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Featured topic and speakers
What is quality improvement and patient safety? Why is quality and safety important in health care? Is there quality and safety education for residents online?
Our guest is Amber Clevenger, GME quality manager at Ohio State College of Medicine. AMA Chief Experience Officer Todd Unger hosts.
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- Find more quality improvement and patient safety online courses from AMA GME Competency Education Program (GCEP login).
- Read about quality improvement and patient safety requirements from the Accreditation Council for Graduate Medical Education (ACGME).
- Wondering how to improve quality and safety in health care? Access Graduate Medical Education (GME login).
- Learn more about our AMA advocacy priorities, including:
- Reforming Medicare payment
- Fighting scope creep
- Fixing prior authorization
- Reducing physician burnout
- Making technology work for physicians
Speaker
- Amber Clevenger, GME quality manager, Ohio State College of Medicine
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Quality improvement is an important part of every physician's job. Today, we're talking about what that looks like for physicians at the start of their career in residency. Our guest today is Amber Clevenger, GME quality manager at Ohio State College of Medicine in Columbus, Ohio—my hometown. I'm Todd Unger, AMA's chief experience officer, in Chicago. Amber, thanks so much for joining us today.
Clevenger: Thank you for having me, Todd. I'm excited to have this conversation with you around such an important topic to our learners.
Unger: There's a lot to think about at the start of residency, but quality improvement might not necessarily be the first thing that comes to mind. Amber, what role should residents expect to play in quality improvement and patient safety at their institution?
Clevenger: I would say that's an integral role as a frontline provider, one of active engagement. Especially as a participant in the reporting culture of their institution, we recognize that our frontline providers, such as our residents and fellows at the beginning of their training, are uniquely positioned within our clinical environment to identify both latent and active errors that can lead to patient safety concerns, as well as opportunities for quality improvement. So I always encourage them to take an empowered, active role as an engaged reporter. See it, say something. So stay engaged.
Unger: Do you find that residents are ready to take on this responsibility coming out of medical school? Or do they tend to get more training or need more training to get started?
Clevenger: I think they do need more training simply because they have limited scope of exposure during medical school. They're starting clinical rotations, but they still are very much within the hierarchy of medicine where their level of responsibility may not be as great as it becomes when they become a trainee, a resident within an institution.
And so I do like to provide not only the education and the tools to be an active and engaged participant in quality improvement and patient safety, but also that permission and that empowerment, and reminding them that this is very much a role that they should fulfill and they should feel it's a sense of responsibility to our patients.
Unger: And it's important and it's essential because the Accreditation Council for Graduate Medical Education also requires that residents receive training in quality improvement and patient safety. How does your institution go about meeting these requirements?
Clevenger: We take a multimodal approach. So we start at the beginning of onboarding where our trainees do complete the quality curriculum, the Quality Patient Safety Curriculum through GCEP. And we then reinforce those educational principles through workshops. I provide educational sessions. We also do some hands-on application of the tools and the methods through quality improvement coaching that I provide.
And then we also have some mock scenarios. So in order to provide that institutional connection specifically to The Ohio State University, I offer mock root cause analysis sessions with real de-identified patient safety cases so our trainees can really learn not only about the tools, but the process and the spirit and intention of those activities that we conduct to keep our patients safe and optimize our outcomes.
Unger: Now I imagine that there's a lot to learn in residency, and it's notoriously a pretty overwhelming experience. It's got to be a challenge to keep residents engaged, especially in this kind of training. How do you deal with that?
Clevenger: I think the key is to keep it relevant, meet them where they are, and when you are introducing new methods, new tools as—right now, medical school is varied in terms of what our trainees are entering residency with. With those tools in their toolbox, how much quality improvement exposure have they had?
And so when I'm teaching a new tool—say, for example, for cause and effect for root cause analysis, a fishbone—or otherwise known as an ishikawa diagram, I usually ask the trainees, you tell me about a problem that you're contending with. What's that pebble in your shoe? And then we're going to tease it out utilizing this really great QI tool so you can see, is there potential maybe for a project here?
If nothing else, it's quite cathartic and memorable because maybe they're frustrated by some simple change in a process or challenge with a transition of care, but it teaches them the practical way of using these tools to really impact the care that they're providing to their patients.
Which is really where our trainees live. They're in the weeds. They are frontline providers, and so patient outcomes are at the forefront of their priorities every day that they join us at the hospital. If they can learn how to make those better, we've already got them bought in.
Unger: Excellent. I'm curious, what kind of feedback, positive or negative, have you gotten from residents that changed how you thought about graduate medical education?
Clevenger: I would say, even the most experienced trainees, the most experienced residents who are very actively engaged in the quality improvement and patient safety space with me on high-level committees, I didn't realize until we had a real honest conversation that they did not recognize themselves as full-fledged members who had a voice at the table, although that's exactly why I want them engaged. I want them to be fully active participants—a full voting member if they're on a quality committee, for example.
And so I recognize that our hierarchy in medicine establishes who has that voice at the table, who has that seat. And so it's really crucial for someone in a role like mine to remind our trainees, you have that seat. And you have it because it's a very important one to hold. You see things that others don't see. You see opportunities, patient safety errors. And so your insights are invaluable as we work to optimize the care that we're providing to our patients in the safest and most effective way possible.
But it's really about building them up and helping them see that this could be their future career as well. If they really like to be engaged, make it happen. Get engaged and learn as much as you can so you can be an active attending as well in quality improvement and patient safety. Be a leader for change.
Unger: I love that, too. Just don't take it for granted. You have to make the mind shift into that—into the new seat at the table, as you say.
Clevenger: Exactly.
Unger: Well, Amber, thank you so much for joining us and sharing your perspective on this topic. Graduate medical education is such an important focus for the AMA. We recently launched a brand new curriculum in the AMA GME Competency Education Program around quality improvement and patient safety. Visit ama-assn.org/gme-program to learn more and see how much easier meeting ACGME requirements can be.
That wraps up today's episode, and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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