Wingate University PA Program R Boeschel MSHS PAC E Maupin MMS PAC amp S Wolf MS PAS PAC Objectives Discuss the rationale for incorporating competencybased QI education across the curriculum ID: 784851
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Slide1
TRANSFORMATIVE COMPETENCY-BASED QUALITY IMPROVEMENT (QI) EDUCATION ACROSS THE CURRICULUM
Wingate University PA Program R. Boeschel MSHS, PA-C, E. Maupin MMS, PA-C & S. Wolf MS PAS, PA-C
Slide2Objectives
Discuss the rationale for incorporating competency-based QI education across the curriculumExamine a longitudinal strategy that includes classroom instruction, learning outside the classroom and culminates in a project-based capstoneLearn basic principles of survey development and evaluation via a hands-on
experience
Evaluate
assessment artifacts and measurement tools associated with a comprehensive QI
strategy
Slide3THE NEED FOR QI EDUCATION
Slide4Call to Arms
Institute of Medicine (IOM)To Err is Human
Crossing
the Quality Chasm: A New Health System for the 21
st
Century
Call for
academic reform
Slide5IOM 6 Care Delivery Areas for QI Focus
(IOM 2001)
Slide6Present Day Need for QI Initiatives
Public Health Globalization of medicineHealthcare accessibility
Healthcare Systems
Patient Safety
Medical Technology
Comprehensive Care
Slide7Need for QI Education
Documented gap70.7% of programs introduce students to the principles of QI in the didactic year38% report no student participation in QI projects
(
Kindratt
and
Orcutt
2017
)
Addressing the gap
ARC- PA
NCCPA
PAEA
AAPA
Slide8Accreditation Standards for QI in PA Education
The Accreditation Review Commission on Education for Physician Assistant Standards (ARC-PA 2012)
B2.13
“include instruction in patient safety,
quality improvement
, prevention of medical errors, and risk management.”
The Accreditation Review Commission on Education for Physician Assistant Standards (
ARC-PA
2019
)
B2.16
“The curriculum must include instruction in:
a) patient safety,
b) prevention of medical errors,
c)
quality improvement
, and
d) risk management
.”
Slide9Competencies for the PA profession
Medical
knowledge
Patient Care
Practice-based learning and improvement
System based practice
Interpersonal & Communication Skills
Professionalism
Slide10Proposed Core Competencies for New
PA Graduates
(PAEA 2018)
Slide11QI EDUCATION ACROSS THE CURRICULUM
Slide12QI Curriculum in Medical Education
Key Themes for Success
Learners need to actively participate in a QI experience
Learners should have access to a faculty member with QI experience
PA Program and faculty commitment
Barriers
Lack of time for QI curriculum
Lack of resources
Lack of expert faculty experience
No standardized approach to instruction with PA education
Making it relevant and interesting for students
(Berkowitz et al
.
2014)
Slide13General QI Curricular Approach
QI Focused Lectures
Online Modules
QI Focused Student Projects
QI Focused Capstone Projects
(Berkowitz et al
.
2014)
Slide14QI Education Across the Curriculum
PA 580: Research, Epidemiology, Statistics
PA 528: Healthcare Issues II
Didactic Phase
PA 620:
Capstone I
PA 720:
Capstone II
Clinical Phase
Apply Concepts of QI & Patient Safety to Practice
Active Participant & Leader in QI Initiatives as a Provider
Practice Ready
Slide15Didactic Phase Instructional Methods
PA 580: Research, Epidemiology, Statistics
In Class
Lectures
Journal
club/Documentary
d
iscussions
Clinical
scenarios
Student
presentations
Out of Class
Discussions
Individual
research
PA 528: Healthcare Issues II
In
Class
Modified
TeamSTEPPS
training
Class discussion
Case scenarios/analysis
Roleplaying exercises
Out of Class
Regular team meetings to prepare for class activities
Personal reflection
Slide16Clinical Phase Instructional Methods
PA
620:
Capstone I
Institute of Healthcare Improvement (IHI) Modules
QI Initiative Capstone Project
identification
&
selection
Survey
workshop
PA
720:
Capstone II
Pilot study of survey tool
Literature review
Evaluation of pilot study
Paper and oral presentation
Slide17SURVEY DEVELOPMENT AND EVALUATION
Slide18Slide19Relevant Terminology
SurveyDefined as
the measure of opinions and experiences of a group of people through the asking of question
Questionnaire
Defined as
a set of printed or written questions with a choice of answers, devised for the purposes of a survey or a statistical study
Pilot Study/Pilot Survey
Defined as
“A small-scale test of the methods and procedures to be used on a larger scale
(Porta, Dictionary of Epidemiology, 5
th
edition, 2008).
