University of South Florida College of Medicine, Department of Emergency Medicine, Tampa, Florida.
Lehigh Valley Hospital, Department of Emergency Medicine, Allentown, Pennsylvania.
West J Emerg Med. 2018 Jan;19(1):148-157. doi: 10.5811/westjem.2017.9.35163. Epub 2017 Dec 5.
The Association of American Medical Colleges' (AAMC) initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13 to "identify system failures and contribute to a culture of safety and improvement." We set out to determine the feasibility of using medical students' action learning projects (ALPs) to expedite implementation of evidence-based pathways for three common patient diagnoses in the emergency department (ED) setting (Atrial fibrillation, congestive heart failure, and pulmonary embolism).
These prospective quality improvement (QI) initiatives were performed over six months in three Northeastern PA hospitals. Emergency physician mentors were recruited to facilitate a QI experience for third-year medical students for each project. Six students were assigned to each mentor and given class time and network infrastructure support (information technology, consultant experts in lean management) to work on their projects. Students had access to background network data that revealed potential for improvement in disposition (home) for patients.
Under the leadership of their mentors, students accomplished standard QI processes such as performing the background literature search and assessing key stakeholders' positions that were involved in the respective patient's care. Students effectively developed flow diagrams, computer aids for clinicians and educational programs, and participated in recruiting champions for the new practice standard. They met with other departmental clinicians to determine barriers to implementation and used this feedback to help set specific parameters to make clinicians more comfortable with the changes in practice that were recommended. All three clinical practice guidelines were initiated at consummation of the students' projects. After implementation, 86% (38/44) of queried ED providers felt comfortable with medical students being a part of future ED QI initiatives, and 84% (26/31) of the providers who recalled communicating with students on these projects felt they were effective.
Using this novel technique of aligning small groups of medical students with seasoned mentors, it is feasible for medical students to learn important aspects of QI implementation and allows for their engagement to more efficiently move evidence-based medicine from the literature to the bedside.
美国医学院协会（AAMC）的核心住院医师可信赖专业活动倡议将“识别系统故障并为安全和改进文化做出贡献”作为可信赖专业活动 13 的一个要素。我们着手确定使用医学生行动学习项目（ALP）来加速实施急诊部（ED）三种常见患者诊断的基于证据的途径的可行性（心房颤动、充血性心力衰竭和肺栓塞）。
这些前瞻性质量改进（QI）计划在宾夕法尼亚州东北部的三家医院进行了六个月。招募急诊医师导师为每位项目的三年级医学生提供 QI 体验。每位导师分配了六名学生，并为他们提供课堂时间和网络基础设施支持（信息技术、精益管理顾问专家）来开展他们的项目。学生可以访问背景网络数据，该数据揭示了改善患者处置（家庭）的潜力。
在导师的领导下，学生完成了标准的 QI 流程，例如进行背景文献检索和评估参与患者护理的关键利益相关者的立场。学生有效地开发了流程图、临床医生的计算机辅助工具和教育计划，并参与了为新实践标准招募拥护者。他们与其他部门的临床医生会面，以确定实施的障碍，并利用这些反馈来帮助确定具体参数，使临床医生对建议的实践变更更有信心。所有三个临床实践指南都在学生项目完成时启动。实施后，86%（38/44）的被调查 ED 提供者对医学生参与未来 ED QI 计划感到满意，84%（26/31）的对这些项目与学生进行沟通的提供者认为他们是有效的。
使用这种将小团体医学生与经验丰富的导师相匹配的新颖技术，医学生可以学习到 QI 实施的重要方面，并使他们的参与能够更有效地将循证医学从文献转移到床边。
