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News from the Academy of Medical Educators and Faculty Affairs

New Study on Remediation Demonstrates Success of School of Medicine Program

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.

Specific findings:

  • 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 than women.
  • 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 sets.”

Learn more.

Institute for Healthcare Quality, Safety and Efficiency (IHQSE) Update

First Cohort Completes Certificate Training Program; Second Cohort Begins Leadership Development Work

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 organizational change.

  • 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.”

What’s Next

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 commitment.”

The IHQSE will continue to implement programs and provide support for people at all levels who deliver care within the Anschutz community. Learn 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.

Read the article.