based care incorporates best practices for FCC. Consistent with this goal, this article begins by overviewing FCC and its merits and challenges in ICUs. It then offers a systemic framework for conceptualizing FCC in this challenging environment, as such a model can help guide the implementation of this invaluable approach. This systemic framework combined with previous guidelines for FCC in the ICU are used to inform the series of recommended best practices for FCC in the ICU that balance the needs and realities of patients, families, and the interprofessional healthcare team. These best practices reflect an integration of the existing literature and previously published guidelines as well as our experiences as healthcare providers, family members, and patients. We encourage healthcare leaders and interprofessional ICU healthcare teams to adopt these best practices and modify them for the specific healthcare needs of the patients they serve and their families.
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Affiliation(s)
- Ann C Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Sarah E Dunn
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Hannah F M Simon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Alvaro Velasquez
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - David Garner
- Department of Nursing, Grady Health System, Atlanta, GA, United States
| | - Duc Quang Tran
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Nadine J Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
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Kakemam E, Albelbeisi AH, Davoodabadi S, Azarmi M, Zolghadr F, Mamene M. The impact of nurses' perceptions of systems thinking on occurrence and reporting of adverse events: a cross-sectional study. J Nurs Manag 2021; 30:482-490. [PMID: 34817095 DOI: 10.1111/jonm.13524] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
AIMS To assess systems thinking level and its relationship with occurrence and reporting of adverse events in Iranian nurses. BACKGROUND Systems thinking has recently emerged important element of patient safety and quality improvement in health care systems. It helps healthcare professionals to understand the different elements of healthcare systems, the interrelatedness, and interdependencies of these elements in the healthcare systems. METHODS This cross-sectional survey was carried out in ten teaching hospitals in Tehran, Iran. A total of 511 nurses were selected using simple random sampling. Systems thinking was measured using the validated Systems Thinking Scale. Data analysis was performed by descriptive analyses, independent t-test, and logistic regression analysis. RESULTS The average score for total systems thinking was a mean of 49.45 (SD = 12.10; range 0-80). In total, 67.5% of participants reported the experience of the occurrence of adverse events leading to harm to patients and 65.2% of them responded as having appropriate adverse events reporting behaviors. Nurses who had higher scores in systems thinking were found to be more likely to report adverse events (Odds ratio = 1.07; 95% CI = 1.05 - 1.09), whereas they were less prone to experience adverse events (Odds ratio = 0.97; 95% CI = 0.95 - 0.98). CONCLUSION Our results indicated that the nurses' systems thinking level was moderate. Systems thinking had a significant role in preventing the occurrence of adverse events as well as improving the reporting of adverse events. Therefore, it is recommended to enhance the competency of nurses' thinking systems to prevent the occurrence of adverse events and to improve the reporting of adverse events. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers need to focus on the systems thinking weaknesses and the occurrence and the reporting of adverse events in policymaking, practice, and research. Also, systems thinking should be integrated with the health care system for preventing the occurrence of adverse events and improving reporting of adverse events. They should support, lead, and allocate the essential pragmatic strategies and resources for the involvement of all health care members in policymaking.
