Aligning Education for Learners and Teachers to Improve Clinical Quality

Background:
Health professions education must be intentionally aligned and designed with the end in mind: to improve patient and learner outcomes. This is a challenging task as learners must meet the standards and competencies outlined by their sponsoring organization(s) in the context of a complex, fast paced clinical workplace. Our aim was to improve targeted quality metrics in two primary care clinics, which served as training sites for physicians, pharmacists and nurse practitioner students by aligning competency-based education with patient care.

Design:
In Phase 1, we aligned physician education across the continuum (medical students, residents, practicing physicians) with identified gaps in clinical care to create a clinical learning environment. We targeted several initiatives (asthma, colorectal screening, well child visits) working with clinic quality managers, and then provided common education to all learners with clearly defined role-based workflows and expectations by trainee levels. In Phase 2 we incorporated pharmacy and NP students and their supervisors into the model as they were already in our clinics. Model was refined to fit physical and scheduling constraints, delineation of supervision roles by profession with associated billing determinations and refining training re: learner roles and team expectations.

Results:
All trainees rotating through the clinics participated in education with over 80% of primary care residents and faculty completing all project elements resulting in American Board of Medical Specialties Part IV Credit. All learners highly valued the alignment of education with quality targets. Students valued having a “clearly defined role” that “makes a difference”. All targeted metrics significantly improved from baseline and have sustained.

Conclusion:
Intentionally designing health profession training allows all team members to work together towards a clear, focused aim resulting in improved patient care and workplace learning!

Reflections/Lessons Learned:
Aligning quality indicators with learning is challenging as trainees come and go, trainee evaluation forms utilize difference words/language making learners and supervisors worried about “checking the requirements”, and time is short in ambulatory setting (15 min patient appointments). Clear goals, a willingness to pilot and continuously improve our approach and transparency were vital elements.