Few studies exist related to struggling learners in medical
education; however, remediation programs, like the one Jeannette Guerrasio, MD
and her team facilitate at the University of Colorado School of Medicine (SOM),
are proving to be successful.
Dr. Guerrasio is Associate Professor in the Department of
Medicine. She and her team recently published findings related to deficit types
and predictors of poor academic outcomes in learners referred to the
university’s remediation program. While remediation required substantial
resources, the team concluded remediation was successful for 90 percent of
learners. Not only did the remediation work, learners also reported that the
program helped them as individuals.
The remediation program at the SOM helps learners referred
(or self-referred) to the program by diagnosing areas of deficiency and
creating strategies for remediation based on the individual student. With the
Offices of Student Life and Graduate Medical Education, struggling learners are
matched with the proper resources, like the Center for Advancing Professional
Excellence (CAPE), communication coaches, mental health services, and more. Dr.
Guerrasio and her team ensure remediation is timely and appropriate.
This study looked at outcomes for 151 learners who were
referred to the program from 2006-2012. Learners were assessed and given
individualized learning plans that incorporated deliberate practice, feedback
and reflection. Data was collected related to training levels, the identified
deficits, remediation plan details, outcomes and the time investment of
faculty. The study concluded with an independent reassessment of learner
achievement of goals.
- Most learners had more than one deficit.
- The most common deficits were related to medical knowledge,
clinical reasoning and professionalism.
- Medical students (as opposed to residents and fellows) were
more likely to have mental well-being issues
- Men struggled with communication and mental well-being more
- Poor professionalism was the only predictor of probationary
status. Faculty on the remediation team spent significantly more time with
learners requiring remediation of clinical reasoning and mental well-being. Per
hour, faculty face time reduced the odds of probation by 3.1 percent and all
negative outcomes by 2.6 percent.
Dr. Guerrasio cautions there were limitations to this study
and points out that future studies need to look at comparing strategies for
effective remediation and optimizing faculty time.
“We respect the fact that not every student is going to
succeed. This program focuses on maximizing the successes of those who are able
to stay in medicine,” said Dr. Guerrasio. “We help those learners who discover
that medicine might not be the best fit to find better uses for their skill
Institute for Healthcare Quality, Safety and Efficiency (IHQSE) Update
The University of Colorado School of Medicine is taking big
steps forward as it develops training and leadership development programs that
focus squarely on keeping patients safe,
reducing waste and improving workflow.
In 2013, a team led by Jeffrey Glasheen, MD embarked on a
large-scale, organizational development program for teams and clinics at the
University of Colorado Hospital (UCH) and the Children’s Hospital Colorado. The
program is helping the Anschutz Medical Campus develop leaders who can
facilitate lasting and sustainable changes at the front lines of patient care,
through an intensive, year-long certification program.
Twelve teams recently completed the program, and Dr.
Glasheen is able to report some big wins:
Measurements of pre- and post-training program outcomes
illustrate significant improvement. The cohorts’ self-reported understanding
improved in such areas as business drivers, managing change, engaging teams,
using quality improvement and process improvement tools, and identifying and
using data for system improvement. For example, prior to the program, 36
percent of people reported having confidence in managing change. Post program,
82 percent reported increased confidence in their ability to lead
Rampant waste was identified and plans are in place to
mitigate. For example, a team from oncology infusion reduced excess “patient
chair” time by 53 minutes—giving valuable time back to the patient and
providing a potential $756,000 in cost savings.
Patient safety issues were identified and strategies are in
place that reduce risk. For example, a team from the neonatal intensive care
unit found that 10 percent of patients suffer discharge- related failures.
Through the certification program, the NICU team learned that 41 percent of
parents received discharge education within 72 hours of discharge. A process is
now in place in which 97 percent of patients receive this education 72 hours before
discharge, allowing more time for teach-back and skill development with the
hope of reducing readmissions. During this time, the nursing staff satisfaction
with the discharge process went from 2 percent to 65 percent.
Workflow can be improved. A team from the stroke unit
discovered issues with flow after a comprehensive review of the timeline of a
stroke patient within the department. The team implemented a project which
reduced the length of a patient’s stay from 6 days to 5.3 days. These changes
alone can potentially result in savings of $206,700 per year.
The incredible interest and engagement Dr. Glasheen has seen
within the first cohort are also impressive. “I have to admit, at first
implementing this program was like throwing a big party. I was just hoping
people would show up,” said Dr. Glasheen. “Yet consistently, 64 people devoted
significant time and energy to these projects. And they’re leaving this program
with the right tools and resources to get the job done.”
In 2014, the IHQSE also implemented an introductory training
program (ITP) that provides one-day courses in process improvement for
frontline staff. “We’re helping everyone at Anschutz understand their roles in
the bigger picture,” said Dr. Glasheen. “The ITP is a mechanism for helping ensure
we’re all speaking the same language, without a significant time and resource
The IHQSE will continue to implement programs and provide
support for people at all levels who deliver care within the Anschutz
more about the institute.
Colorado Refugee Wellness Center Featured in Colorado Public Radio Story
This is the first year students from the University of
Colorado School of Medicine completed clinical rotations at the Colorado
Refugee Wellness Center, and it’s receiving statewide attention.
The story featured center director and faculty member Jamal
Moloo, MD as well as resident Robin Chand, detailing Chand’s experience and
sharing the challenges refugees face.