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Affiliation(s)
- Edris Kakemam
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmed Hassan Albelbeisi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
| | - Samane Davoodabadi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Azarmi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zolghadr
- Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Mamene
- Department of Nursing, Faculty of Nursing & Midwifery, Ilam University of Medical sciences, Ilam, Iran
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Pien LC, Colbert CY, Hoyt A, French JC. Current trends in medical education affecting allergy and immunology physicians and learners. Ann Allergy Asthma Immunol 2021; 128:248-255. [PMID: 34673222 DOI: 10.1016/j.anai.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review current and relevant trends in medical education, undergraduate medical education, graduate medical education, and continuing medical education for the allergy and clinical immunology (A/I) community. DATA SOURCES English-only published literature from the past 5 years were obtained by means of a PubMed search and Google Scholar searches in addition to pertinent review articles and relevant textbooks as selected by the authors. STUDY SELECTIONS A total of 62 articles were selected for their relevance to the article's objective. Older references regarding medical education trends were included when they were felt to be essential. RESULTS Competency-based medical education is the contextual framework for curriculum, instruction, and assessment. Current trends influencing competency-based medical education are the following: e-learning; interprofessional education; simulation-based medical education; diversity, inclusion, and equity; and mentoring. This review clarifies terminology and offers examples of the potential impact of these trends within the A/I educational community. The development of knowledge and skills related to these topics can be achieved through formal faculty development, mentoring, and self-directed, asynchronous instruction. CONCLUSION Medical education continues to evolve as health care adapts to meet the changing needs of the health care system and our patients. The A/I physicians should be aware of current trends because these trends impact their roles as instructors and lifelong learners.
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Affiliation(s)
- Lily C Pien
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Office of Educator and Scholar Development, Education Institute, Cleveland Clinic, Cleveland, Ohio; Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio.
| | - Colleen Y Colbert
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Office of Educator and Scholar Development, Education Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alice Hoyt
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Judith C French
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
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Zucca C, Long E, Hilton J, McCann M. Appraising the Implementation of Complexity Approaches Within the Public Health Sector in Scotland. An Assessment Framework for Pre-Implementation Policy Evaluation. Front Public Health 2021; 9:653588. [PMID: 34631638 PMCID: PMC8492954 DOI: 10.3389/fpubh.2021.653588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/25/2021] [Indexed: 12/04/2022] Open
Abstract
Complexity approaches have gained international attention as potentially effective strategies to address population health challenges. In light of this, the Scottish government (Scot. Gov.) set the implementation of these approaches as the recommended practice for its public health sector organizations. This study evaluates the opportunity and feasibility of implementing complexity approaches in public health Scotland employees' everyday routine by employing a qualitative study that involves 20 stakeholders, representative of different organizations and roles. We made use of an assessment framework based on Soft Systems Methodology (SSm) and Normalization Process Theory (NPT) comprised of five phases: Phase One defines the boundaries, aims, and goals of the issue under study; Phase Two consists of data collection, drawing on the e-Health Implementation Toolkit (e-HIT); Phase Three involves short presentations and breakout group activities to provide information on the new policy; Phase Four employs system thinking tasks to structure debate and builds shared understanding among participants; Phase Five applies NPT to appraise the organizational position around complexity based on information from the preceding steps. We found two main obstacles to implementing complexity approaches: (1) a lack of a shared understanding of the key concepts in complexity and their practical implications; (2) stakeholders' fear of significant disruption to work routines and power relationships. We recommend addressing these issues with appropriate training and customization of goals and tools that may enable complexity approaches to succeed within the Scottish public health context. Our assessment framework allows the recognition of key mechanisms to support how Scotland's Public Health body can enhance the implementation of complexity approaches. The appraisal framework could be used to study early-stage policy implementation in other contexts.
