MEDU-4086 - Closing the Gap in Diabetes Care with Quality and Safety Research

MEDU-4086 - Closing the Gap in Diabetes Care with Quality and Safety Research

Elective Title: Closing the Gap in Diabetes Care with Quality and Safety Research
Course Number: MEDU-4086
Elective Type: research Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 1
Additional Requirements: A R-form must be submitted 60 days in advance of all research electives.
Responsible Faculty Director: Maria L. Belalcazar, MD Periods Offered: 1-7; 9-13 including holiday period 8 
Coordinator: Kiki Baldwin Other Faculty:
Location to Report on First Day:
Email Dr. Belalcazar

To learn the basics of quality improvement and apply a team approach to understand and address a problem or gap affecting the care or safety of patients with diabetes within our healthcare system

1. With faculty guidance, identify a gap or deficiency in diabetes care and understand its underlying determinants

2. Become familiar with current guidelines and standards of care for the specific aspect of diabetes care that has been identified as deficient

3. Learn the basic tools of quality of care assessment and participate in the proposal and/or implementation of an intervention to improve an unfavorable diabetes-related outcome

Description of course activities
Complete an online CITI training to be able to participate in research (certificate awarded)

a). With faculty support, identify a problem or gap in care related to diabetes management
B). Review pertinent literature, including guidelines and published work on the issues. Summarize key findings in a table format.
C) Use pertinent quality tools including a Fish Bone Cause and Effect diagram, a Swim Lane chart of Processes of Care and a Pareto Chart , as applicable, to understand and describe the problem
d) Collect pre-intervention data
e) With team and faculty input, design an intervention and define your quality aim
f) Depending on the intervention, project may end in the pre-intervention phase or after completion of the intervention and analysis if the data
g) Submit project findings in abstract form to a meeting for presentation. If project completed and findings publishable, manuscript preparation could follow but would likely be beyond the 4 weeks of this elective.

Type of students who would benefit from the course
Medical students with an interest in opportunities to improve patient care and develop clinical scholarship.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM

 Average number of patients seen per week:
 Call Schedule: none

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time 4
Self-Directed Study 16
Data-Collection/Analysis 20

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?
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Project progress; expectations are discussed on first day of the elective by faculty preceptor
  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)?
    ONCE: Abstract submission for presentation at regional/national meeting
  B. Format - What guidelines are set for the student's written work?
    Faculty will provide examples and guidance
  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.?
    related cases
  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)?
    Abstract for submission for presentation at regional/national meeting

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.