PEDU-4060 - Foundations in Patient Safety and Health Care Quality

PEDU-4060 - Foundations in Patient Safety and Health Care Quality

Elective Title: Foundations in Patient Safety and Health Care Quality
Course Number: PEDU-4060
Elective Type: career Duration/Weeks: 4 Max Enrollment: 60
Prerequisites: Successful completion of Year 2
Additional Requirements: C-form required
Responsible Faculty Director: Susan Gerik, M.D. Periods Offered: 1-16 excluding holiday period 8 Offered 100% Online
Coordinator: Other Faculty:
Location to Report on First Day:

Students will develop awareness and gain insight into important topics of patient safety and quality. They will familiarize themselves with the relevant literature and reflect on topics that emerge from their clinical experiences, from research papers, from online resources, and even from the media. They will explore their roles and analyze barriers in the context of the health care system in ensuring patient safety and top quality care.

At the completion of this course the student will be able to: 1) Discuss the problem of patient quality and safety in health care including the impact of quality and safety issues on the cost of health care. 2) Define patient safety and quality from several perspectives: inpatient, outpatient, administration, and the operating room. 3) Define multiple causes and the various adverse effects associated with medical errors in health care. 4) Emphasize the importance of integrity and communication in both the prevention and management of medical errors. 5) Describe some quality improvement processes. 6) Describe the evidence base for quality improvement. 7) Describe processes for monitoring, investigating and preventing medical errors.

Description of course activities
This elective provides Medical students with the opportunity to read, watch, and reflect on various aspects of patient safety and quality. Students will review relevant journal articles and/or health care cases either from in-house or from external sources such as the Agency for Healthcare Research and Quality’s web-based Morbidity and Mortality Rounds. Students will have the opportunity to view selected films, interact and dialogue on the course Discussion Board, review video presentations, and other media products addressing medical errors and patient safety in healthcare on Blackboard. They will submit five 1-page reflections on the material they have reviewed. Reflections will include a brief synopsis of the issue, their thoughts and feelings about it, a brief review of the relevant literature on the topic, and lessons learned.

Type of students who would benefit from the course
Students enrolled in this course will have an opportunity to engage in a variety of learning activities designed to facilitate professional competencies for health care practitioners. The problems with quality and safety are reviewed from a health care systems perspective. Quality improvement processes are addressed utilizing clinical examples from across clinical settings. Any student interested in patient safety and in decreasing adverse patient experiences would benefit from this elective.

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

 Average number of patients seen per week: N/A
 Call Schedule: N/A

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time Online prn
Self-Directed Study 15-20/ week
Other Research, Library Research, Literature review/writing/data analysis, Operating Room Demonstrations 5-15/ week

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?
    Students are not observed clinically in this course
  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?
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
  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)?
    Five written assignments will be assigned for the course. Students will be asked to write reflections on an experience or encounter each week. The reflection may be on any of the following: a film, book, course reading, discussion topic, or an observation in a meeting or clinical setting.One will be the group project assignment quality improvement group project. The second will be the written final problem analysis paper. (research paper with references.) Students may be asked to write a reflection on a particular aspect of a presentation or course activity. Weekly Deliverable – Students will be asked to write a reflection on an experience or encounter each week. The reflection may be on any of the following: a film, book, course reading, discussion topic, or an observation in a meeting or clinical setting.
  B. Format - What guidelines are set for the student's written work?
    The Faculty member will grade the students’ work using an outline rubric developed by the participating faculty members. Some of the criterion may include: 1. Relevance of the topic 2. Thesis Statement- The author identifies a thesis based on relevant experiences and research. 3.Thesis synopsis- The author synthesizes her/his argument to support the thesis. The author reflects critically on her/his relevant experiences, feelings pertaining to the topic. 4.Reaction- The reaction expresses a personal, reasoned response to how her/his reflections might be helpful in her/his health care career. 5.Style – the essay was proofed for spelling errors and typos and follows stylistic guidelines. The paragraphs reflect basic principles of organization. The writing is grammatically correct.
  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?
    UTMB Library reference materials may be used in order to complete this outline and expectations of the assignments. (if current materials are unavailable
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student –selected, related to cases, chosen from resources offered on course website. A student may self-select a research topic with guidance from the faculty. Related to cases presented in the course, a particular research topic of interest and items relevant to patient safety and quality may individually be considered.
  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.
    Faculty will evaluate students by the quality of their weekly reflections and contributions to the Discussion Board on Blackboard. In addition, a students’ overall evaluation may be based on the degree of initiative, enthusiasm, professionalism, and preparedness the student exhibited during the course. Students may also demonstrate participation by asking thought provoking questions, applying the information that is taught, reviewing literature and relevant patient safety journals. These actions would also demonstrate favorable participation in the elective. Because the topic of patient safety requires that a physician have excellent communication skills, special emphasis will be given to observing the student’s communication style with team members and other parties involved. Feedback will be given and communication coaching will be provided as appropriate.

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.