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Affiliation(s)
- Claudia Zucca
- Jheronimus Academy of Data Science, Tilburg University, Tilburg, Netherlands,*Correspondence: Claudia Zucca
| | - Emily Long
- MRC/CSO Social and Public Health Sciences Unit (MRC), University of Glasgow, Glasgow, United Kingdom
| | - Jeremy Hilton
- School of Defence and Security, Cranfield University at the Defence Academy of the UK, Cranfield, United Kingdom
| | - Mark McCann
- MRC/CSO Social and Public Health Sciences Unit (MRC), University of Glasgow, Glasgow, United Kingdom
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Guralnick S, Fondahn E, Amin A, Bittner EA. Systems-Based Practice: Time to Finally Adopt the Orphan Competency. J Grad Med Educ 2021; 13:96-101. [PMID: 33936541 PMCID: PMC8078067 DOI: 10.4300/jgme-d-20-00839.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Susan Guralnick
- Susan Guralnick, MD, FAAP, is Associate Dean for Graduate Medical Education, Designated Institutional Official, and Professor of Pediatrics, University of California, Davis
| | - Emily Fondahn
- Emily Fondahn, MD, FACP, is Associate Professor of Medicine, and Associate Program Director, Internal Medicine Residency, Washington University School of Medicine in St. Louis, and Medical Director of Graduate Medical Education and Medical Staff Services, Barnes-Jewish Hospital
| | - Alpesh Amin
- Alpesh Amin, MD, MBA, MACP, SFHM, FACC, FRCP (Lond), is Professor and Chair, Department of Medicine, University of California, Irvine
| | - Edward A. Bittner
- Edward A. Bittner, MD, PhD, MSEd, is Associate Professor of Anesthesia, Harvard Medical School, and Program Director, Critical Care-Anesthesiology Fellowship, Massachusetts General Hospital
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Gonzalo JD, Chuang CH, Glod SA, McGillen B, Munyon R, Wolpaw DR. General Internists as Change Agents: Opportunities and Barriers to Leadership in Health Systems and Medical Education Transformation. J Gen Intern Med 2020; 35:1865-1869. [PMID: 31898138 PMCID: PMC7280380 DOI: 10.1007/s11606-019-05611-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/21/2019] [Accepted: 12/06/2019] [Indexed: 01/20/2023]
Abstract
Health systems are increasingly engaging in mission development around the quadruple aim of patient experience of care, population health, cost of care, and work-life balance of clinicians. This integrated approach is closely aligned with the education principles and competencies of health systems science (HSS), which includes population health, high-value care, leadership, teamwork, collaboration, and systems thinking. Influenced by health outcomes research, the systems-based practice competency, and the Clinical Learning Environment Review, many medical schools and residency programs are taking on the challenge of comprehensively incorporating these HSS competencies into the education agenda. General internal medicine physicians, inclusive of hospitalists, geriatricians, and palliative and primary care physicians, are at the frontlines of this transformation and uniquely positioned to contribute to and lead health system transformation, role model HSS competencies for trainees, and facilitate the education of a new workforce equipped with HSS skills to accelerate change in healthcare. Although GIM faculty are positioned to be early adopters and leaders in evolving systems of care and education, professional development and changes with academic health systems are required. This Perspective article explores the conceptualization and opportunities to effectively link GIM with healthcare and medical education transformation.
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Affiliation(s)
- Jed D Gonzalo
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA.
| | - Cynthia H Chuang
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Susan A Glod
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Brian McGillen
- Division of Hospital Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Ryan Munyon
- Division of Hospital Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel R Wolpaw
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
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Gonzalo JD, Ogrinc G. Health Systems Science: The "Broccoli" of Undergraduate Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1425-1432. [PMID: 31149925 DOI: 10.1097/acm.0000000000002815] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Health system leaders are calling for reform of medical education programs to meet evolving needs of health systems. U.S. medical schools have initiated innovative curricula related to health systems science (HSS), which includes competencies in value-based care, population health, system improvement, interprofessional collaboration, and systems thinking. Successful implementation of HSS curricula is challenging because of the necessity for new curricular methods, assessments, and educators and for resource allocation. Perhaps most notable of these challenges, however, is students' mixed receptivity. Although many students are fully engaged, others are dissatisfied with curricular time dedicated to competencies not perceived as high yield. HSS learning can be viewed as "broccoli"-students may realize it is good for them in the long term, but it may not be palatable in the moment. Further analysis is necessary for accelerating change both locally and nationally.With over 11 years of experience in global HSS curricular reform in 2 medical schools and informed by the curricular implementation "performance gap," the authors explore student receptivity challenges, including marginalization of HSS coursework, infancy of the HSS field, relative nascence of curricula and educators, heterogeneity of pedagogies, tensions in students' perceptions of their professional role, and culture of HSS integration. The authors call for the reexamination of 5 issues influencing HSS receptivity: student recruitment processes, faculty development, building an HSS academic "home," evaluation metrics, and transparent collaboration between medical schools. To fulfill the social obligation of meeting patients' needs, educators must seek a shared understanding of underlying challenges of HSS innovations.