Minutes 07.22.13

Minutes 07.22.13

Clinical Medicine Committee Minutes
July 22, 2013

Megan Bray, Yvonne Newberry, Huai Cheng, Laurie Archibald-Pannone, Peter Ham, Catherine Casey, Wanda Hudson, Pamila Herrington, Nassima Ait-Daoud Tiouririne, Meg Keeley, Gene McGahren, Anneke Schroen, Amita Sudhir, Chris Ghaemmaghamii, Guillermo Solorzano, Binit Shah, Ashley Shilling, Stephen Collins, Brian Wispelwey, Evan Heald, William Wilson, Robert Boyle, Anne Chapin, Allison Innes, Darci Lieb, Nancy McDaniel, Thomas Jenkins, John Jackson, Donald Innes, Karen Knight, Sylvie Moore, Carolyn Engelhard, Derrick Thiel, Mary Grace Baker (SMD 2014)

Members Present: Bold
Guests: Peggy Plews Ogan, MD


1. Peggy Plews Ogan: Patient Safety Curriculum:

Dr. Plews Ogan is the Patient Safety Thread Leader for the SOM. The Curriculum was shared electronically with the committee and  the concepts discussed. A table summarizing the current activities related to the Patient Safety learning objectives was discussed. Not all clerkships responded to the requests.

The Learning objectives, patient safety concepts and patient safety tools were discussed. Clerkship directors as well as the student representative note that these items are covered in the clerkships in the day to day care of patients. It was noted in discussion that lecture format is not optimal for these topics, but there does need to be assurance that the major topics are covered consistently so that all students will have exposure to all of the topics over the course of the clerkships. Having concept anchored to a patient will make the learning more memorable.

Patient Safety Concepts that need to be covered in the clerkships

Human factors (distraction, memory, perceptual errors, clinical decision-making errors including biases, early closure)

**Team function/communication in patient safety: working well in teams, team communication, team rounding, patient as a part of the team

Handoff of care (can be a whole separate topic)

**Culture of safety: speaking up, talking about and learning from mistakes, flattening the hierarchy, team expectations, clear communication, closing the loop

Error reporting: why report, when should you report, who should report, what happens when you report an error

Disclosure and Peer support: When to disclose, how to disclose, team brief and debrief, who should be involved in disclosure, peer support program

Patient/family role in patient safety: empowering and encouraging patient/family participation in care

Infection control (handwashing, central line infections, cdiff)

**Escalation of care and topic of appropriate supervision

Medication safety (medication reconciliation, health literacy, dosing errors, look alike/sound alike, drop down menu errors, drug-drug, drug-disease interactions, evidence based methods for preventing medication errors:  clinical pharmacists on rounds, IT for alerts, drug/disease monitoring (renal failure, INR), involving patient in medication safety (know your drugs)

Transitions in care

**How we use data to improve safety in each specialty


Patient safety tools that can be used to support and teach the concepts

Central line checklist
Surgical checklist
Other procedure checklist
Tracking systems (for example, abnormal PAP, abnormal mammo)
Handoff of care tool
Sepsis best practice alert

**DATA tools for safety (in each clerkship/department, what safety and quality parameters are you following?  Can you share those with the students, get them involved in what the data mean and what is being done to improve?  What are the handwashing numbers on the floors the students work on?  What is the central line infection rate in the surgical ICU this month?)

SBAR or other communication tool
Medication reconciliation
Read back
Root Cause Analysis
Disclosure tool (Ask/tell/ask) and resources
EMR safety tools
- Alerts (drug drug interactions, allergies, drug monitoring alerts)
- reminders (health maintenance, best practice)
- decision support  ( example=sepsis)
**=something that every clerkship should address in some way  

The curriculum thread curriculum for patient safety will be posted on the Curriculum web page of the SOM. All clerkships should link to it from their web page.

2. Discussion of Clerkship Readiness survey (SMD 2015)

The responses from the Clerkship directors were discussed. The table of responses was shared. For the most part the students were found to be adequately prepared with acceptable basic skills. They were found to be professional with good cultural awareness. There was some discussion that this early cohort was more dependent learners than expected however this could be related to the fact that this was the first rotation. This survey will be repeated each year and the results share with the curriculum committee and CPD leadership in addition to this committee.

Questions asked:

  • The overall preparation of the cohort was adequate or not adequate?
  • Was the level of background knowledge at the expected level?
  • Areas of strength? Areas of weakness?
  • Ability of the group to preform basic physical examination? Comments
  • Ability of this group to present patients? Comments on oral presentations and written documentation.
  • Can most of the students generate a basic assessment of the clinical situation and articulate a rudimentary management plan?
  • Are the students professional in their attitudes and behavior?
  • Do the students appear to have cultural awareness?
  • Any concerns or comments?

3. Discussion of SMD12 Survey-

Residency directors and SMD 2012 were surveyed by Elizabeth Bradley (Medical Education Research) as to their level of preparedness for internship. While the numbers of response was not large it appeared that the UVA students were judged to be as well or better prepared for the tasks of internships compared to their peers from other schools of medicine. The individuals felt that they were as well prepared or better prepared than their peers from other institutions. Individual comments had wide range of responses with many comments about the desire for UVA to allow students to do more procedures. It was noted that the trend towards students doing fewer procedures is not unique to UVA.


4. Clerkship Orientation materials (example from Pediatric Clerkship at Inova)

Materials were shared from Pediatric Clerkship at Inova. These were noted to be welcoming and informative. Debra Reed will have these to view.


5. Other business

a.       Residents as Teachers    http://www.med-ed.virginia.edu/courses/resasteachers/ 

b.      Opportunity to observe inpatient rounds: Students will be offered the opportunity to observe rounds during the fall of 2013 (for the class of 2016). This was offered by Internal Medicine, Pediatrics and Psychiatry. This opportunity to observe during rounds is to provide a context for the students prior to clerkships. A more targeted shadowing experience is proposed as a part of the transition course. Organizational in progress.

Nancy McDaniel, Co-Chair, recording of minutes


Action Items

  1. Email Peggy Plews Ogan with the patient safety concepts that your clerkship will cover each rotation.
  2. If there are key concepts not covered they will be assigned to a clerkship and director will be notified.


Next Meeting:  August 26th meeting: please forward any agenda items.