Jun 18, 2009

A Hospital-Based Chapter: Curriculum, Research, and Reasons to Exist

In my second posting about my experiences as Aultman Hospital’s Institute for Healthcare Improvement (IHI) Open School Chapter Leader, I will describe the responses that the IHI Open School received from my medical school and hospital administrators and faculty. Each entity seemed to be drawn toward different aspects of the Open School. I believe such responses can serve as reference points as to how the Open School and individual Chapters can improve and evolve over time.

As I stated in my first posting, Aultman Hospital is a hospital-based Chapter of the IHI Open School. The hospital, itself, is a training ground for students in various health professions – including the students of my medical school whose main campus is about 35 minutes away. Those students at the medical school’s main campus are mainly first and second-year medical and pharmacy students who have yet to start their formal clinical training.

The response on campus was positive – if not slightly hesitant. The apparent hesitation as well as the overall positive reaction both appeared to stem from the same theme: quality improvement (QI) and patient safety (PS) in the curriculum. At our kick-off event, the topic of QI in medical education was touched upon by our speaker. Immediately, questions and comments arose from the audience, which was made up of both faculty and students. The discussion revolved around a point that was made by one of the clinical faculty members: to insert a topic into the curriculum, many times, can only result at the expense of another. If this is true, how does one justify the teaching of a topic that will not be directly tested on student exams?

There are no easy answers to this question. But, after the kick-off event, I wanted to look for clues.

I set up a meeting with my school’s Director of Career Development and Advising. I was interested to hear what the actual buzz was in terms of the Open School as well as the possibility of injecting IHI’s ideals into the medical school curriculum. I was surprised to hear of the faculty’s strong interest in the direct teaching of topics such as QI and PS. I gave my opinions on how such a thing could be implemented, and the meeting ended with both parties taking a “we shall see”-approach.

Shortly after this meeting, I was informed by multiple third year medical students as well as the Chair of the Department of Family Medicine that IHI’s online questions were used as part of the school’s M3 clinical site orientation (what my medical school calls “Intersession”). Though the Chair was extremely happy with the questions, themselves, he found that students were not as interested in doing the questions as he would have liked.

Nevertheless, as a Chapter Leader, I was sold on the idea that it was possible to include various lessons about QI and PS in an already established curriculum without sacrificing other lessons. The hope is that disseminating such information so early in the curriculum creates a stronger foundation upon which the student can build his or her tools as a physician. Also, such topics may even strike a chord of emotional importance to a few students as they did me. Further, I believe these events show the evolution of a campus from one that was once “IHI-less” to one that is working (even, at times, seemingly fighting the students, themselves) to include the ideals of QI and PS in the curriculum.

While the school seemed to be interested in curricular matters, the hospital at which my Chapter is based seemed to be more interested in matters of research and inclusion. The whole point (and rightly so) of a hospital-based chapter (as opposed to one that is campus-based) was to stress the universal importance of PS and QI. As I mentioned in my last posting, a number of nursing students seemed to have latched onto these ideals, and it remains to be seen how easily such ideals will be able to be stressed to other health care disciplines. As for communicating our message to medical students at Aultman Hospital, I found great partnerships with the hospital’s residency directors. In fact, one went out of his way to personally invite his students to our hospital kick-off event. I was also impressed with Aultman Hospital’s interest in the vast amount of possibilities that a group of students such as the Open School Chapter can offer in terms of conducting research. The broad topics of QI and PS allow for a vast amount of research options as well as a way to research ways to improve in-hospital methodology directly.

After setting the goal of developing a research project with my Open School Chapter, the hospital went out of its way to help our Chapter create, develop, fine-tune, and submit our research request and protocol to the human research review board. My Chapter Advisors did their best to read literature and brainstorm along with our Open School Chapter to develop the best research project. Yet, they allowed us the freedom to find our own way in terms of developing the project, itself. The research project was recently passed by the hospital’s HRRB, and it will begin at the end of the month of June.