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is associate professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-1253-2963. G. Ogrinc is professor of medicine, Dartmouth Institute for Health Policy and Clinical Practice, and senior associate dean for medical education, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Wang ES, Velásquez ST, Smith CJ, Matthias TH, Schmit D, Hsu S, Leykum LK. Triaging Inpatient Admissions: an Opportunity for Resident Education. J Gen Intern Med 2019; 34:754-757. [PMID: 30993610 PMCID: PMC6502926 DOI: 10.1007/s11606-019-04882-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the context of internal medicine, "triage" is a newly popularized term that refers to constellation of activities related to determining the most appropriate disposition plans for patients, including assessing patients for admissions into the inpatient medicine service. The physician or "triagist" plays a critical role in the transition of care from the outpatient to the inpatient settings, yet little literature exists addressing this particular transition. The importance of this set of responsibilities has evolved over time as health systems become increasingly complex to navigate for physicians and patients. With the emphasis on hospital efficiency metrics such as emergency department throughput and appropriateness of admissions, this type of systems-based thinking is a necessary skill for practicing contemporary inpatient medicine. We believe that triaging admissions is a critical transition in the care continuum and represents an entrustable professional activity that integrates skills across multiple Accreditation Council for Graduate Medical Education (ACGME) competencies that internal medicine residents must master. Specific curricular competencies that address the domains of provider, system, and patient will deliver a solid foundation to fill a gap in skills and knowledge for the triagist role in IM residency training.
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Affiliation(s)
- Emily S Wang
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA.
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Sadie Trammell Velásquez
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Christopher J Smith
- Division of Hospital Medicine, University of Nebraska Medicine Center, Omaha, NE, USA
| | - Tabatha H Matthias
- Division of Hospital Medicine, University of Nebraska Medicine Center, Omaha, NE, USA
| | - David Schmit
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sherwin Hsu
- Department of Medicine, Olive View - University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Luci K Leykum
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General and Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Plack MM, Goldman EF, Scott AR, Pintz C, Herrmann D, Kline K, Thompson T, Brundage SB. Systems Thinking and Systems-Based Practice Across the Health Professions: An Inquiry Into Definitions, Teaching Practices, and Assessment. TEACHING AND LEARNING IN MEDICINE 2018; 30:242-254. [PMID: 29283669 DOI: 10.1080/10401334.2017.1398654] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Phenomenon: Systems thinking is the cornerstone of systems-based practice (SBP) and a core competency in medicine and health sciences. Literature regarding how to teach or apply systems thinking in practice is limited. This study aimed to understand how educators in medicine, physical therapy, physician assistant, nursing, and speech-language pathology education programs teach and assess systems thinking and SBP. APPROACH Twenty-six educators from seven different degree programs across the five professions were interviewed and program descriptions and relevant course syllabi were reviewed. Qualitative analysis was iterative and incorporated inductive and deductive methods as well as a constant comparison of units of data to identify patterns and themes. FINDINGS Six themes were identified: 1) participants described systems thinking as ranging across four major levels of healthcare (i.e., patient, care team, organization, and external environment); 2) participants associated systems thinking with a wide range of activities across the curriculum including quality improvement, Inter-professional education (IPE), error mitigation, and advocacy; 3) the need for healthcare professionals to understand systems thinking was primarily externally driven; 4) participants perceived that learning systems thinking occurred mainly informally and experientially rather than through formal didactic instruction; 5) participants characterized systems thinking content as interspersed across the curriculum and described a variety of strategies for teaching and assessing it; 6) participants indicated a structured framework and inter-professional approach may enhance teaching and assessment of systems thinking. Insights: Systems thinking means different things to different health professionals. Teaching and assessing systems thinking across the health professions will require further training and practice. Tools, techniques, taxonomies and expertise outside of healthcare may be used to enhance the teaching, assessment, and application of systems thinking and SBP to clinical practice; however, these would need to be adapted and refined for use in healthcare.
