ACGMEs Best Practices

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ACGMEs Best Practices

• Practice Based Learning and Improvement
• Systems Based Practice
• Ann Burke, MD, FAAP
• Pediatrics

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Practice Based Learning and Improvement

• Residents must be able to investigate and
  evaluate their patient care practices, appraise
  and assimilate scientific evidence, and improve
  their practices.

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Practice Based Learning and Improvement

• Analyze practice and improve using systematic
  methodology
• Identify weakness
• Engage in learning
• Apply new learning
• Check for improvement

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Systems-Based Practice

• Residents must demonstrate awareness of and
  responsiveness to the larger context and system
  of healthcare
• AND the ability to effectively call on system
  resources to provide care that is of optimal
  value

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Systems-Based Practice

• Analyze system and improve using systematic
  methodology
• Identify weakness/ identify need
• Engage in learning
• Apply new learning/make a change
• Check for improvement

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Quality Improvement

• SBP and PBLI are Quality Improvement concepts
• Sometimes difficult to measure and assess
• Measure actual performance
• Identify areas for improvement
• Be practical
• Do over time to discern growth

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Background

• Skills for Health Professionals
• Find new knowledge evaluate its significance and
  effectiveness decide how to incorporate it
• Synthesize the evidence base
• Combine the evidence base, knowledge about
  population outcomes patient preferences
• Use decision support systems
• From Crossing the Quality Chasm, 2000

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Background

• Skills for Health Professionals
• Identify errors and hazards in care implement
  basic safety design principles
• Continually measure quality of care, both
  processes and outcomes
• Work collaboratively in teams with shared
  responsibility
• From Crossing the Quality Chasm, 2000

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A Thought

• The crucial question for medical education is
  whether it will passively accommodate itself to
  market imperatives or will act affirmatively,vigor
  ously, and quickly to create new forms of
  practice to which it will be linkedsuch that
  medical professionalismcan survive and
  flourish.
• From Frankford and Conrad, Acad Med, 1998

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Practice Based Learning and Improvement

• Residents must internalize the value of
  on-going, self-directed learning and improvement
  of their practice of medicine.
• Self Reflective Learning
• Life Long Learning

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Systems-Based Practice

• Systems thinking
• Interdependencies
• Structure drives behavior
• Any change in a system has unintended consequences

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Metaphors

• The Mirror
• The Village

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Example 1

• Medical Education in Critical Care Improving
  Medical Knowledge, Patient Safety and Quality in
  the Intensive Care Unit
• Critical Care at Duke, Internal Medicine
  residents
• Tools used were web-based curriculum, specific
  checklists and faculty
• Self assessment
• Feedback following delivery of care
• Attempt to improve patient care by identifying
  weaknesses.

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Example 2

• Teaching Residents to Implement Best Practices
  at the Front Lines of Care
• Dartmouth Internal Medicine Residents
• PBLI elective-Started 2001
• Knowledge of systems (SBP) and how to improve
  care (PBLI)
• Quality improvement project

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Example 2...continued

• Projects included
• Changing the set up process for central line
  placement in the ICU
• Increasing the use of patient care materials for
  low back pain in general internal medicine clinic
• Improving care for diabetics in resident clinics

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Example 3

• Clinical Profiling in Surgical Education A
  Process in Evolution
• Data on a few common surgical procedures improves
  patient care- faculty started this in 1988, now
  residents involved
• Evidence used to recommend change,not blame
• Systems approach is emphasized

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Example 3continued

• Residents use trended information (incidence of
  bile duct injury) with scientific evidence and
  benchmarks to lead discussions
• They are expected to help identify problems,
  research current knowledge, and assist in
  implementing a plan

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Other Tools

• Portfolios
• Evidence Based Medicine in Journal Club
• Individual Learning Plans
• Critical Incident Analysis
• Self Reflective Journals
• Self Assessments

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Outcome Initiative Principles

• Whatever we measure we tend to improve
• Programs need flexibility to adapt to their needs
• Public accountability

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Principles Discovered after the Fact

• Competencies allow conversations about the work
  of medicine across all medical specialties
• Competencies have invited a surprising amount of
  creativity
• Competencies help distinguish substance from form

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Improve Education

• Be creative
• Just do it
• Record efforts
• Attempt to assess and measure results
• More examples and speakers notes_at_
• www.acgme.org/outcome/conferences/conf_index.asp