Using Medical Student Quality Improvement Projects to Promote Evidence-Based Care in the Emergency Department

Abstract

IntroductionThe 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).MethodsThese 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.ResultsUnder 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.ConclusionUsing 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.

Quality Improvement Amid a Global Pandemic: A Virtual Curriculum for Medical Students in the Time of COVID-19

“…22 Many other QI curricula have been developed for trainees with success and positive feedback both from trainees and faculty. 6 , 7 , 23 – 24 QI competency can be achieved through implementation of an established and systematic curriculum. 7 Prior literature has identified three factors that are critical to establishing a successful curriculum: projects with opportunities for trainees to present and publish, QI-focused or formally credentialed mentors, and projects aligned with institutional goals.…”

Medical students and metrics: seven techniques for a win-win situation

“…For example, there is evidence that students can be effective team members of ED quality improvement (QI) projects. In a study of QI initiatives, Manning et al found that with appropriate leadership, third-year medical students could effectively learn about and become effective members of QI teams [16].…”

Student Experience with a Quality Improvement Project in the Emergency Department

“…We read with great interest Manning et al's recent article on the use of medical student quality improvement projects (QIP) to promote evidence-based care in the accident and emergency (A&E) department (Manning et al, 2018). We believe that students are well positioned to effect change via QI initiatives and offer our experience to support their recommendations, alongside further suggestions to aid implementation and integration of medical student QIPs into clinical practice.…”