Paul M. Paulman

From professional silos to interprofessional education: campuswide focus on quality of care.

Objectives The Institute of Medicine called for the integration of interprofessional education (IPE) into health professions curricula, in order to improve health care quality. In response, we developed, implemented, and evaluated a campus wide IPE program, shifting from traditional educational silos to greater collaboration. Methods Students (155) and faculty (30) from 6 academic programs (nursing, medicine, public health, allied health, dentistry, and pharmacy) engaged with a university hospital partner to deliver this program. The content addressed principles of IPE, teamwork development and 2 common quality care problems: hospital-acquired infections and communication errors. Pre-/post-surveys, the Readiness for Interprofessional Learning Scale, and the Interprofessional Education Perception Scale, were used for descriptive assessment of student learning. Results Students demonstrated increased understanding of health care quality and interprofessional teamwork principles and reported positive attitudes toward shared learning. While responses to the Readiness for Interprofessional Learning Scale grew more positive after the program, scores on the Interprofessional Education Perception Scale were more homogeneous. Both students and faculty highly evaluated the experience. Conclusion This program was a first step in preparing individuals for collaborative learning, fostering awareness and enthusiasm for IPE among students and faculty, and demonstrating the feasibility of overcoming common barriers to IPE such as schedule coordination and faculty buy-in.

Do Clerkship Directors Think Medical Students Are Prepared for the Clerkship Years

Purpose Educators have begun to question whether medical students are adequately prepared for the core clerkships. Inadequate preclerkship preparation may hinder learning and may be predictive of future achievement. This study assessed and compared the views of clerkship directors regarding student preparation for the core clinical clerkships in six key competencies. Method In 2002, a national survey was conducted of 190 clerkship directors in internal medicine, family medicine, pediatrics, surgery, obstetrics/gynecology, and psychiatry from 32 U.S. medical schools. Clerkship directors were asked to report their views on the appropriate level of student preparation needed to begin the core clinical clerkships (none, minimal, intermediate, advanced), and the adequacy of that preparation (ranging from “much less” to “much more than necessary”) in six key clinical competencies. Results A total of 140 clerkship directors responded (74%). The majority reported that students need at least intermediate ability in five of six competencies: communication (96%), professionalism (96%), interviewing/physical examination (78%), life-cycle stages (57%), epidemiology/probabilistic thinking (56%), and systems of care (27%). Thirty to fifty percent of clerkship directors felt students are less prepared than necessary in the six competencies. Views were similar across all specialties and generally did not differ by other clerkship director characteristics. Conclusions Almost half of clerkship directors were concerned that students do not receive adequate preparation in key competencies before starting the core clinical clerkships. Many medical schools may need to give more attention to the preclerkship preparation of students in these high-priority areas.

Student-Perceived Influences on Performance During Simulation.

BACKGROUND Understanding the effect of the context of simulation to learning and performance is critical to ensure not only optimal learning but to provide a valid and reliable means to evaluate performance. The purpose of this study is to identify influences on performance from the student perspective and understand the contextual barriers inherent in simulation before using simulation for high-stakes testing. METHOD This study used a qualitative descriptive design. Senior nursing students (N = 29) provided nursing care during simulation. Vocalized thoughts during simulation and reflective debriefing were digitally recorded and transcribed verbatim. Thematic analysis was conducted on transcribed data. RESULTS Student performance during simulation was influenced by anxiety, uncertainty, technological limitations, and experience with the patient condition. Students had few previous simulation-based learning experiences that may have influenced performance. CONCLUSIONS More needs to be understood regarding factors affecting simulation performance before pass-or-fail decisions are made using this technology. [J Nurs Educ. 2016;55(7):396-398.].

Summary of Proceedings From the Association of American Medical Colleges 2011 Integrating Quality Meeting

As Editor-in-Chief of the American Journal of Medical Quality (AJMQ), and as a member of the Association of American Medical Colleges (AAMC) Integrating Quality (IQ) Steering Committee, I am particularly pleased to bring this special supplement to fruition. The supplement highlights proceedings from the AAMC 2011 IQ Meeting, which was held in Chicago, Illinois, on June 9 and 10, 2011. Having delivered the keynote address at the 2010 version of the IQ meeting, I have seen firsthand how far this important initiative has come. Let us examine the full title more closely, that is, “Integrating Quality: Linking Clinical and Educational Excellence.” How exactly can we link clinical improvement and educational excellence? I believe the genesis of this linkage can be traced directly to October 26, 2009, when the Lucien Leape Institute at the National Patient Safety Foundation published Unmet Needs: Teaching Physicians to Provide Safe Care. The recommendations contained in this report came from an expert roundtable comprising Lucien Leape Institute board members and invited experts (including this author) from medical education and related fields. The report described the existing system of medical education as greatly lacking in the arena of quality and safety and called for sweeping reform of both undergraduate and graduate medical education curricula. My colleagues and I used the unmet needs report as a jumping-off point. Indeed, Academic Medicine received scores of papers from a national solicitation, and those that were published in this journal laid out multiple worthy plans for integrating clinical improvement and educational excellence in such a way that the die was cast by late in the fourth quarter of 2009. In the editorial accompanying the Academic Medicine special issue, I noted that there were “growing choruses of voices from across all of organized medicine, which have collectively spoken out about the crucial need for better care.” Astute observers noted that “unless everyone in health care recognizes that they have 2 jobs when they come to work every day—that is, doing the work and improving it—we will have difficulty maintaining and nurturing our true professionalism . . . continuously moving toward new and better levels of performance.” At this point, the AAMC launched its IQ initiative. Lending their national authority to this important topic, the AAMC has come a long way in providing leadership for this crucial linkage. They have gone beyond the Lucien Leape unmet needs report and eclipsed all previous work in this arena. The June 2011 meeting is further evidence of their success, luring hundreds of individuals to Chicago to ponder issues that only 3 or 4 years ago seemed like the distant future. This is all well and good, but the AAMC cannot rest on its laurels. What will success look like when we finally link clinical improvement and educational excellence? I envision the development of a national core curriculum on quality and safety, applicable to both undergraduate and graduate medical education settings. I envision a world where quality and safety are not simply add-ons or electives to be slotted somewhere in the second semester of the fourth year of medical school. I also envision growth in the number of endowed chairs in quality and safety and a great expansion in the number of master’s programs in our field. Furthermore, with the implementation of the highly anticipated Accreditation Council for Graduate Medical Education institutional visit program, we finally will quantify institutional responses to the quality and safety agenda at the residency training level. We will no longer be able to check a box regarding our capabilities in systems-based learning and practice-based improvement. We will have to prove, once and for all, that house officers get it—that they are intimately involved in self-evaluation, measurement, and improvement. House officers will embrace the 2 jobs that all practitioners must have. 445460 AJMXXX10.1177/106286061244 5460American Journal of Medical Quality

STFM sponsors Predoctoral Directors Development Institute.

Imagine yourself as a faculty member in a family medicine department tasked with administrative responsibilities consistent with the role of a predoctoral director, such as oversight of the courses and advising programs offered to medical students. Although you may have a few years of experience with predoctoral teaching, you may feel you need more help to develop in your role and advance in your career. Now you have an opportunity for this training through a program called the Predoctoral Directors Development Institute or PDDI, sponsored by STFM.