Slide20Survey Workshop Fundamentals*
Data collection logisticsInstrument design and constructionEmbedded instructions Question developmentResponse options
Timetable for administration and follow-up
Analysis of survey results
*
Adapted from Association of American Medical Colleges Medical Education Research Certificate Course 2013
Slide21Writing Questions: Where do you begin?
What do you want to learn?What can the respondents tell you?What questions will help you answer your research question?Mentoring is key!
Slide22Common Problems with Student Surveys
Number of questionsUnanswerable questions
Double-barreled questions
Unclear references or excessive jargon
Implicit negatives
Biased questions
Leading questions
Inappropriate response options
Unprofessional in appearance
Instructions unclear
Cumbersome to complete
Slide23“We do a very good job of teaching the biologic and physical sciences as the basis for the practice of medicine, but we have not done as well incorporating other content such as patient safety, quality improvement, and population health in our teaching. We need to broaden and integrate our curriculum across the educational continuum.”
~ The Josiah Macy Jr. Foundation
Slide24WHERE DO WE GO FROM HERE…
Slide25End Goals
Develop new PA graduates which practice evidence-based medicine and utilize clinical guidelines while embracing a true understanding of QI initiatives Encourage PA graduates to initiate and lead QI focused projects
E
ndorse quality value-based care
Slide26QUESTIONS?
Slide27References
The Accreditation Review Commission on Education for Physician Assistant. Accreditation Standards For Physician Assistant Education (4th ed.). http://www.arc-pa.org/wp-content/uploads/2016/10/Standards-4th-Ed. Published 2010, updated 2018. Accessed February 25, 2019. The Accreditation Review Commission on Education for Physician Assistant. Accreditation Standards For Physician Assistant Education (5th Ed.). http://www.arc-pa.org/wp-content/uploads/2019/09/Standards-5th-Ed-Sept-2019-fnl.pdf. Published 2019. Accessed September 27, 2019.
Agency for Health Care Research and Quality.
TeamSTEPPS
2.0. https://
www.ahrq.gov/teamstepps/index.html. Accessed September
30,
2019.
Berkowitz O, White SE, Goldgar C, Brisotti MF, Warner ML. Defining quality improvement education for physician assistants. The Journal of Physician Assistant Education. 2014;25(4):55-60.Boucher N, McMillen M, Gould, J. Agents for change: Nonphysician medical providers and health care quality. The Permanente Journal. 2015;19 (1): 90-93. Institute of Healthcare Improvement. IHI Open School Online Courses. http://www.ihi.org/education/IHIOpenSchool/Courses/Pages/default.aspx. Updated 2016. Accessed September 30, 2019. Institute of Medicine (U.S.). Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001.Kindratt TB,
Orcutt
VL. D
evelopment of a quality improvement curriculum in physician assistant studies.
The Journal of Physician Assistant Education.
2017;28(2):103-107.
Physician Assistant
Education
Association.
Core
Competencies for
New Physician
Assistant
Graduates.
https://
paealearning.org/wp-content/uploads/2018/10/Core-Competencies-for-New-PA-Graduates_FINAL_061918.pdf. Published 2018. Accessed September 29, 2019.
National Commission on Certification of Physician Assistants. Competencies for the physician assistant profession. https://prodcmsstoragesa.blob.core.windows.net/uploads/files/PACompetencies.pdf Published 2005, updated 2012. Accessed March 1, 2019.Ramos J. 5 ways QI can create stronger PAs. https://paeapnline.org/a2016/06/.
Published June 29, 2016.
Accessed February 28, 2019
.