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Affiliation(s)
- Margaret M Plack
- a Department of Physical Therapy and Health Care Sciences , School of Medicine and Health Sciences, George Washington University , Washington, DC , USA
| | - Ellen F Goldman
- b Department of Human and Organizational Learning , Graduate School of Education and Human Development, George Washington University , Washington, DC , USA
- c Office of Faculty Affairs and Professional Development, George Washington University , Washington, DC , USA
| | - Andrea R Scott
- b Department of Human and Organizational Learning , Graduate School of Education and Human Development, George Washington University , Washington, DC , USA
| | - Christine Pintz
- d School of Nursing, George Washington University , Washington, DC , USA
| | - Debra Herrmann
- e Department of Physician Assistant Studies , George Washington University , Washington, DC , USA
| | - Kathleen Kline
- f Office of Medical Education, School of Medicine and Health Sciences, George Washington University , Washington DC , USA
| | - Tracey Thompson
- f Office of Medical Education, School of Medicine and Health Sciences, George Washington University , Washington DC , USA
| | - Shelley B Brundage
- g Department Speech , Language, and Hearing Sciences, George Washington University , Washington, DC , USA
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Hwang JI, Park HA. Nurses’ systems thinking competency, medical error reporting, and the occurrence of adverse events: a cross-sectional study. Contemp Nurse 2017; 53:622-632. [DOI: 10.1080/10376178.2017.1409081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jee-In Hwang
- Department of Nursing, College of Nursing Science, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul 02447, South Korea
| | - Hyeoun-Ae Park
- Department of Biostatistics and Health Informatics, School of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
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21
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Vithanage R, Knox B, Ryan A. Game of Hospitals. CLINICAL TEACHER 2017; 14:279-283. [DOI: 10.1111/tct.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ruvini Vithanage
- Department of Medical Education; University of Melbourne; Melbourne Victoria Australia
| | - Benita Knox
- Department of Medical Education; University of Melbourne; Melbourne Victoria Australia
| | - Anna Ryan
- Department of Medical Education; University of Melbourne; Melbourne Victoria Australia
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Gonzalo JD, Graaf D, Kass LE, Promes SB, Wolpaw DR, George DR. Medical Students as Systems Ethnographers: Exploring Patient Experiences and Systems Vulnerabilities in the Emergency Department. AEM EDUCATION AND TRAINING 2017; 1:225-233. [PMID: 30051039 PMCID: PMC6001711 DOI: 10.1002/aet2.10038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The objectives were 1) to design systems ethnography roles for first-year medical students that could enhance student learning with regard to healthcare systems, ethnography, and systems thinking and 2) to describe strategies for other education programs seeking to implement systems ethnography roles in clinical settings. METHODS Fourteen medical students were educated about ethnography and systems thinking and linked with patients in the emergency department (ED) for 12 to 15 hours to observe patient experiences and clinical processes. Students submitted written assignments, participated in a debriefing exercise with ED and medical education leadership, and completed an electronic survey regarding educational benefits and perceived clinical value conferred to the ED using 5-point Likert-scale questions. Qualitative methods were used to analyze both students' assignments and notes taken during the debriefing session, including small-group report-outs and discussions, and to identify vulnerabilities in the patient experience. RESULTS Students identified one overarching theme of the patient experience-prolonged waiting in close proximity to the fast-paced, hectic "world" of the ED. Four key categories of systems vulnerabilities were identified through student observations: 1) patient experience; 2) communication and collaboration; 3) processes, physical space, and resources; and 4) professionalism. Students reported improved appreciation for challenges experienced by patients (3.92/5), importance of communication between providers and patients (3.92/5), and improved understanding of the patient experience while receiving care (3.77/5). CONCLUSIONS These results demonstrate how innovative systems ethnography experiences for medical students can provide unique educational opportunities while at the same time adding value by highlighting shortcomings in the care environment that can be used for system improvement.
