Teaching Essential Skills: Training Medical Students in Quality Improvement, Procedures, and Transitions of Care

1Duke University School of Medicine, Durham, NC
2Duke University School of Medicine, Durham, NC
3Duke University School of Medicine, Durham, NC
4Duke University School of Medicine, Durham, NC
5Duke University School of Medicine, Durham, NC
6Duke University School of Medicine, Durham, NC

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 168

Background:

Medical school educators are charged with providing students the tools needed to succeed as physicians. Trainees begin residency with a knowledge base shaped by individual experiences and with an awareness of both strengths and potential gaps in preparation. At our institution, 3 fields — overnight patient care, hands‐on experience performing procedures, and an understanding of quality improvement in medicine — are areas in which additional training can be provided in an effective, efficient manner. Introducing a new selective in hospital medicine and quality improvement provides students a way to cultivate their understanding of these crucial topics.

Purpose:

To determine whether a hospital medicine and quality improvement selective focused on specific aspects of patient care affords medical students a measurable growth in clinical competency and confidence while introducing them to essential quality improvement principles.

Description:

The new selective exposes students to overnight care and emergencies, common bedside procedures (thoracentesis, paracentesis, and lumbar puncture), training in consultative general medicine, practice with patient care transitions, and an introduction to quality improvement in health care. Students completed optional prerotation and postrotation confidence and knowledge assessments. Students were directly observed and given feedback on transitions of care by practicing physicians. Self‐reported confidence was assessed using a 5‐point Likert‐type scale. Data were analyzed using the paired t test.

Conclusions:

Postrotation confidence improved in management of cross‐cover emergencies including chest pain, dyspnea, hyperglycemia, altered mental status, and responding to alert laboratories (P < 0.05). Similar improvement in confidence was seen in common general medicine consultation diagnoses, encompassing cardiac risk assessment, hypertension, anemia, acute kidney injury, and delirium (P < 0.05). Confidence with delivering clear, concise verbal handoffs of care (P < 0.05) also improved. Significant improvement was seen in developing a quality improvement project, writing an aim statement, and using a PDSA cycle to document a test of change (P < 0.05). All students scored 100% on the postrotation knowledge assessment of quality improvement principles. These data frame evidence of an effective, novel medical school curriculum. Early results indicate a promising combination of improved clinical knowledge, improved procedural skills, and improved confidence in areas that would benefit medical trainees given more emphasis in the medical school curriculum. Medical student training requires an increased and earlier emphasis on clinical skills and understanding of quality improvement to improve patient safety and care. By beginning this training earlier in medical school and in a directed manner, it provides a framework for a more competent and confident health care provider.

To cite this abstract:

McManigle W, Graham A, Bae J, O'Brien C, Setji N, Chudgar S. Teaching Essential Skills: Training Medical Students in Quality Improvement, Procedures, and Transitions of Care. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 168. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/teaching-essential-skills-training-medical-students-in-quality-improvement-procedures-and-transitions-of-care/. Accessed June 17, 2019.

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