Educational Innovations Project

In 2005, we were notified that we had passed our recent site visit with flying colors—receiving the maximum accreditation cycle of five years.  We simultaneously became eligible to submit a proposal to participate in the Educational Innovations Project(EIP)—a demonstration project sponsored by the Internal Medicine Residency Review Committee (RRC) of the Accreditation Council of Graduate Medical Education (ACGME).  This program offered selected programs with a history of accreditation excellence the opportunity to use a more streamlined set of regulations in exchange for agreeing to develop innovative educational programs and to provide data on both resident and patient outcomes under this innovation.  Additionally, the RRC agreed that programs participating in this project would have their accreditation cycle extended to 10 years.

Never fear:  work hours and work load restrictions are the same for EIP programs as they are for all other residency programs.

Why did the OSUMC participate in the Educational Innovations Project? 

1. We believe that the time is right for a phase shift in residency education.  At the beginning of the last century, Abraham Flexner prompted educators to move from a pure apprenticeship model of medical education to a curriculum based model of education. His focus on process was critically important.  The next stage of educational change will focus on outcomes—what is the evidence that certain educational strategies are effective at helping residents develop the skills necessary to provide high quality care in today’s medical environment?  Our residents and faculty want to lead the way in shaping the residency of the future.

2. Our residency program has a long tradition of educational innovations.  For example, our strategy for teaching residents to analyze medical error through a newly designed morbidity and mortality conference has received national recognition and has been adopted by many medical centers across the country.  Unfortunately, the current ACGME regulations, except under the EIP, discourage innovations.  Our residents and faculty want to have the freedom to innovate and address some of the most difficult issues in residency education today.

3. We believe that physicians must willingly take on the responsibility of assessing and improving the quality of care they and their colleagues deliver.  To do so requires education about strategies that enable physicians to identify care delivery problems and to lead the redesign of critical processes.  Our residents and faculty believe that the best way to learn is by doing.  The EIP provides a perfect opportunity to use data for the betterment of both patient care and resident education.

What are our innovations?

The attached poster summarizes our EIP Strategy.  All innovations are under the guidance and supervision of three resident-faculty design teams: the inpatient team, the outpatient team and the critical care team.

Core Beliefs:

Quality Improvement: We believe that physicians of tomorrow must be comfortable analyzing data and initiating strategies to improve both their performance and the performance of their colleagues and institutions

Demonstrable Competency: We believe that physicians of tomorrow must be capable of demonstrating competency through outcomes, not simply through the presence of a graduation certificate.

Effective Teamwork: We believe that health care of tomorrow will be delivered by a set of diverse multidisciplinary teams and that physicians must be capable of effectively leading and monitoring these teams. 

Strategies:

Quality Improvement:
     o Inpatient Wards: CMS Core Measures for CHF, AMI, CAP
     o Critical Care Units: Cross Discipline Team Training
     o Outpatient: Resident and Patient Satisfaction with Access and Continuity
          - Redesign of Continuity Clinic into Blocks rather than weekly clinics
Demonstrable Competency:

                                      
     o Procedural Competency through Simulation and Formal Assessment               
     o Resident and Faculty driven assessment of interpretive skills
          - EKG and CXR reading implementation underway
          - Gram Stain and Blood Stain interpretation likely next steps
     o Resident Clinic Performance Improvement Modules
          - Year 1: Hypertension data collection and analysis
          - Year 2: Hypertension improvement strategy and re-analysis
Effective Teamwork:
     o Transitions of Care design groups
          - Day team to night team
          - ICU to ward team
          - Inpatient to outpatient
     o Fundamentals of Critical Care coursework: Simulation based
          - Optimizing response to the critically ill patient
          - Effective communication under crisis

OSUMC Infrastructure

High Fidelity Simulation Center
     o METI®  Anesthesia mannequin allows us the opportunity to run complex simulations of real-life critical care situations.  These mannequins respond physiologically to physical (i.e. synchronized cardioversion) and chemical (i.e. medications) interventions and can be programmed to mimic many different physiologic conditions.  This allows residents to test their diagnostic and therapeutic strategies in realistic but low stakes environments.
     o Central Line Simulators: with and without ultrasound.  These simulators are used by residents to practice their procedural skills and to allow for faculty to ‘sign off’ on core techniques prior to practice on patients.
     o IV, endoscopic, arthrocentesis, and other simulators

Information Warehouse
     o The information warehouse is a central data repository that brings together clinical data, resource utilization data and financial data so that they can be easily searched. This will allow us to tie interventions in residency education to patient outcomes.

The Office for Scholarship in Medical Education
     o The OSME provides consultant support for research design and data analysis as well as small grants for faculty and residents who are interested in studying the results of an educational innovation.