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Affiliation(s)
- Jed D. Gonzalo
- Office of Medical EducationPenn State College of MedicineHersheyPA
| | - Deanna Graaf
- Office of Medical EducationPenn State College of MedicineHersheyPA
| | - Lawrence E. Kass
- Department of Emergency MedicinePenn State College of MedicineHersheyPA
| | - Susan B. Promes
- Department of Emergency MedicinePenn State College of MedicineHersheyPA
| | - Daniel R. Wolpaw
- Office of Medical EducationPenn State College of MedicineHersheyPA
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O'Brien BC, Bachhuber MR, Teherani A, Iker TM, Batt J, O'Sullivan PS. Systems-Oriented Workplace Learning Experiences for Early Learners: Three Models. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:684-693. [PMID: 27254010 DOI: 10.1097/acm.0000000000001243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Early workplace learning experiences may be effective for learning systems-based practice. This study explores systems-oriented workplace learning experiences (SOWLEs) for early learners to suggest a framework for their development. METHOD The authors used a two-phase qualitative case study design. In Phase 1 (spring 2014), they prepared case write-ups based on transcribed interviews from 10 SOWLE leaders at the authors' institution and, through comparative analysis of cases, identified three SOWLE models. In Phase 2 (summer 2014), studying seven 8-week SOWLE pilots, the authors used interview and observational data collected from the seven participating medical students, two pharmacy students, and site leaders to construct case write-ups of each pilot and to verify and elaborate the models. RESULTS In Model 1, students performed specific patient care activities that addressed a system gap. Some site leaders helped students connect the activities to larger systems problems and potential improvements. In Model 2, students participated in predetermined systems improvement (SI) projects, gaining experience in the improvement process. Site leaders had experience in SI and often had significant roles in the projects. In Model 3, students worked with key stakeholders to develop a project and conduct a small test of change. They experienced most elements of an improvement cycle. Site leaders often had experience with SI and knew how to guide and support students' learning. CONCLUSIONS Each model could offer systems-oriented learning opportunities provided that key elements are in place including site leaders facile in SI concepts and able to guide students in SOWLE activities.
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Affiliation(s)
- Bridget C O'Brien
- B.C. O'Brien is associate professor, Department of Medicine, and research faculty member, Office of Research and Development in Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California. M.R. Bachhuber is associate clinical professor, Department of Medicine, University of California, San Francisco, and deputy associate chief of staff for education, San Francisco VA Medical Center, San Francisco, California. A. Teherani is professor, Department of Medicine, and research faculty member, Office of Research and Development in Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California. T.M. Iker was research assistant, Office of Research and Development in Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California, at the time this work was completed. J. Batt is clinical research coordinator, Department of Nephrology, University of California, San Francisco, San Francisco, California. P.S. O'Sullivan is professor, Department of Medicine and Surgery, and director, Office of Research and Development in Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California
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Bowe CM, Armstrong E. Assessment for Systems Learning: A Holistic Assessment Framework to Support Decision Making Across the Medical Education Continuum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:585-592. [PMID: 27465232 DOI: 10.1097/acm.0000000000001321] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Viewing health care from a systems perspective-that is, "a collection of different things which, working together, produce a result not achievable by the things alone"-raises awareness of the complex interrelationships involved in meeting society's goals for accessible, cost-effective, high-quality health care. This perspective also emphasizes the far-reaching consequences of changes in one sector of a system on other components' performance. Medical education promotes this holistic view of health care in its curricula and competency requirements for graduation at the undergraduate and graduate training levels. But how completely does medical education apply a systems lens to itself?The continuum of medical training has undergone a series of changes that have moved it more closely to a systems organizational model. Competency assessment criteria have been expanded and more explicitly defined for learners at all levels of training. Outcomes data, in multiple domains, are monitored by external reviewers for program accreditation. However, translating increasing amounts of individual outcomes into actionable intelligence for decision making poses a formidable information management challenge.Assessment in systems is designed to impart a "big picture" of overall system performance through the synthesis, analysis, and interpretation of outcomes data to provide actionable information for continuous systems improvement, innovation, and long-term planning. A systems-based framework is presented for use across the medical education continuum to facilitate timely improvements in individual curriculum components, continuous improvement in overall program performance, and program decision making on changes required to better address society's health care needs.
