# Presentation: 012332

## Alternative Formats for Learning Patient Safety – Faculty Development

**John Gosbee, MD, MS**
**VA National Center for Patient Safety**
- _[John.Gosbee@med.va.gov](mailto:John.Gosbee@med.va.gov)_**     **_[www.patientsafety.gov](http://www.patientsafety.gov/)_

**Notes:**
Additions and edits by J Gosbee  (e.g., objectives added)

## Location in our VA NCPS Curriculum Toolkit

_**Content**_
-  Patient Safety Introduction
-  Human Factors Engineering
-  Etc...

_**Alternative Education Formats**_
-  Pt Safety Case Conference (M&M)
-  Pt Safety on Rounds (Modulettes)
-  One-month Elective
-  Etc...

_**Instructor Preparation**_
- Swift and Long Term Trust
-  “Selling the Curriculum”
-  Etc...

## Objectives for this Session

- Provide concrete tactics for using adult learning model during safety curriculum efforts
- Early anecdotal success...
- Soon to be more concrete/quantitative
- Lessons learned
- How to make it work in your world!

**Notes:**
Ah yes, pitfalls

## A Call to Action...

**ACGME Competencies (2003)**
_**Systems-Based Practice**_: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
- Residents are evaluated on their use of systematic approaches to reduce errors and improve patient care and their assistance in the development of system improvements

## ACGME Requirements

- Tangible, documentable teaching sessions
- Tangible, documentable activities for “practice”
- Something to put in their “log book”

## Barriers to Addressing Patient Safety in Medical Education

- Imposter syndrome
- “They might find out that I don’t really belong here.”
- Cognitive dissonance
- “Doesn’t happen here.”
- Cultural Attitudes
- “Name, blame and shame.”
- Systems vs. Individuals
- Responsibility to identify and remediate deficiencies in learners

## Need for Creative Solutions to these Significant Barriers

- Powerpoints will NOT cut it!
- And,...need both:
- “Initial inoculation”
- “Booster shots!”

**Notes:**
PPT Fairy from the New Yorker Feb 04
Even with help from the PowerPoint Fairy, retention is only ~5%

## Alternative Formats Cover a Wide Range of Activities and Formality

- Doc-U-Dramas **(later)**
- Modified Case Conferences **(later)**
- Working Rounds (Modulettes) **following this!**
- Others (Brief Success Stories)
- Orientation
- Self-study and Journal Club (e.g., using Web M&M)
- Homework (spanning weeks or months)
- Projects (spanning months or a “research” year)
- Month-long rotation “Patient Safety Consult Service”
- Year(s) for Scholarly Activity
- Teaching your colleagues!!

## Orientation

- Australian Community Teaching Hospital
- John Wakefield
- “Stations” for each new house officer to learn/interact
- VA Hospital
- Susan Lott (for VA people, see Outlook)
- During July one-day session, she gets 30 min
- Focuses on basics; and herself as resource

## Self-Study

- University of California – San Diego med students
- Short meeting with mentor prior to longer RCA session
- Assignments to read up on one or two types of vulnerability
- West Virginia University Anesthesiology Residents
- Journal Club
- Some articles chose from “Web M&M”

## “ Homework”

- Should be...
- Easy enough to do with minimal mentoring
- Bounded with clear beginning and end
- Integrated with reality so as not to breed cynicism
- Example frameworks/assignments
- What is a system and how does it relate to health care?
- Structured approach to hazard identification

## “Patient Safety Homework” Case Studies

- Cleveland VA Urgent Care Rotation Residents
- Anne Tomolo, MD
- “Outcomes card” to fill out over weeks or months
- Discover what happened and why to select patients
- University of Michigan
- Resident hand-off issues documented and analyzed
- Raj Mangrulkar, MD

## Projects

- University of Minnesota Med and Nursing Students
- You tell me...I heard about this indirectly
- Final report heard and acted upon by operational committee
- Univ of Michigan
- Took actual event, 6 weeks of analysis
- Reported to Univ Hosp Patient Safety committee

## Month-long rotation “Patient Safety Consult Service”

- In place at Univ of Michigan
- Fourth year medical student elective in place (no one signed up yet)
- R3 for Internal Medicine (2004-5 year)
- Surgery?
- Other sites?

## Year(s) of Scholarly Activity

- University of Pittsburgh  Pt safety House officer
- Eric Mardenstein
- “Rewarding”, “frustrating”, and “learning to be an advocate”
- University of Wisconsin  MD/PhD
- Bentzi Karsh, PhD and others lead in IE, Pop Health
- Masters “Patient Safety Certificate” courses

## Year(s) of Scholarly Activity

- Dartmouth University
- Combined Preventive Medicine and “Primary Care Residency
- See Brochure – adds two years...but CMS “pays” for the time
- University of Missouri – 50% Fam Medicine Fellow
- Wendy Madigosky with MS2’s (lots of assessment)
- She is publishing her two year experience soon
- Super-plugged in to both Univ and VA patient safety operations

## Teaching your colleagues!!

- Scholarly pursuit (research, education, practice)
- HRSA gave 4 grants in 2001 (sort of)
- University of Washington – Nursing & Medical School
- _http://interprofessional.washington.edu/fliepps/_
- HRSA grant to train faculty leaders in the best practices of interprofessional teaching and learning patient safety

## Conclusion

- There is more than one way to get started
- It is dependent on your ability to change it
- (Probably) dependent on recruiting 1-2 other colleagues to sustain it