CEEU-4009 - LEAN Methodology in Practice: From Theory to Transformation

CEEU-4009 - LEAN Methodology in Practice: From Theory to Transformation

Elective Title: LEAN Methodology in Practice: From Theory to Transformation
Course Number: CEEU-4009
Elective Type: career Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: C form required
Responsible Faculty Director: N. Miles Farr MD, MPH Periods Offered: All except 8 excluding holiday period 8 
Coordinator: Marta Rivera Other Faculty: Mythili Ram, Manager of the System Optimization & Performance Office
Location to Report on First Day:
Room 2.302, Rebecca Sealy

The goal of this elective is to train medical students with the knowledge of integrating Lean principles into their medical education and future healthcare careers. By doing so, they can enhance patient care, foster a culture of continuous improvement, develop essential problem-solving skills, and contribute meaningfully to the healthcare industry's overall efficiency and effectiveness. Embracing Lean methodologies and tools will not only benefit the patients they care for but also provide medical students with a rewarding and fulfilling healthcare journey.

-To empower medical students with Lean principles and methodologies, fostering a culture of continuous improvement and patient-centered care, while cultivating essential problem-solving skills and promoting efficiency in healthcare delivery.
-To prepare medical students for future leadership roles and contribute meaningfully to the overall quality and effectiveness of healthcare organizations.
-Understand the principles and core concepts of LEAN methodology.

Description of course activities
This course offers an exploration of the LEAN methodology, a proven system for process improvement and organizational efficiency. Key components of the course include theoretical study, practical application in Model Cells, individual project work, and the creation of a presentation to showcase learning and results.
-Participate and support ongoing activities of the System Optimization and Performance office.
-Attend Lean Management Systems and Coaching for Performance Improvement classes offered by the System Optimization and Performance team, 4 hours per week of didactics plus 4 hours of week of outside learning.
-Learn to apply Lean Methodologies and Tools in Model cells where local improvement work is performance, including 8 hours of face-to-face time and up to 10 hours to work on an area of interest related to the model cell or applying the principles learned in the model cell to a project of interest.
-Learn hands-on facilitation and coaching skills in improvement events.
-Explore opportunities for long-time LEAN and quality improvement work that can result in a meaningful longitudinal project that may lead to dissemination and scholarship opportunities.
-Select and execute a project applying LEAN principles, underpinning the transformative potential of the methodology.
-Learners will maintain a journal documenting their course activities and insights to reflect upon and solidify their understanding of the methodology.

Students will have at least 30 hours of course activities per week. This will include the activities listed below. The time allotment for each activity which will depend on activities ongoing in the System Optimization & Performance Office and the students’ personal interests and project selection.

-Lean Management Systems and Coaching Performance Improvement – 8 hours per week
-Model Cells Direct Participation and Areas of Interest – 18 hours per week
-Support of Ongoing activities of the System Optimization and Performance office – 10 hours per week
-Independent work on selected project – 10 hours per week

Type of students who would benefit from the course
Designed for learners interested in all specialties, participants will learn to apply the LEAN principles in a variety of settings to drive performance, eliminate waste, and add value. Students interested in quality improvement, system optimization and producing a scholarly product in these areas.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM

 Average number of patients seen per week:
 Call Schedule:

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Health system and course leadership
  B. Frequency / Duration of Presentation(s)?
    Last week of elective, once.
  C. Format - What guidelines are set for the student's presentation?
    Produce a presentation by the end of the course, capturing the journey, insights, and results from your participation in the elective that you will present to Health System Leadership and Program Leadership.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Personal journal as noted in course activities Presentation to health system leadership and course director, likely in the form of presentation slides Poster presentation (if applicable)
  B. Format - What guidelines are set for the student's written work?
    Will be provided an outline of expectations of topics to include in final presentation.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Combination of course leadership and student selected.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.