Thankfully, I encountered very little in terms of negative reaction towards the IHI and the Open School. Many were excited to help bring the ideals of the IHI to the students on campus and at the hospital, and the lessons I took away from these experiences are important ones that I would like to pass on. To be honest, such lessons may be old-hat to the driven students who are no doubt reading this post. Yet, they are worth repeating because, in the midst of our busy lives as students, it is always nice for a Chapter Leader to have a starting point.

1. Do not be afraid to talk with administrators 1-on-1. My school is constantly fine-tuning its curriculum in order to continually improve its students’ knowledge-base. Yet, evaluations and focus groups aside, you and the administrator may surprise one another by merely sitting down in a quiet room for a candid discussion in regards to your passions.

2. This stuff is new – so make it familiar. Going over the possibilities of IHI’s curriculum with a school administrator was easy only after I sat down to reflect as to where such information would naturally fit into what has already been established. Sessions prior to clinical courses, times normally set aside for small group discussion, and lectures dealing with ethical considerations were areas in the curriculum where the IHI’s curriculum can be included without necessarily excluding other material.

3. Open School = inquiring minds who WANT to know – and have some time to find it out. Many physicians with whom I spoke about possible research topics seemed to be bursting with research questions that they had always harbored. Unfortunately, they never had the time or the man-power to investigate. Your Open School Chapter has that time and that man-power. The only rule: decide on a research question as a group. While discussing possible research topics (no matter how I felt, personally) I always inquired as to how each individual member felt about each particular topic. If even one person was not on board, I discarded the topic. My reason? The Open School is made up of unpaid students who all have other responsibilities and stressors other than the Open School. Therefore, I wanted to choose a research topic that would sustain the interest of the entire group for the duration of the project.

4. Act fast. I set up my meetings with administrators and students very shortly after our IHI Open School events. Even though they were engaged at our events, I wanted to be able to speak to them personally while they were still interested. Again, people have other things going on in their lives, so make sure to speak to them personally while their interest has been peaked.

5. Have a reason for your Chapter to exist. In other words, set a goal for your Chapter. On a number of occasions, I was asked to not merely restate the overarching goal of the IHI or the Open School but to instead explain why it is important for my particular Chapter to exist in a particular place (“Why at Aultman?” or “Why start this student group on campus?”). Truthfully, students create “student interest groups” all the time. Differentiate your Chapter from these groups by using the tools on the IHI Open School website and the goals that you and your Chapter decide upon.

6. Smoothly and competently transition leadership. I have since graduated from medical school and will begin life as a resident in July. The transition from me to our new Chapter Leader was an easy one, because I did not accomplish any of what has been described above alone. I started my Chapter of the Open School knowing that I did not want to put my time into something that would dissolve shortly after my departure. More likely than not – if you are reading this – your Chapter of the Open School would not exist if it were not for your hard work. Therefore, why hand it over to someone who is only casually interested in the topic? Transfer leadership to a person (or a group of people) you trust and who will work to build upon what you have worked so hard to achieve. For me, that person is Holly Dyer. She has attended almost every IHI Open School meeting with me, has dealt with my crazy M4 schedule, and, most importantly, cares about this stuff as much as I do.

In my opinion, the IHI Open School’s broad range of possible topics and methodologies for individual Chapters to cover is a double-edged sword. Research, online cases, clinical case discussion, on-call conferences are just a few of the possible topics to cover at Chapter meetings. This aspect is wonderful in terms of catering to the different interests of individual members. Yet, I believe so many options can sometimes make it difficult for new Chapters to find their footing, their niche, and, really, their reason to exist. My Chapter has elicited positive reactions from both campus-based and hospital-based administrators. Our Chapter’s existence has opened up new discussions about matters of curriculum as well as avenues of research. Nevertheless, such things would not have been possible without our Chapter’s work to narrow its focus, set its goals early, and be proactive.

I am interested to know how other Hospital-Based Chapters are faring. Has anyone encountered any negative reactions towards their Chapters? Are any Chapters having trouble finding members or establishing/accomplishing goals?

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