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Affiliation(s)
- Constance M Bowe
- C.M. Bowe is codirector, Systems Approach to Assessment in Health Professions Education, Harvard Macy Institute, senior consultant, Partners Health Care International, and professor emeritus, Clinical Neurology, University of California, Davis, School of Medicine, Sacramento, California. E. Armstrong is director, Harvard Macy Institute, and clinical professor, Pediatrics, Harvard Medical School, Boston, Massachusetts
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Ruis AR, Shaffer DW, Shirley DK, Safdar N. Teaching health care workers to adopt a systems perspective for improved control and prevention of health care-associated infections. Am J Infect Control 2016; 44:1360-1364. [PMID: 27424302 PMCID: PMC6055227 DOI: 10.1016/j.ajic.2016.04.211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
Affiliation(s)
- A R Ruis
- Wisconsin Center for Education Research and Dept of Surgery, University of Wisconsin-Madison, Madison, WI
| | | | - Daniel K Shirley
- Department of Medicine, Division of Infectious Disease, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Disease, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
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Brainard J, Hunter PR. Do complexity-informed health interventions work? A scoping review. Implement Sci 2016; 11:127. [PMID: 27647152 PMCID: PMC5029105 DOI: 10.1186/s13012-016-0492-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/06/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The lens of complexity theory is widely advocated to improve health care delivery. However, empirical evidence that this lens has been useful in designing health care remains elusive. This review assesses whether it is possible to reliably capture evidence for efficacy in results or process within interventions that were informed by complexity science and closely related conceptual frameworks. METHODS Systematic searches of scientific and grey literature were undertaken in late 2015/early 2016. Titles and abstracts were screened for interventions (A) delivered by the health services, (B) that explicitly stated that complexity science provided theoretical underpinning, and (C) also reported specific outcomes. Outcomes had to relate to changes in actual practice, service delivery or patient clinical indicators. Data extraction and detailed analysis was undertaken for studies in three developed countries: Canada, UK and USA. Data were extracted for intervention format, barriers encountered and quality aspects (thoroughness or possible biases) of evaluation and reporting. RESULTS From 5067 initial finds in scientific literature and 171 items in grey literature, 22 interventions described in 29 articles were selected. Most interventions relied on facilitating collaboration to find solutions to specific or general problems. Many outcomes were very positive. However, some outcomes were measured only subjectively, one intervention was designed with complexity theory in mind but did not reiterate this in subsequent evaluation and other interventions were credited as compatible with complexity science but reported no relevant theoretical underpinning. Articles often omitted discussion on implementation barriers or unintended consequences, which suggests that complexity theory was not widely used in evaluation. CONCLUSIONS It is hard to establish cause and effect when attempting to leverage complex adaptive systems and perhaps even harder to reliably find evidence that confirms whether complexity-informed interventions are usually effective. While it is possible to show that interventions that are compatible with complexity science seem efficacious, it remains difficult to show that explicit planning with complexity in mind was particularly valuable. Recommendations are made to improve future evaluation reports, to establish a better evidence base about whether this conceptual framework is useful in intervention design and implementation.
