A MODEL TO INCREASE FACULTY COMPETENCY IN TEACHING QI TO GERIATRIC AND PALLIATIVE CARE FELLOWS

C Chang, S Chopra, W Hung, B Shah, H Fernandez, K Cummings Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai

INTRODUCTION:

• A major barrier to the expansion of Quality

Improvement (QI) and Patient Safety (PS) in medical education has been the lack of faculty development (FD) in quality and safety. • Our geriatric and palliative medicine fellows participate in a 9-month project-based QI

curriculum coached by volunteer faculty.

• Year 6 survey of faculty coaches revealed: • 43% never completed formal QI curriculum • only 43% felt very comfortable being a QI mentor • 86% would welcome further QI FD.

OBJECTIVE:

• Our project aims to improve faculty QI knowledge and teaching skills to increase

trainees’ engagement in QI/PS.

METHODS :

• 8 QI projects with 16 coaches were offered to 35 fellows to rank. • All faculty coaches participated in the FD curriculum in QI that included: • A web-based training to teach QI principles • Train-the-Trainer Model to coach faculty on teaching and facilitating QI team projects during

faculty-fellow “co-learning” QI curriculum.

• A mid-year “check-in” with faculty explored team project challenges.

• Evaluation consisted of a prospective pre-post survey with • Demographics • 6-item questionnaire on comfort with QI concepts on a Likert Scale (5= Very Comfortable, 1= Very Uncomfortable) • 3 cases from the Quality Improvement Knowledge Application Tool (QIKAT) • 2 question open-ended course evaluation for faculty and fellows.

CONCLUSIONS:

Use of asynchronous web-based training with the Train-the-Trainer Model to coach faculty on how to teach and facilitate the QI team projects is an effective method to improve faculty comfort and competency in teaching QI skills to fellows. Course evaluations by fellows were positive with recommendations to include • More protected time, frequent short meetings/check-ins q3weeks • Stronger faculty facilitation • Improved equitable group participation. • Allow fellows to propose their own QI projects • Focus on a smaller slice of the problem

RESULTS:

3 Faculty only education session

• Faculty QI development Session 1: Call for Fellow’s

QI project proposals Objectives: Develop appropriate

Fellow QI projects based on quality metrics that matter for the Department • Faculty QI development Session 2: The purpose of this meeting is to review group facilitation techniques to address some of the barriers identified by the 2018-19

Y6 faculty QI coaches.

• Faculty QI development session 3: The purpose of this meeting is to monitor team projects and to refresh on

QI concepts as well as review group facilitation

techniques discussed above. This will occur between

Team work session 2 (10/31/19) and session 3 (1/16/20) 16 coaches participated in the QI FD curriculum

• 56% were 1st time coaches. • 43% had no prior QI training. • Only 8% felt very comfortable while 46% felt neutral or uncomfortable being a QI mentor.

Year 7​ Pre QIKAT​ Post QIKAT​ IHI

Attendings (n=15)​ 93% (14)​ 87% (13)​ 67% (10)​

Post curriculum,coaches demonstrated improved comfort in being a mentor and utilizing the 3 key QI concept/tools (p<0.05) as well as improved QI knowledge (pre 22.6; post 24.5 p <0.16). Similarly, all fellows demonstrated improved comfort with utilizing the 5 key QI concept/tools (p<0.05) and improved QI knowledge (pre 20.7; post 23.0 p< 0.01).

Attending Comfort level

Likert 1-5 NOT comfortable to Very comfortable p

Likert 1-5 NOT comfortable to Very comfortable p

Likert 1-5 NOT comfortable to Very comfortable p

1st yr (n=8) mentor 2+ yrs (n=5) mentor All mentors

Being a QI Coach/Mentor 2.875-->3.875 0.02 4-->4.2 0.70 3.3-->4 0.03 Constructing a Process map 3.75-->4.125 0.08 4.2-->4.6 0.18 3.9-->4.3 0.03 Constructing a Fishbone 3.5-->4.25 0.02 4.4-->4.6 0.62 3.9-->4.4 0.03 Diagram Set SMART Aims 3.125-->3.875 0.05 4.2-->4.2 1 3.5-->4 0.08

Identifying Measures to Assess a Change 3.375-->3.75 0.20 4-->4.4 0.18 3.6-->4 0.05

PDSA Model for Improvement 4.125-->4.125 1 4.4-->4.4 1 4.2-->4.2 1

Yr 7 Comfort level Likert 1-5 P Likert 1-5 P Likert 1-5 P

Yr 1 Yr 2 All Fellows fellow fellow Y1+ Y2

How essential is QI in your profession? 4.7-->4.7 0.75 4.71-->4.71 1 4.71-->4.68 0.79 Confidence to make local improvement 3.9-->4.0 0.50 3.9-->4.1 0.36 3.89-->4.07 0.31 Constructing a Process map 3.1-->4.2 <0.01 4.43-->4.43 1 3.46-->4.25 <0.01

Constructing a Fishbone Diagram 3.4-->4.5 <0.01 4.71-->4.9 0.6 3.75-->4.61 <0.01

Set SMART Aims 3-->3.9 <0.01 4.14-->4.14 1 3.32-->3.96 <0.01

Identifying Measures to Assess a Change 3.3-->4 <0.01 3.71-->4.14 0.36 3.39-->4.07 <0.01 PDSA Model for Improvement 3.1-->4.3 <0.01 4.3-->4.4 0.69 3.43-->4.36 <0.01

NEXT STEPS:

• Address feedback from Course eval • How to develop projects that both faculty and fellows want to work on? • Interesting to attending and fellow, important for patient, do-able within 8 months • Addresses racial inequity/bias/access in the practice that affects health outcomes? • Improve new workflow given COVID (translators, ipads, telehealth, Patch 24) • Priorities for our dept and health system • Have data that we are already (or can easily) monitor in an ongoing way