The Advocate for Clinical Education (ACE): A Point‐of‐Care Coaching and Feedback Model for Resident Education in Quality Improvement and Patient Safety

1Harborview Medical Center, Seattle, WA
2Harborview Medical Center, Seattle, WA
3Harborview Medical Center, Seattle, WA
4Harborview Medical Center, Seattle, WA
5University of Washington, Seattle, WA
6Harborview Medical Center, Seattle, WA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 190


As quality improvement (Ql) and patient safety (PS) gain momentum as unquestioned core competencies in hospital medicine, residency Training programs are charged wilh educating the next generation of physicians in practice and promotion of these principles. Adult learning theory suggests that delivery of new content in the context of current experiences, rote modeling, and feedback is essential. In‐person coaching has been shown to improve QI process outcomes, yet lo our knowledge, there are no published sludies examining the impact of an integrated point‐of‐care coaching‐and‐feedback model on resident OI/PS education.


To assess the effects of an in‐person coaching program (ACE) on internal medicine (IM) and general surgery (GS) resident OI/PS behaviors at 1 hospital in our university health care system.


This multidisciplinary program is an ongoing 6‐month pilot. The intervention was designed to be resident centered and integrated at point of care within an existing educational framework. Target behaviors for all residents include professionalism (team introductions/identification, shaking hands, contact wilh primary care physicians, wearing white coals/identification badges}, infection control (hand washing/adherence lo contacl precautions), appropriate restraint use, interpreter utilizalion for patients with Jimited English proficiency (IM), and pain control related to wound care (GS). The ACE receives 0.5 FTE from the medical director's office with additional support from hospital QI and nursing and the IM and GS departments; she is a practicing ICU nurse. Alternating months on IM and GS, the ACE rounds wilh intervention teams, collects performance data, and provides in‐time feedback at the bedside. Intervention teams review aggregate data, presented in the context of impact on patient outcomes (e.g., rates of hospital‐acquired infections relative to hand hygiene). To control for differences in behavior throughout call cycles and effects of observation alone: data are obtained on postcall and non‐poslcall days and on control learns receiving no feedback. To date, the ACE has observed about 2000 patient encounters, 96 residents, and 16 attending physicians. Preliminary data suggest that IM and GS residents place high value on OI/PS education yet overestimate the degree to which they conform to standards. Following ACE implemenlalion, we have demonstrated improvements in professionalism and hand washing for IM and GS residents. There appears to be a positive correlation between intensity of point‐of‐care coaching and compliance. Early qualitative results suggest lhat the program is well received; quantitative evaluation is forthcoming.


The ACE program is 1 prototype of a coaching model for OI/PS education. This program is easily incorporated into existing care delivery systems, can be tailored to unique learner needs and may serve as a model for integration of hospital medicine core competencies at the bedside.

Author Disclosure:

A. Schleyer. none; J. Best, none; L. Mclntyre, none; D. Fleming, none; D. Martin, none: J. R. Goss, none.

To cite this abstract:

Schtayw A, Best J, Mclntyre L, Fleming D, Martin D, Goss J. The Advocate for Clinical Education (ACE): A Point‐of‐Care Coaching and Feedback Model for Resident Education in Quality Improvement and Patient Safety. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 190. Journal of Hospital Medicine. 2010; 5 (suppl 1). Accessed May 26, 2019.

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