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Affiliation(s)
- Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Paul R. Hunter
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
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Colbert CY, Dannefer EF, French JC. Clinical Competency Committees and Assessment: Changing the Conversation in Graduate Medical Education. J Grad Med Educ 2015. [PMID: 26221426 PMCID: PMC4512781 DOI: 10.4300/jgme-d-14-00448.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Brandon CJ, Mullan PB. Teaching medical management and operations engineering for systems-based practice to radiology residents. Acad Radiol 2013; 20:345-50. [PMID: 23452480 DOI: 10.1016/j.acra.2012.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 09/16/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
Abstract
RATIONALE AND OBJECTIVES To better prepare radiology residents for providing care within the context of the larger health care system, this study evaluated the feasibility and impact of a curriculum to enhance radiology residents' understanding and ability to apply concepts from medical management and industrial and operational engineering to systems-based practice problems in radiology practice. MATERIALS AND METHODS A multiprofessional team including radiology, medical education, and industrial and operational engineering professionals collaborated in developing a seven-module curriculum, including didactic lectures, interactive large-group analysis, and small-group discussions with case-based radiology examples, which illustrated real-life management issues and the roles physicians held. Residents and faculty participated in topic selection. Pre- and post-instruction formative assessments were administered, and results were shared with residents during teaching sessions. RESULTS Attendance and participation in case-based scenario resolutions indicate the feasibility and impact of the interactive curriculum on residents' interest and ability to apply curricular concepts to systems-based practice in radiology. Paired t test analyses (P < .05) and effect sizes showed residents significantly increased their knowledge and ability to apply concepts to systems-based practice issues in radiology. CONCLUSIONS Our iterative curriculum development and implementation process demonstrated need and support for a multiprofessional team approach to teach management and operational engineering concepts. Curriculum topics are congruent with Accreditation Council for Graduate Medical Education requirements for systems-based practice. The case-based curriculum using a mixed educational format of didactic lectures and small-group discussion and problem analysis could be adopted for other radiology programs, for both residents and continuing medical education applications.
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Educating fellows in practice-based learning and improvement and systems-based practice: The value of quality improvement in clinical practice. J Crit Care 2013; 28:112.e1-5. [DOI: 10.1016/j.jcrc.2012.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 06/21/2012] [Accepted: 07/01/2012] [Indexed: 11/20/2022]
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Colbert CY, Myers JD, Cable CT, Ogden PE, Mirkes C, McNeal T, Skeen S. An alternative practice model: residents transform continuity clinic and become systems thinkers. J Grad Med Educ 2012; 4:232-6. [PMID: 23730447 PMCID: PMC3399618 DOI: 10.4300/jgme-d-11-00133.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 12/29/2011] [Accepted: 01/09/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND A changing health care environment has created a need for physicians trained in health system improvement. Residency programs have struggled to teach and assess practice-based learning and improvement and systems-based practice competencies, particularly within ambulatory settings. INTERVENTION We describe a resident-created and resident-led quality and practice-improvement council in an internal medicine continuity clinic. We conducted focus groups and report on residents' perspectives on council membership, practice management experiences, quality improvement projects, and resident satisfaction. METHOD Focus groups were held from May 2009 to March 2010 with internal medicine residents (N = 5/focus group) who participated in the Continuity Clinic Ownership in Resident Education (CCORE) council. Data were analyzed with a grounded theory approach. RESULTS DURING THE FOCUS GROUPS, RESIDENTS RESPONDED TO THE QUESTION: "Do you have any new insights into delivering quality patient care in an outpatient clinic as a result of this experience (CCORE membership)?" The qualitative analysis resulted in 6 themes: systems thinking and systems-based care skills; improving quality of patient care; improved clinic efficiency; ownership of patients; need for improved communication of practice changes; and a springboard for research. CONCLUSIONS CCORE residents participated in system changes and acquired leadership skills while working on practice-based and system problems in a clinic microsystem. We believe this model can be implemented by other residency programs to promote the development of systems thinking in residents, increase their ownership of continuity clinic, and empower them to implement system changes.
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